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Ryan MJ, Clemmer JS, Mathew RO, Faulkner JL, Taylor EB, Abais-Battad JM, Hollis F, Sullivan JC. Revisiting sex as a biological variable in hypertension research. J Clin Invest 2024; 134:e180078. [PMID: 39225093 PMCID: PMC11364402 DOI: 10.1172/jci180078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Half of adults in the United States have hypertension as defined by clinical practice guidelines. Interestingly, women are generally more likely to be aware of their hypertension and have their blood pressure controlled with treatment compared with men, yet hypertension-related mortality is greater in women. This may reflect the fact that the female sex remains underrepresented in clinical and basic science studies investigating the effectiveness of therapies and the mechanisms controlling blood pressure. This Review provides an overview of the impact of the way hypertension research has explored sex as a biological variable (SABV). Emphasis is placed on epidemiological studies, hypertension clinical trials, the genetics of hypertension, sex differences in immunology and gut microbiota in hypertension, and the effect of sex on the central control of blood pressure. The goal is to offer historical perspective on SABV in hypertension, highlight recent studies that include SABV, and identify key gaps in SABV inclusion and questions that remain in the field. Through continued awareness campaigns and engagement/education at the level of funding agencies, individual investigators, and in the editorial peer review system, investigation of SABV in the field of hypertension research will ultimately lead to improved clinical outcomes.
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Affiliation(s)
- Michael J. Ryan
- Columbia VA Health Care System, Columbia, South Carolina, USA
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - John S. Clemmer
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Roy O. Mathew
- Loma Linda VA Health Care System, Loma Linda, California, USA
| | | | - Erin B. Taylor
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Fiona Hollis
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Young BE, Kissell CE, Vranish JR, Stephens BY, Holwerda SW, Fadel PJ. Sex differences in sympathetic transduction in black and white adults: implications for racial disparities in hypertension and cardiovascular disease risk. Am J Physiol Heart Circ Physiol 2024; 327:H672-H680. [PMID: 39058432 DOI: 10.1152/ajpheart.00337.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
The prevalence of hypertension in non-Hispanic black (BL) individuals is the greatest of any racial/ethnic group. Whereas women generally display lower rates of hypertension than men of the same background, BL women display a similar if not greater burden of hypertension compared with BL men. The risk for cardiovascular disease and related events is also highest in BL individuals. Given the importance of the sympathetic nervous system for the regulation of the cardiovascular system, a growing body of literature has investigated sympathetic function in BL and non-Hispanic white (WH) individuals. Here, we are focused on emerging evidence indicating that sympathetic function may be altered in BL individuals, with particular emphasis on the process by which bursts of muscle sympathetic nerve activity (MSNA) are transduced into vasoconstriction and increases in blood pressure (sympathetic vascular transduction). To synthesize this growing body of literature we discuss sex and race differences in 1) sympathetic outflow, 2) sympathetic vascular transduction, and 3) adrenergic receptor sensitivity. Sex differences are discussed foremost, to set the stage for new data indicating a sex dimorphism in sympathetic regulation in BL individuals. Specifically, we highlight evidence for a potential neurogenic phenotype including greater adiposity-independent sympathetic outflow and enhanced sympathetic vascular transduction in BL men that is not observed in BL women. The implications of these findings for the greater hypertension and cardiovascular disease risk in BL adults are discussed along with areas that require further investigation.
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Affiliation(s)
- Benjamin E Young
- Department of Kinesiology, Health Promotion and Recreation, College of Education, University of North Texas, Denton, Texas, United States
| | - Claire E Kissell
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, United States
| | - Jennifer R Vranish
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan, United States
| | - Brandi Y Stephens
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, United States
| | - Seth W Holwerda
- Department of Anesthesiology, Pain and Perioperative Medicine, Kansas University Medical Center, Kansas City, Kansas, United States
| | - Paul J Fadel
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, United States
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Scatà C, Ferreira FC, Padilha MCSV, Carandina A, Asnaghi R, Bellocchi C, Tobaldini E, Montano N, Soares PPDS, Rodrigues GD. Blunted cardiac autonomic dynamics to active standing test in postmenopausal women. Front Cardiovasc Med 2024; 11:1402086. [PMID: 39228661 PMCID: PMC11368856 DOI: 10.3389/fcvm.2024.1402086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/31/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Although both aging and menopause influence cardiovascular autonomic control, the effect of menopause per se remains unclear. The current study was undertaken to test the hypothesis that post-menopausal women (PMW) have a blunted cardiovascular autonomic adjustment to active standing compared to pre-menopausal women. Thus, we compared the heart rate variability (HRV) indexes from supine (SUP) to orthostatic (ORT) positions among young women (YW), young men (YM), older men (OM), and PMW. Methods The participants rested for 10 min in SUP and then stood up and remained for 5 min in ORT. ECG was continuously recorded, and R-R time series of about 300 beats were analyzed using linear (spectral analysis) and non-linear (symbolic analysis) methods. The variation from SUP to ORT was calculated (Δ = ORT-SUP) for each HRV index. Results In SUP, no difference was found for any HRV index among groups. However, Δ0V% and ΔLFn (cardiac sympathetic modulation) were reduced in PWM compared to all groups (OM, YW, and YM), while Δ2UV% and ΔHFn (cardiac vagal modulation) were reduced in PMW than the younger group (YW and YM). No differences were found among the male groups (OM and YM). Discussion In light of our results, the cardiac autonomic dynamic response to orthostatic stress is blunted in post-menopausal women compared to younger women and older men, a finding that might be influenced not only by aging.
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Affiliation(s)
- Costanza Scatà
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Felipe C. Ferreira
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | | | - Angelica Carandina
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Riccardo Asnaghi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chiara Bellocchi
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Gabriel D. Rodrigues
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
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4
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D'Souza AW, Moore JP, Manabe K, Lawley JS, Washio T, Hissen SL, Sanchez B, Fu Q. The interactive effects of posture and biological sex on the control of muscle sympathetic nerve activity during rhythmic handgrip exercise. Am J Physiol Regul Integr Comp Physiol 2024; 327:R133-R144. [PMID: 38766771 DOI: 10.1152/ajpregu.00055.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/28/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
Body posture and biological sex exhibit independent effects on the sympathetic neural responses to dynamic exercise. However, the neural mechanisms (e.g., baroreflex) by which posture impacts sympathetic outflow during rhythmic muscular contractions, and whether biological sex affects posture-mediated changes in efferent sympathetic nerve traffic during exercise, remain unknown. Thus, we tested the hypotheses that increases in muscle sympathetic nerve activity (MSNA) would be greater during upright compared with supine rhythmic handgrip (RHG) exercise, and that females would demonstrate smaller increases in MSNA during upright RHG exercise than males. Twenty young (30 [6] yr; means [SD]) individuals (9 males, 11 females) underwent 6 min of supine and upright (head-up tilt 45°) RHG exercise at 40% maximal voluntary contraction with continuous measurements of MSNA (microneurography), blood pressure (photoplethysmography), and heart rate (electrocardiogram). In the pooled group, absolute MSNA burst frequency (P < 0.001), amplitude (P = 0.009), and total MSNA (P < 0.001) were higher during upright compared with supine RHG exercise. However, body posture did not impact the peak change in MSNA during RHG exercise (range: P = 0.063-0.495). Spontaneous sympathetic baroreflex gain decreased from rest to RHG exercise (P = 0.006) and was not impacted by posture (P = 0.347). During upright RHG exercise, males demonstrated larger increases in MSNA burst amplitude (P = 0.002) and total MSNA (P = 0.001) compared with females, which coincided with greater reductions in sympathetic baroreflex gain among males (P = 0.004). Collectively, these data indicate that acute attenuation of baroreflex-mediated sympathoinhibition permits increases in MSNA during RHG exercise and that males exhibit a greater reserve for efferent sympathetic neural recruitment during orthostasis than females.NEW & NOTEWORTHY The impact of posture and sex on cardiovascular control during rhythmic handgrip (RHG) exercise is unknown. We show that increases in muscle sympathetic nerve activity (MSNA) during RHG are partly mediated by a reduction in sympathetic baroreflex gain. In addition, males demonstrate larger increases in total MSNA during upright RHG than females. These data indicate that the baroreflex partly mediates increases in MSNA during RHG and that males have a greater sympathetic vasoconstrictor reserve than females.
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Affiliation(s)
- Andrew W D'Souza
- Divison of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Jonathan P Moore
- Department of Sports and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Kazumasa Manabe
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Justin S Lawley
- Division of Performance Physiology and Prevention, Department of Sport Science, Universität Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Belinda Sanchez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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McMillan NJ, Jacob DW, Shariffi B, Harper JL, Foster GE, Manrique-Acevedo C, Padilla J, Limberg JK. Effect of acute intranasal insulin administration on muscle sympathetic nerve activity in healthy young adults. Am J Physiol Heart Circ Physiol 2024; 327:H000. [PMID: 38787381 DOI: 10.1152/ajpheart.00253.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 05/25/2024]
Abstract
Systemic insulin increases muscle sympathetic nerve activity (MSNA) via both central actions within the brainstem and peripheral activation of the arterial baroreflex. Augmented MSNA during hyperinsulinemia likely restrains peripheral vasodilation and contributes to the maintenance of blood pressure (BP). However, in the absence of insulin action within the peripheral vasculature, whether central insulin stimulation increases MSNA and influences peripheral hemodynamics in humans remains unknown. Herein, we hypothesized intranasal insulin administration would increase MSNA and BP in healthy young adults. Participants were assigned to time control [TC, n = 13 (5 females/8 males), 28 ± 1 yr] or 160 IU of intranasal insulin administered over 5 min [n = 15 (5 females/10 males), 26 ± 2 yr]; five (1 female/4 males) participants completed both conditions. MSNA (fibular microneurography), BP (finger photoplethysmography), and leg blood flow (LBF, femoral Doppler ultrasound) were assessed at baseline, and 15 and 30 min following insulin administration. Leg vascular conductance [LVC = (LBF ÷ mean BP) × 100] was calculated. Venous insulin and glucose concentrations remained unchanged throughout (P > 0.05). Following intranasal insulin administration, MSNA (burst frequency; baseline = 100%; minute 15, 121 ± 8%; minute 30, 118 ± 6%; P = 0.009, n = 7) and mean BP (baseline = 100%; minute 15, 103 ± 1%; minute 30, 102 ± 1%; P = 0.003) increased, whereas LVC decreased (baseline = 100%; minute 15, 93 ± 3%; minute 30, 99 ± 3%; P = 0.03). In contrast, MSNA, mean BP, and LVC were unchanged in TC participants (P > 0.05). We provide the first evidence that intranasal insulin administration in healthy young adults acutely increases MSNA and BP and decreases LVC. These results enhance mechanistic understanding of the sympathetic and peripheral hemodynamic response to insulin.NEW & NOTEWORTHY Systemic insulin increases muscle sympathetic nerve activity (MSNA) via central actions within the brainstem and peripheral activation of the arterial baroreflex. In the absence of peripheral insulin action, whether central insulin stimulation increases MSNA and influences peripheral hemodynamics in humans was unknown. We provide the first evidence that intranasal insulin administration increases MSNA and blood pressure and reduces leg vascular conductance. These results enhance mechanistic understanding of the sympathetic and hemodynamic response to insulin.
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Affiliation(s)
- Neil J McMillan
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
- NextGen Precision Health, University of Missouri, Columbia, Missouri, United States
| | - Dain W Jacob
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
| | - Brian Shariffi
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
| | - Jennifer L Harper
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
| | - Glen E Foster
- School of Health and Exercise Sciences, Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, Canada
| | - Camila Manrique-Acevedo
- NextGen Precision Health, University of Missouri, Columbia, Missouri, United States
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Missouri, Columbia, Missouri, United States
- Research Services, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri, United States
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
- NextGen Precision Health, University of Missouri, Columbia, Missouri, United States
- Research Services, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri, United States
| | - Jacqueline K Limberg
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri, United States
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Stewart LC, Wainman L, Ahmadian M, Duffy J, Seethaler R, Mueller PJ, Eves ND, West CR. The left ventricle increases contractility in response to baroreceptor unloading, which is sympathetically mediated in the anesthetized rat. J Appl Physiol (1985) 2024; 137:136-144. [PMID: 38813608 DOI: 10.1152/japplphysiol.00722.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024] Open
Abstract
Contemporary discussion of the baroreflex includes the efferent vascular-sympathetic and cardiovagal arms. Since sympathetic postganglionic neurons also innervate the left ventricle (LV), it is often assumed that the LV produces a sympathetically mediated increase in contractility during baroreceptor unloading, but this has not been characterized using a load-independent index of contractility. We aimed to determine 1) whether LV contractility increases in response to baroreceptor unloading and 2) whether such increases are mediated via the sympathetic or parasympathetic arm of the autonomic nervous system. Ten male Wistar rats were anesthetized (urethane) and instrumented with arterial and LV pressure-volume catheters to measure mean arterial pressure (MAP) and load-independent LV contractility [maximal rate of increase in pressure adjusted to end-diastolic volume (PAdP/dtmax)], respectively. Rats were placed in a servo-controlled lower-body negative pressure (LBNP) chamber to reduce MAP by 10% for 60 s to mechanically unload baroreceptors under control conditions. LBNP was repeated in each animal following infusions of cardiac autonomic blockers using esmolol (sympathetic), atropine (parasympathetic), and esmolol + atropine. Under control conditions, PAdP/dtmax increased during baroreceptor unloading (26 ± 6 vs. 31 ± 9 mmHg·s-1·μL-1, P = 0.031). During esmolol, there was no increase in LV contractility during baroreceptor unloading (11 ± 2 vs. 12 ± 2, P = 0.125); however, during atropine, there was an increase in LV contractility during baroreceptor unloading (26 ± 6 vs. 31 ± 9, P = 0.019). During combined esmolol and atropine, there was a small increase in contractility versus control (13 ± 3 vs. 15 ± 4, P = 0.046). Our results demonstrate that, in anesthetized rats, LV contractility increases in response to baroreceptor unloading, which is largely sympathetically mediated.NEW & NOTEWORTHY This study empirically demonstrates a sympathetically mediated increase in LV contractility in response to baroreceptor unloading using a load-independent index of cardiac contractility in the anesthetized rat.
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Affiliation(s)
- Liam C Stewart
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Medicine, Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liisa Wainman
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Medicine, Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mehdi Ahmadian
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Education, School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Duffy
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Medicine, Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rudolph Seethaler
- School of Engineering, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Patrick J Mueller
- Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Neil D Eves
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Health and Social Development, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Christopher R West
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Medicine, Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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Stone AJ, Grotle AK, Stachenfeld NS. Call for papers: "Cardiovascular regulation during exercise: role of biological sex and consequences of aging". Am J Physiol Regul Integr Comp Physiol 2024; 326:R89-R90. [PMID: 38145291 DOI: 10.1152/ajpregu.00285.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Audrey J Stone
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, United States
| | - Ann-Katrin Grotle
- Department of Sports, Food and Natural Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - Nina S Stachenfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
- John B. Pierce Laboratory, Yale University, New Haven, Connecticut, United States
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Stephens BY, Young BE, Nandadeva D, Skow RJ, Greaney JL, Brothers RM, Fadel PJ. Sympathetic transduction at rest and during cold pressor test in young healthy non-Hispanic Black and White women. Am J Physiol Regul Integr Comp Physiol 2023; 325:R682-R691. [PMID: 37781734 PMCID: PMC11178294 DOI: 10.1152/ajpregu.00073.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/01/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Non-Hispanic Black (BL) individuals have the highest prevalence of hypertension and cardiovascular disease (CVD) compared with all other racial/ethnic groups. Previous work focused on racial disparities in sympathetic control and blood pressure (BP) regulation between young BL and White (WH) adults, have mainly included men. Herein, we hypothesized that BL women would exhibit augmented resting sympathetic vascular transduction and greater sympathetic and BP reactivity to cold pressor test (CPT) compared with WH women. Twenty-eight young healthy women (BL: n = 14, 22 [Formula: see text] 4 yr; WH: n = 14, 22 [Formula: see text] 4 yr) participated. Beat-to-beat BP (Finometer), common femoral artery blood flow (duplex Doppler ultrasound), and muscle sympathetic nerve activity (MSNA; microneurography) were continuously recorded. In a subset (BL n = 10, WH n = 11), MSNA and BP were recorded at rest and during a 2-min CPT. Resting sympathetic vascular transduction was quantified as changes in leg vascular conductance (LVC) and mean arterial pressure (MAP) following spontaneous bursts of MSNA using signal averaging. Sympathetic and BP reactivity were quantified as changes in MSNA and MAP during the last minute of CPT. There were no differences in nadir LVC following resting MSNA bursts between BL (-8.70 ± 3.43%) and WH women (-7.30 ± 3.74%; P = 0.394). Likewise, peak increases in MAP following MSNA bursts were not different between groups (BL: +2.80 ± 1.42 mmHg; vs. WH: +2.99 ± 1.15 mmHg; P = 0.683). During CPT, increases in MSNA and MAP were also not different between BL and WH women, with similar transduction estimates between groups (ΔMAP/ΔMSNA; P = 0.182). These findings indicate that young, healthy BL women do not exhibit exaggerated sympathetic transduction or augmented sympathetic and BP reactivity during CPT.NEW & NOTEWORTHY This study was the first to comprehensively investigate sympathetic vascular transduction and sympathetic and BP reactivity during a cold pressor test in young, healthy BL women. We demonstrated that young BL women do not exhibit exaggerated resting sympathetic vascular transduction and do not have augmented sympathetic or BP reactivity during cold stress compared with their WH counterparts. Collectively, these findings suggest that alterations in sympathetic transduction and reactivity are not apparent in young, healthy BL women.
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Affiliation(s)
- Brandi Y Stephens
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Benjamin E Young
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Damsara Nandadeva
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rachel J Skow
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Jody L Greaney
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - R Matthew Brothers
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
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9
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Grotle AK, Langlo JV, Holsbrekken E, Stone AJ, Tanaka H, Fadel PJ. Age-related alterations in the cardiovascular responses to acute exercise in males and females: role of the exercise pressor reflex. Front Physiol 2023; 14:1287392. [PMID: 38028783 PMCID: PMC10652405 DOI: 10.3389/fphys.2023.1287392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Autonomic adjustments of the cardiovascular system are critical for initiating and sustaining exercise by facilitating the redistribution of blood flow and oxygen delivery to meet the metabolic demands of the active skeletal muscle. Afferent feedback from active skeletal muscles evokes reflex increases in sympathetic nerve activity and blood pressure (BP) (i.e., exercise pressor reflex) and contributes importantly to these primary neurovascular adjustments to exercise. When altered, this reflex contributes significantly to the exaggerated sympathetic and BP response to exercise observed in many cardiovascular-related diseases, highlighting the importance of examining the reflex and its underlying mechanism(s). A leading risk factor for the pathogenesis of cardiovascular disease in both males and females is aging. Although regular exercise is an effective strategy for mitigating the health burden of aging, older adults face a greater risk of experiencing an exaggerated cardiovascular response to exercise. However, the role of aging in mediating the exercise pressor reflex remains highly controversial, as conflicting findings have been reported. This review aims to provide a brief overview of the current understanding of the influence of aging on cardiovascular responses to exercise, focusing on the role of the exercise pressor reflex and proposing future directions for research. We reason that this review will serve as a resource for health professionals and researchers to stimulate a renewed interest in this critical area.
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Affiliation(s)
- A. K. Grotle
- Department of Sports, Food and Natural Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - J. V. Langlo
- Department of Sports, Food and Natural Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - E. Holsbrekken
- Department of Sports, Food and Natural Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - A. J. Stone
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - H. Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - P. J. Fadel
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
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10
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D'Souza AW, Hissen SL, Manabe K, Takeda R, Washio T, Coombs GB, Sanchez B, Fu Q, Shoemaker JK. Age- and sex-related differences in sympathetic vascular transduction and neurohemodynamic balance in humans. Am J Physiol Heart Circ Physiol 2023; 325:H917-H932. [PMID: 37594483 DOI: 10.1152/ajpheart.00301.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023]
Abstract
Bursts of muscle sympathetic nerve activity (MSNA) and the ensuing vasoconstriction are pivotal determinants of beat-by-beat blood pressure regulation. Although age and sex impact blood pressure regulation, how these factors affect the central and peripheral arcs of the baroreflex remains unclear. In 27 young [25 (SD 3) yr] males (YM; n = 14) and females (YF; n = 13) and 23 older [71 (SD 5) yr] males (OM; n = 11) and females (OF; n = 12), femoral artery blood flow, blood pressure, and MSNA were recorded for 10 min of supine rest. Sympathetic baroreflex sensitivity (i.e., central arc) was quantified as the relationship between diastolic blood pressure and MSNA burst incidence. Signal averaging was used to determine sympathetic vascular transduction into leg vascular conductance (LVC) for 12 cardiac cycles following MSNA bursts (i.e., peripheral arc). Older adults demonstrated attenuated sympathetic transduction into LVC (both P < 0.001) following MSNA bursts, and smaller increases in sympathetic transduction as a function of MSNA burst size and firing pattern compared with young adults (range, P = 0.004-0.032). YM (r2 = 0.36; P = 0.032) and OM (r2 = 0.51; P = 0.014) exhibited an inverse relationship between the central and peripheral arcs of the baroreflex, whereas females did not (YF, r2 = 0.03, P = 0.621; OF, r2 = 0.06, P = 0.445). MSNA burst incidence was inversely related to sympathetic transduction in YM and OF (range, P = 0.03-0.046) but not in YF or OM (range, P = 0.360-0.603). These data indicate that age is associated with attenuated sympathetic vascular transduction, whereas age- and sex-specific changes are present in the relationship between the central and peripheral arcs of the baroreflex regulation of blood pressure.NEW & NOTEWORTHY Sympathetic vascular transduction is attenuated in older compared with young adults, regardless of biological sex. Males, but not females (regardless of age), demonstrate an inverse relationship between central (sympathetic baroreflex sensitivity) and peripheral (sympathetic vascular transduction) components of the baroreflex arc. Young males and older females exhibit an inverse relationship between resting sympathetic outflow and sympathetic vascular transduction. Our results indicate that age and sex exert independent and interactive effects on sympathetic vascular transduction and sympathetic neurohemodynamic balance in humans.
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Affiliation(s)
- Andrew W D'Souza
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kazumasa Manabe
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Geoff B Coombs
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Belinda Sanchez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - J Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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11
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Gentilin A, Moghetti P, Cevese A, Mattioli AV, Schena F, Tarperi C. Circadian and sex differences in post-ischemic vasodilation and reactive hyperemia in young individuals and elderly with and without type 2 diabetes. Microcirculation 2023; 30:e12818. [PMID: 37246844 DOI: 10.1111/micc.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/26/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cardiovascular events show morning preference and sex differences, and are related to aging and type 2 diabetes. We assessed circadian variations and sex differences in vascular conductance (VC) and blood flow (BF) regulations following a brief bout of forearm ischemia. METHODS Young healthy individuals (H18-30) and elderly without (H50-80) and with type 2 diabetes (T2DM50-80) of both sexes were included. Forearm VC and BF, and mean arterial pressure (MAP) at baseline and following circulatory reperfusion were measured at 6 a.m. and 9 p.m. RESULTS In the morning compared to evening, following reperfusion, the VC and BF increments were similar in H18-30 (p>.71), but lower in H50-80 (p<.001) and T2DM50-80 (p<.01). VC and BF following circulatory reperfusion were higher in men than women in H18-30 (p<.001), but similar between sexes in the older groups (p>.23). CONCLUSIONS Forearm vasodilation following reperfusion is attenuated in the morning in the elderly, impairing BF towards an ischemic area. Diabetes does not affect the circadian regulation of VC and BF, but that of MAP. There are sex differences in VC and BF at baseline and after circulatory reperfusion at a young age, being greater in men, which disappear with aging without being affected by diabetes.
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Affiliation(s)
- Alessandro Gentilin
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Italian Institute for Cardiovascular Research (INRC), Bologna, Italy
| | - Paolo Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonio Cevese
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Italian Institute for Cardiovascular Research (INRC), Bologna, Italy
| | - Anna Vittoria Mattioli
- Italian Institute for Cardiovascular Research (INRC), Bologna, Italy
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Italian Institute for Cardiovascular Research (INRC), Bologna, Italy
| | - Cantor Tarperi
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
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12
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Bruno RM, Varbiro S, Pucci G, Nemcsik J, Lønnebakken MT, Kublickiene K, Schluchter H, Park C, Mozos I, Guala A, Hametner B, Seeland U, Boutouyrie P. Vascular function in hypertension: does gender dimension matter? J Hum Hypertens 2023; 37:634-643. [PMID: 37061653 DOI: 10.1038/s41371-023-00826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023]
Abstract
Blood pressure and vascular ageing trajectories differ between men and women. These differences develop due to sex-related factors, attributable to sex chromosomes or sex hormones, and due to gender-related factors, mainly related to different sociocultural behaviors. The present review summarizes the relevant facts regarding gender-related differences in vascular function in hypertension. Among sex-related factors, endogenous 17ß-estradiol plays a key role in protecting pre-menopausal women from vascular ageing. However, as vascular ageing (preceding and inducing hypertension) has a steeper increase in women than in men starting already from the third decade, it is likely that gender-related factors play a prominent role, especially in the young. Among gender-related factors, psychological stress (including that one related to gender-based violence and discrimination), depression, some psychological traits, but also low socioeconomic status, are more common in women than men, and their impact on vascular ageing is likely to be greater in women. Men, on the contrary, are more exposed to the vascular adverse consequences of alcohol consumption, as well as of social deprivation, while "toxic masculinity" traits may result in lower adherence to lifestyle and preventive strategies. Unhealthy diet habits are more prevalent in men and smoking is equally prevalent in the two sexes, but have a disproportional negative effect on women's vascular health. In conclusion, given the major and complex role of gender-related factors in driving vascular alterations and blood pressure patterns, gender dimension should be systematically integrated into future research on vascular function and hypertension and to tailor cardiovascular prevention strategies.
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Affiliation(s)
- Rosa-Maria Bruno
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France.
| | - Szabolcs Varbiro
- Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Giacomo Pucci
- Internal Medicine Unit, "Santa Maria" Terni Hospital and Department of Medicine and Surgery-University of Perugia, Perugia, Italy
| | - János Nemcsik
- Department of Family Medicine and Health Service of Zuglo (ZESZ), Semmelweis University, Budapest, Hungary
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Karolina Kublickiene
- Institution for Clinical Science, Intervention and Technology, Department of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Schluchter
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Bernhard Hametner
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna, Austria
| | - Ute Seeland
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pierre Boutouyrie
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France
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13
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Nattero-Chávez L, Insenser M, Quintero Tobar A, Fernández-Durán E, Dorado Avendaño B, Fiers T, Kaufman JM, Luque-Ramírez M, Escobar-Morreale HF. Sex differences and sex steroids influence on the presentation and severity of cardiovascular autonomic neuropathy of patients with type 1 diabetes. Cardiovasc Diabetol 2023; 22:32. [PMID: 36793089 PMCID: PMC10127589 DOI: 10.1186/s12933-023-01766-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Sex differences characterize cardiovascular outcomes in patients with type 1 diabetes. Cardioautonomic neuropathy is a common complication of type 1 diabetes that associates increased morbi-mortality. Data regarding the interplay between sex and cardiovascular autonomic neuropathy are scarce and controversial in these patients. We aimed to address sex-related differences in the prevalence of seemingly asymptomatic cardioautonomic neuropathy in type 1 diabetes, and their associations with sex steroids. METHODS We conducted a cross-sectional study including 322 consecutively recruited patients with type 1 diabetes. Cardioautonomic neuropathy was diagnosed using Ewing's score and power spectral heart rate data. We assessed sex hormones by liquid chromatography/tandem mass spectrometry. RESULTS When considering all subjects as a whole, asymptomatic cardioautonomic neuropathy prevalence was not significantly different between women and men. When age was taken into account, the prevalence of cardioautonomic neuropathy was similar among young men and those > 50 years. However, in women > 50 years, the prevalence of cardioautonomic neuropathy doubled that of young women [45.8% (32.6; 59.7) vs. 20.4% (13.7; 29.2), respectively]. The OR of having cardioautonomic neuropathy was 3.3 higher in women > 50 years than in their younger counterparts. Furthermore, women presented more severe cardioautonomic neuropathy than men. These differences were even more marked when women were classified according their menopausal status instead of age. Peri- and menopausal women had an OR 3.5 (1.7; 7.2) of having CAN compared with their reproductive-aged counterparts [CAN prevalence: 51% (37; 65) vs. 23% (16; 32), respectively]. A binary logistic regression model (R2: 0.161; P = 0.001) displayed age > 50 years as a significant determinant of cardioautonomic neuropathy only in women. Androgens were positively associated with heart rate variability in men, and negatively in women. Accordingly, cardioautonomic neuropathy was associated with increased testosterone/estradiol ratio in women but to decreased testosterone concentrations in men. CONCLUSIONS Menopause in women with type 1 diabetes is accompanied by an increase in the prevalence of asymptomatic cardioautonomic neuropathy. This age-related excess risk of cardioautonomic neuropathy is not observed in men. Men and women with type 1 diabetes have opposite associations between circulating androgens and indexes of cardioautonomic function. Trial registration ClinicalTrials.gov Identifier: NCT04950634.
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Affiliation(s)
- Lía Nattero-Chávez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain.,Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - María Insenser
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandra Quintero Tobar
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Fernández-Durán
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Dorado Avendaño
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Tom Fiers
- Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Jean-Marc Kaufman
- Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Manuel Luque-Ramírez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain. .,Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain. .,University of Alcalá, Madrid, Spain.
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Km 9.1, 28034, Madrid, Spain.,Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium.,University of Alcalá, Madrid, Spain
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14
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Mann LM, Chan JS, Angus SA, Doherty CJ, Thompson BP, Foster GE, Hughson RL, Dominelli PB. Peripheral hypercapnic chemosensitivity in trained and untrained females and males during exercise. J Appl Physiol (1985) 2022; 133:1309-1317. [PMID: 36302156 DOI: 10.1152/japplphysiol.00460.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hypercapnic chemosensitivity is the response to the increased partial pressure of carbon dioxide and results from central and peripheral chemosensor stimulation. The hypercapnic chemosensitivity of the peripheral chemoreceptors is potentially impacted by acute exercise, aerobic fitness, and sex. We sought to determine the peripheral chemoresponse to transient hypercapnia at rest and during exercise in males and females of various fitness. We hypothesized that 1) higher fitness participants would have lower hypercapnic chemosensitivity compared with those with lower fitness and 2) males would have a higher chemoresponse than females. Forty healthy participants (20 females) participated in one test day involving transient hypercapnic chemosensitivity testing and a maximal exercise test. Chemosensitivity testing involved two breaths of 10% CO2 repeated five times (45 s to 1 min between repeats) at rest and the first two stages of a maximal exercise test. There was no significant difference between higher and lower aerobic fitness groups, (mean difference 0.23 ± 0.22 rest; -0.07 ± 0.04 stage 1; 0.11 ± 0.17 stage 2 L/mmHg·min) during each stage (P = 0.472). However, we saw a significant increase in the hypercapnic response during stage 1 (0.98 ± 0.4 L/mmHg·min) compared with rest (0.79 ± 0.5 L/mmHg·min; P = 0.01). Finally, at 80 W, males had a higher chemoresponse compared with females, which persisted following body surface area correction (0.56 ± 0.2 vs. 0.42 ± 0.2 L/mmHg·min·m2, for females and males respectively (P = 0.038). Our findings suggest that sex, unlike aerobic fitness, influences peripheral hypercapnic chemosensitivity and that context (i.e., rest vs. exercise) is an important consideration.NEW & NOTEWORTHY The hypercapnic chemoresponse to transient CO2 showed an increase during acute physical activity; however, this response did not persist with further increases in intensity and was not different between participants of different aerobic fitness. Males and females show a differing response to CO2 during exercise when compared with an iso-V̇co2. Our results suggest that adaptations that lead to increased aerobic fitness do not impact the hypercapnic ventilatory response but there is an effect of sex.
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Affiliation(s)
- Leah M Mann
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jason S Chan
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah A Angus
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Connor J Doherty
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Benjamin P Thompson
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Glen E Foster
- Centre for Heart, Lung & Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Richard L Hughson
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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15
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D'Souza AW, Klassen SA, Badrov MB, Lalande S, Shoemaker JK. Aging is associated with enhanced central, but impaired peripheral arms of the sympathetic baroreflex arc. J Appl Physiol (1985) 2022; 133:349-360. [PMID: 35736951 DOI: 10.1152/japplphysiol.00045.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We tested the hypothesis that the baroreflex control of action potential (AP) subpopulations would be blunted in older compared to young adults. Integrated muscle sympathetic nerve activity (MSNA) and the underlying sympathetic APs were obtained using microneurography and a continuous wavelet analysis approach, respectively, during 5 minutes of supine rest in 13 older (45-75 years, 6 females) and 14 young (21-30 years, 7 females) adults. Baroreflex threshold relationships were quantified as the slope of the linear regression between MSNA burst probability (%) and diastolic blood pressure (mmHg), or AP cluster firing probability (%) and diastolic blood pressure (mmHg). Integrated MSNA baroreflex threshold gain was greater in older compared to young adults (older: -7.6±3.6 %/mmHg vs. Young: -3.5±1.5 %/mmHg, P<0.001). Similarly, the baroreflex threshold gain of AP clusters was modified by aging (group-by-cluster effect: P<0.001) such that older adults demonstrated greater baroreflex threshold gains of medium-sized AP clusters (e.g., Cluster 4, older: -8.2±3.2 %/mmHg vs. Young: -3.6±1.9 %/mmHg, P=0.003) but not for the smallest- (Cluster 1, older: -1.6±1.9 %/mmHg vs. Young: -1.0±1.7 %/mmHg, P>0.999) and largest-sized (Cluster 10, older: -0.5±0.5 %/mmHg vs. Young: -0.2±0.1 %/mmHg, P=0.819) AP clusters compared to young adults. In contrast, the peak change in mean arterial pressure (MAP) following a spontaneous MSNA burst (i.e., sympathetic transduction) was impaired with aging (older: -0.7±0.3 mmHg vs. Young: 1.8±1.2 mmHg, P<0.001). We conclude that aging is associated with elevated baroreflex control over high-probability AP content of sympathetic bursts that may compensate for impaired sympathetic neurovascular transduction.
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Affiliation(s)
- Andrew W D'Souza
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Stephen A Klassen
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada.,Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Mark B Badrov
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada.,University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Lalande
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada.,Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - J Kevin Shoemaker
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada.,Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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16
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Whitaker AA, Aaron SE, Kaufman CS, Kurtz BK, Bai SX, Vidoni ED, Montgomery RN, Billinger SA. Cerebrovascular response to an acute bout of low-volume high-intensity interval exercise and recovery in young healthy adults. J Appl Physiol (1985) 2022; 132:236-246. [PMID: 34882027 PMCID: PMC8759972 DOI: 10.1152/japplphysiol.00484.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
High-intensity interval exercise (HIIT) is performed widely. However, there is a gap in knowledge regarding the acute cerebrovascular response to low-volume HIIT. Our objective was to characterize the middle cerebral artery blood velocity (MCAv) response during an acute bout of low-volume HIIT in young healthy adults. We hypothesized that MCAv would decrease below the baseline (BL), 1) during HIIT, 2) immediately following HIIT, and 3) 30 min after HIIT. As a secondary objective, we investigated sex differences in the MCAv response during HIIT. Twenty-four young healthy adults completed HIIT [12 males, age = 25 (SD = 2)]. HIIT included 10 min of 1-min high intensity (∼70% estimated maximal Watts) and active recovery (10% estimated maximal Watts) intervals on a recumbent stepper. MCAv, mean arterial pressure (MAP), heart rate (HR), and end-tidal carbon dioxide ([Formula: see text]) were recorded at BL, during HIIT, immediately following HIIT, and 30 min after HIIT. Contrary to our hypothesis, MCAv remained above BL during HIIT. MCAv peaked at minute 3 then decreased concomitantly with [Formula: see text]. MCAv was lower than BL immediately following HIIT (P < 0.001). Thirty minutes after HIIT, MCAv returned to BL (P = 0.47). Compared with men, women had a higher MCAv at BL (P = 0.001), during HIIT (P = 0.009), immediately following HIIT (P = 0.004), and 30 min after HIIT (P = 0.001). MCAv did not decrease below BL during low-volume HIIT. However, MCAv decreased below BL immediately following HIIT and returned to resting values 30 min after HIIT. MCAv also differed between sexes.NEW & NOTEWORTHY We are the first, to our knowledge, to characterize the cerebrovascular and hemodynamic response to low-volume high-intensity interval exercise (HIIT, 1-min intervals) in young healthy adults. Middle cerebral artery blood velocity (MCAv) decreased during the HIIT bout and rebounded during active recovery. Women demonstrated a significantly higher resting MCAv than men and the difference remained during HIIT. Here, we report a novel protocol and characterized the MCAv response during an acute bout of low-volume HIIT.
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Affiliation(s)
- Alicen A. Whitaker
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Stacey E. Aaron
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Carolyn S. Kaufman
- 2Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Brady K. Kurtz
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen X. Bai
- 3Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric D. Vidoni
- 4University of Kansas Alzheimer’s Disease Research
Center, Fairway, Kansas
| | - Robert N. Montgomery
- 5Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Sandra A. Billinger
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas,2Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas,3Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas,4University of Kansas Alzheimer’s Disease Research
Center, Fairway, Kansas,6Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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17
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Mielke MM, Miller VM. Improving clinical outcomes through attention to sex and hormones in research. Nat Rev Endocrinol 2021; 17:625-635. [PMID: 34316045 PMCID: PMC8435014 DOI: 10.1038/s41574-021-00531-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
Biological sex, fluctuations in sex steroid hormones throughout life and gender as a social construct all influence every aspect of health and disease. Yet, for decades, most basic and clinical studies have included only male individuals. As modern health care moves towards personalized medicine, it is clear that considering sex and hormonal status in basic and clinical studies will bring precision to the development of novel therapeutics and treatment paradigms. To this end, funding, regulatory and policy agencies now require inclusion of female animals and women in basic and clinical studies. However, inclusion of female animals and women often does not mean that information regarding potential hormonal interactions with pharmacological treatments or clinical outcomes is available. All sex steroid hormones can interact with receptors for drug targets, metabolism and transport. Genetic variation in receptors or in enzymatic function might contribute to sex differences in therapeutic efficacy and adverse drug reactions. Outcomes from clinical trials are often not reported by sex, and, if the data are available, they are not translated into clinical practice guidelines. This Review will provide a historical perspective for the current state of research related to hormone trials and provide concrete strategies that, if implemented, will improve the health of all people.
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Affiliation(s)
- Michelle M Mielke
- Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Specialized Center of Research Excellence, Mayo Clinic, Rochester, MN, USA.
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Virginia M Miller
- Mayo Clinic Specialized Center of Research Excellence, Mayo Clinic, Rochester, MN, USA
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
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18
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Klassen SA, Joyner MJ, Baker SE. The impact of ageing and sex on sympathetic neurocirculatory regulation. Semin Cell Dev Biol 2021; 116:72-81. [PMID: 33468420 PMCID: PMC8282778 DOI: 10.1016/j.semcdb.2021.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
The sympathetic nervous system represents a critical mechanism for homoeostatic blood pressure regulation in humans. This review focuses on age-related alterations in neurocirculatory regulation in men and women by highlighting human studies that examined the relationship between muscle sympathetic nerve activity (MSNA) acquired by microneurography and circulatory variables (e.g., blood pressure, vascular resistance). We frame this review with epidemiological evidence highlighting sex-specific patterns in age-related blood pressure increases in developed nations. Indeed, young women exhibit lower blood pressure than men, but women demonstrate larger blood pressure increases with age, such that by about age 60 years, blood pressure is greater in women. Sympathetic neurocirculatory mechanisms contribute to sex differences in blood pressure rises with age. Muscle sympathetic nerve activity increases with age in both sexes, but women demonstrate greater age-related increases. The circulatory adjustments imposed by MSNA - referred to as neurovascular transduction or autonomic (sympathetic) support of blood pressure - differ in men and women. For example, whereas young men demonstrate a positive relationship between resting MSNA and vascular resistance, this relationship is absent in young women due to beta-2 adrenergic vasodilation, which offsets alpha-adrenergic vasoconstriction. However, post-menopausal women demonstrate a positive relationship between MSNA and vascular resistance due to a decline in beta-2 adrenergic vasodilatory mechanisms. Emerging data suggest that greater aerobic fitness appears to modulate neurocirculatory regulation, at least in young, healthy men and women. This review also highlights recent advances in microneurographic recordings of sympathetic action potential discharge, which may nuance our understanding of age-related alterations in sympathetic neurocirculatory regulation in humans.
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Affiliation(s)
- Stephen A Klassen
- Human and Integrative Physiology and Clinical Pharmacology Laboratory, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael J Joyner
- Human and Integrative Physiology and Clinical Pharmacology Laboratory, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sarah E Baker
- Human and Integrative Physiology and Clinical Pharmacology Laboratory, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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19
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Assadpour E, Ivry I, Wasef S, Adeyinka B, Murray KR, Edgell H. Oral contraceptives and menstrual cycle influence autonomic reflex function. Physiol Rep 2021; 8:e14550. [PMID: 32889781 PMCID: PMC7507440 DOI: 10.14814/phy2.14550] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/31/2022] Open
Abstract
Progesterone and its analogues are known to influence ventilation. Therefore, the purpose of this study was to investigate the role of endogenous and pharmaceutical female sex hormones in ventilatory control during the activation of the metaboreflex, mechanoreflex, and CO2 chemoreflex. Women aged 18–30 taking (n = 14) or not taking (n = 12) oral contraceptives (OC and NOC, respectively) were tested in the low hormone (LH) and high hormone (HH) conditions corresponding to the early follicular and mid‐luteal phases (NOC) or placebo and high‐dose pills (OC). Women underwent three randomized trials: (a) 3 min of passive leg movement (PLM), (b) 2 min of 40% maximal voluntary handgrip exercise followed by 2 min of post‐exercise circulatory occlusion (PECO), and (c) 5 min of breathing 5% CO2. We primarily measured hemodynamics and ventilation. During PLM, the OC group had a smaller pressor response (p = .012). During PECO, the OC group similarly exhibited a smaller pressor response (p = .043) and also exhibited a greater ventilatory response (p = .024). Lastly, in response to breathing 5% CO2, women in the HH phase had a greater ventilatory response (p = .022). We found that OC use attenuates the pressor response to both the metaboreflex and mechanoreflex while increasing the ventilatory response to metaboreflex activation. We also found evidence of an enhanced CO2 chemoreflex in the HH phase. We hypothesize that OC effects are from the chronic upregulation of pulmonary and vascular β‐adrenergic receptors. We further suggest that the increased cyclic progesterone in the HH phase enhances the chemoreflex.
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Affiliation(s)
- Elnaz Assadpour
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Ilana Ivry
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Sara Wasef
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Baithat Adeyinka
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Kevin R Murray
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Heather Edgell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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20
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Saxena M, Schmieder RE, Kirtane AJ, Mahfoud F, Daemen J, Basile J, Lurz P, Gosse P, Sanghvi K, Fisher NDL, Rump LC, Pathak A, Blankestijn PJ, Mathur A, Wang Y, Weber MA, Sharp ASP, Bloch MJ, Barman NC, Claude L, Song Y, Azizi M, Lobo MD. Predictors of blood pressure response to ultrasound renal denervation in the RADIANCE-HTN SOLO study. J Hum Hypertens 2021; 36:629-639. [PMID: 34031548 PMCID: PMC9287166 DOI: 10.1038/s41371-021-00547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
The blood pressure (BP) lowering response to renal denervation (RDN) remains variable with about one-third of patients not responding to ultrasound or radiofrequency RDN. Identification of predictors of the BP response to RDN is needed to optimize patient selection for this therapy. This is a post-hoc analysis of the RADIANCE-HTN SOLO study. BP response to RDN was measured by the change in daytime ambulatory systolic blood pressure (dASBP) at 2 months post procedure. Univariate regression was used initially to assess potential predictors of outcome followed by multivariate regression analysis. In the univariate analysis, predictors of response to RDN were higher baseline daytime ambulatory diastolic blood pressure (dADBP), the use of antihypertensive medications at screening, and presence of orthostatic hypertension (OHTN) whilst the presence of untreated accessory arteries was a negative predictor of response. Multivariate analysis determined that dADBP and use of antihypertensive medications were predictors of response to RDN with a trend for OHTN to predict response. Obese females also appeared to be better responders to RDN in an interaction model. RDN is more effective in patients with elevated baseline dADBP and those with OHTN, suggesting increased peripheral vascular resistance secondary to heightened sympathetic tone. These assessments are easy to perform in clinical setting and may help in phenotyping patients who will respond better to RDN.
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Affiliation(s)
- Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Felix Mahfoud
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, NL, The Netherlands
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | | | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco, Monaco
| | | | - Anthony Mathur
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | | | | | - Yang Song
- Baim Institute for Clinical Research, Boston, MA, USA
| | - Michel Azizi
- Université de Paris, Paris, France.,Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.,INSERM, CIC1418, Paris, France
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
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21
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Alwatban MR, Aaron SE, Kaufman CS, Barnes JN, Brassard P, Ward JL, Miller KB, Howery AJ, Labrecque L, Billinger SA. Effects of age and sex on middle cerebral artery blood velocity and flow pulsatility index across the adult lifespan. J Appl Physiol (1985) 2021; 130:1675-1683. [PMID: 33703940 DOI: 10.1152/japplphysiol.00926.2020] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Reduced middle cerebral artery blood velocity (MCAv) and flow pulsatility are contributors to age-related cerebrovascular disease pathogenesis. It is unknown whether the rate of changes in MCAv and flow pulsatility support the hypothesis of sex-specific trajectories with aging. Therefore, we sought to characterize the rate of changes in MCAv and flow pulsatility across the adult lifespan in females and males as well as within specified age ranges. Participant characteristics, mean arterial pressure, end-tidal carbon dioxide, unilateral MCAv, and flow pulsatility index (PI) were determined from study records compiled from three institutional sites. A total of 524 participants [18-90 yr; females 57 (17) yr, n = 319; males 50 (21) yr, n = 205] were included in the analysis. MCAv was significantly higher in females within the second (P < 0.001), fifth (P = 0.01), and sixth (P < 0.01) decades of life. Flow PI was significantly lower in females within the second decade of life (P < 0.01). Rate of MCAv decline was significantly greater in females than males (-0.39 vs. -0.26 cm s-1·yr, P = 0.04). Rate of flow PI rise was significantly greater in females than males (0.006 vs. 0.003 flow PI, P = 0.01). Rate of MCAv change was significantly greater in females than males in the sixth decade of life (-1.44 vs. 0.13 cm s-1·yr, P = 0.04). These findings indicate that sex significantly contributes to age-related differences in both MCAv and flow PI. Therefore, further investigation into cerebrovascular function within and between sexes is warranted to improve our understanding of the reported sex differences in cerebrovascular disease prevalence.NEW & NOTEWORTHY We present the largest dataset (n = 524) pooled from three institutions to study how age and sex affect middle cerebral artery blood velocity (MCAv) and flow pulsatility index (PI) across the adult lifespan. We report the rate of MCAv decline and flow PI rise is significantly greater in females compared with in males. These data suggest that sex-specific trajectories with aging and therapeutic interventions to promote healthy brain aging should consider these findings.
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Affiliation(s)
- Mohammed R Alwatban
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.,Abiomed, Inc., Danvers, Massachusetts
| | - Stacey E Aaron
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Carolyn S Kaufman
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Canada
| | - Jaimie L Ward
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Kathleen B Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anna J Howery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Canada
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.,Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas.,Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas.,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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22
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Harrison CL, Hirschberg AL, Moholdt T. Editorial: Exercise and Sport: Their Influences on Women's Health Across the Lifespan. Front Physiol 2021; 11:615468. [PMID: 33551842 PMCID: PMC7855965 DOI: 10.3389/fphys.2020.615468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Women's Clinic, St. Olavs Hospital, Trondheim, Norway
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23
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Wang S, Wecht JM, Legg Ditterline B, Ugiliweneza B, Maher MT, Lombard AT, Aslan SC, Ovechkin AV, Bethke B, Gunter JTH, Harkema SJ. Heart rate and blood pressure response improve the prediction of orthostatic cardiovascular dysregulation in persons with chronic spinal cord injury. Physiol Rep 2020; 8:e14617. [PMID: 33080121 PMCID: PMC7575221 DOI: 10.14814/phy2.14617] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
Unstable blood pressure after spinal cord injury (SCI) is not routinely examined but rather predicted by level and completeness of injury (i.e., American Spinal Injury Association Impairment Scale AIS classification). Our aim was to investigate hemodynamic response to a sit-up test in a large cohort of individuals with chronic SCI to better understand cardiovascular function in this population. Continuous blood pressure and ECG were recorded from individuals with SCI (n = 159) and non-injured individuals (n = 48). We found orthostatic hypotension occurred within each level and AIS classification (n = 36). Moreover, 45 individuals with chronic SCI experienced a drop in blood pressure that did not meet the criteria for orthostatic hypotension, but was accompanied by dramatic increases in heart rate, reflecting orthostatic intolerance. A cluster analysis of hemodynamic response to a seated position identified eight distinct patterns of interaction between blood pressure and heart rate during orthostatic stress indicating varied autonomic responses. Algorithmic cluster analysis of heart rate and blood pressure is more sensitive to diagnosing orthostatic cardiovascular dysregulation. This indicates blood pressure instability cannot be predicted by level and completeness of SCI, and the consensus statement definition of orthostatic hypotension is insufficient to characterize the variability of blood pressure and heart rate responses during orthostatic stress. Both blood pressure and heart rate responses are needed to characterize autonomic function after SCI.
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Affiliation(s)
- Siqi Wang
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Jill M. Wecht
- James J Peters VA Medical CenterBronxNYUSA
- Departments of Medicine and Rehabilitation Medicinethe Icahn School of MedicineMount SinaiNew YorkNYUSA
| | - Bonnie Legg Ditterline
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Matthew T. Maher
- James J Peters VA Medical CenterBronxNYUSA
- Kessler Institute for RehabilitationWest OrangeNJUSA
| | - Alexander T. Lombard
- James J Peters VA Medical CenterBronxNYUSA
- Kessler Institute for RehabilitationWest OrangeNJUSA
| | - Sevda C. Aslan
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Alexander V. Ovechkin
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | | | | | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
- Frazier Rehab InstituteLouisvilleKYUSA
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24
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Aydin V, Akici A, Sakarya S, Akman M, Fak AS. Baseline characteristics predicting clinical outcomes and serious adverse events in middle-aged hypertensive women: a subanalysis of the SPRINT in women aged <65 years. Turk J Med Sci 2020; 50:1298-1306. [PMID: 32490642 PMCID: PMC7491286 DOI: 10.3906/sag-1907-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 05/23/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim The predictability of clinical outcomes in hypertension in specific patient groups, especially underrepresented populations is the key to rational treatment. This study aimed to investigate the impact of baseline characteristics of <65-year-old hypertensive women with an increased risk of cardiovascular events, managed with standard- or intensive-approach, on their clinical outcomes and serious adverse events (SAEs). Materials and methods Baseline characteristics of <65-year-old hypertensive women (n = 1247) in SPRINT, a multicenter randomized trial to compare standard and intensive antihypertensive treatment, were analyzed with Cox-regression method to determine potential predictors of the clinical outcomes and SAEs. The primary outcome was the composite of myocardial infarction (MI), non-MI acute coronary syndrome, stroke, heart failure, or cardiovascular death. Results The primary outcome occurred in 3.1% and SAEs in 27.6% of the population. The treatment groups were similar in terms of the primary outcome, SAEs, or their individual components. The primary outcome occurred significantly more in current smokers vs. nonsmokers (HR: 2.85, 95% CI: 1.34–6.09). The subjects who were on aspirin in the intensive-group were significantly more likely to develop the primary outcome (HR: 3.17, 95% CI: 1.23-8.19) and MI (HR: 10.15, 95% CI: 1.19-86.88) compared with those not using aspirin. The risk of overall SAEs was significantly higher in blacks vs. nonblacks (HR: 1.27, 95% CI: 1.01-1.58), in current-smokers vs. nonsmokers (HR: 1.59, 95% CI: 1.23-2.05), and those with vs. without chronic kidney disease (CKD), (HR: 1.38, 95% CI: 1.08-1.77). The likelihood of SAEs significantly increased with age (HR: 1.04, 95% CI: 1.01-1.07). Conclusion Smoking, aspirin, CKD, black race, and age seemed as important baseline characteristics in follow-up of <65-year-old hypertensive women, also depending on therapeutic strategy. Clinicians are expected to consider these critical parameters for effective antihypertensive management that promotes better outcomes in this middle-aged female population.
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Affiliation(s)
- Volkan Aydin
- Hypertension and Atherosclerosis Research Center (HIPAM), Marmara University, İstanbul, Turkey
| | - Ahmet Akici
- Hypertension and Atherosclerosis Research Center (HIPAM), Marmara University, İstanbul, Turkey
| | - Sibel Sakarya
- Department of Public Health, School of Medicine, Koç University, İstanbul, Turkey
| | - Mehmet Akman
- Hypertension and Atherosclerosis Research Center (HIPAM), Marmara University, İstanbul, Turkey
| | - Ali Serdar Fak
- Hypertension and Atherosclerosis Research Center (HIPAM), Marmara University, İstanbul, Turkey
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25
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Dougherty RJ, Boots EA, Lindheimer JB, Stegner AJ, Van Riper S, Edwards DF, Gallagher CL, Carlsson CM, Rowley HA, Bendlin BB, Asthana S, Hermann BP, Sager MA, Johnson SC, Okonkwo OC, Cook DB. Fitness, independent of physical activity is associated with cerebral blood flow in adults at risk for Alzheimer's disease. Brain Imaging Behav 2020; 14:1154-1163. [PMID: 30852709 PMCID: PMC6733668 DOI: 10.1007/s11682-019-00068-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patterns of decreased resting cerebral blood flow (CBF) within the inferior temporal gyri, angular gyri, and posterior cingulate are a feature of aging and Alzheimer's disease (AD) and have shown to be predictive of cognitive decline among older adults. Fitness and physical activity are both associated with many indices of brain health and may positively influence CBF, however, the majority of research to date has examined these measures in isolation, leaving the potential independent associations unknown. The purpose of this study was to determine the unique contributions of fitness and physical activity when predicting CBF in cognitively healthy adults at risk for AD. One hundred participants (63% female) from the Wisconsin Registry for Alzheimer's Prevention underwent a maximal exercise test, physical activity monitoring, and a 3-D arterial spin labeling magnetic resonance imaging scan. For the entire sample, fitness was significantly associated with CBF while accounting for physical activity, age, gender, APOE ε4, family history of AD, education, and handedness (p = .026). Further, fitness explained significantly more variance than the combined effect of the covariates on CBF (R2 change = .059; p = .047). These results appear to be gender dependent, our data suggest fitness level, independent of physical activity, is associated with greater CBF in regions that are known to decline with age and AD for female (p = .011), but not male participants.
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Affiliation(s)
- Ryan J Dougherty
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Elizabeth A Boots
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, 60607, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
| | - Stephanie Van Riper
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
| | - Dorothy F Edwards
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Catherine L Gallagher
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Howard A Rowley
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Bruce P Hermann
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Mark A Sager
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Ozioma C Okonkwo
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA.
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA.
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26
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Pereira HM, Larson RD, Bemben DA. Menstrual Cycle Effects on Exercise-Induced Fatigability. Front Physiol 2020; 11:517. [PMID: 32670076 PMCID: PMC7332750 DOI: 10.3389/fphys.2020.00517] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
Estrogen and progesterone have distinct concentrations across the menstrual cycle, each one promoting several physiological alterations other than preparing the uterus for pregnancy. Whether these physiological alterations can influence motor output during a fatiguing contraction is the goal of this review, with an emphasis on the obtained effect sizes. Studies on this topic frequently attempt to report if there is a statistically significant difference in fatigability between the follicular and luteal phases of the menstrual cycle. Although the significant difference (the P-value) can inform the probability of the event, it does not indicate the magnitude of it. We also investigated whether the type of task performed (e.g., isometric vs. dynamic) can further influence the magnitude by which exercise-induced fatigue changes with fluctuations in the concentration of ovarian hormones. We retrieved experimental studies in eumenorrheic women published between 1975 and 2019. The initial search yielded 921 studies, and after manual refinement, 46 experimental studies that reported metrics of motor output in both the follicular and luteal phases of the menstrual cycle were included. From these retrieved studies, 15 showed a statistical difference between the luteal and follicular phases (seven showing less fatigability during the luteal phase and eight during the follicular phase). The effect size was not consistent across studies and with a large range (-6.77; 1.61, favoring the luteal and follicular phase, respectively). The inconsistencies across studies may be a consequence of the differences in the limb used during the fatiguing contraction (upper vs. lower extremity), the type of contraction (isometric vs. dynamic), the muscle mass engaged (single limb vs. full body), and the techniques used to define the menstrual cycle phase (e.g., serum concentration vs. reported day of menses). Further studies are required to determine the effects of a regular menstrual cycle phase on the exercise-induced fatigability.
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Affiliation(s)
- Hugo M. Pereira
- Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
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Abstract
Baroreceptors are mechanosensitive elements of the peripheral nervous system that maintain homeostasis by coordinating physiologic responses to external and internal stimuli. While it is recognized that carotid and cardiopulmonary baroreceptor reflexes modulate autonomic output to mitigate excessive fluctuations in arterial blood pressure and to maintain intravascular volume, increasing evidence suggests that baroreflex pathways also project to key regions of the central nervous system that regulate somatosensory, somatomotor, and central nervous system arousal. In addition to maintaining autonomic homeostasis, baroreceptor activity modulates the perception of pain, as well as neuroimmune, neuroendocrine, and cognitive responses to physical and psychologic stressors. This review summarizes the role that baroreceptor pathways play in modulating acute and chronic pain perception. The contribution of baroreceptor function to postoperative outcomes is also presented. Finally, methods that enhance baroreceptor function, which hold promise in improving postoperative and pain management outcomes, are presented.
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Abstract
Obesity increases sympathetic nerve activity (SNA) in men, but not women. Here, we review current evidence suggesting that sexually dimorphic sympathoexcitatory responses to leptin and insulin may contribute. More specifically, while insulin increases SNA similarly in lean males and females, this response is markedly amplified in obese males, but is abolished in obese females. In lean female rats, leptin increases a subset of sympathetic nerves only during the high estrogen proestrus reproductive phase; thus, in obese females, because reproductive cycling can become impaired, the sporadic nature of leptin-induced sympathoexcitaton could minimize its action, despite elevated leptin levels. In contrast, in males, obesity preserves or enhances the central sympathoexcitatory response to leptin, and current evidence favors leptin’s contribution to the well-established increases in SNA induced by obesity in men. Leptin and insulin increase SNA via receptor binding in the hypothalamic arcuate nucleus and a neuropathway that includes arcuate neuropeptide Y (NPY) and proopiomelanocortin (POMC) projections to the paraventricular nucleus. These metabolic hormones normally suppress sympathoinhibitory NPY neurons and activate sympathoexcitatory POMC neurons. However, obesity appears to alter the ongoing activity and responsiveness of arcuate NPY and POMC neurons in a sexually dimorphic way, such that SNA increases in males but not females. We propose hypotheses to explain these sex differences and suggest areas of future research.
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Affiliation(s)
- Zhigang Shi
- Department of Physiology and Pharmacology, L-334, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Jennifer Wong
- Department of Physiology and Pharmacology, L-334, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Virginia L Brooks
- Department of Physiology and Pharmacology, L-334, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
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Smith JR, Koepp KE, Berg JD, Akinsanya JG, Olson TP. Influence of Sex, Menstrual Cycle, and Menopause Status on the Exercise Pressor Reflex. Med Sci Sports Exerc 2019; 51:874-881. [PMID: 30986812 DOI: 10.1249/mss.0000000000001877] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In this review, we highlight the underlying mechanisms responsible for the sex differences in the exercise pressor reflex (EPR), and, importantly, the impact of sex hormones and menopausal status. The EPR is attenuated in premenopausal women compared with age-matched men. Specifically, activation of the metaboreflex (a component of the EPR) results in attenuated increases in blood pressure and sympathetic vasomotor outflow compared with age-matched men. In addition, premenopausal women exhibit less transduction of sympathetic outflow to the peripheral vasculature than men. In stark contrast, postmenopausal women exhibit an augmented EPR arising from exaggerated metaboreflex-induced autonomic and cardiovascular reflexes. We propose that metaboreflex-induced autonomic and cardiovascular changes associated with menopause majorly contribute to the elevated blood pressure response during dynamic exercise in postmenopausal women. In addition, we discuss the potential mechanisms by which sex hormones in premenopausal women may impact the EPR as well as metaboreflex.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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30
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Martin ZT, Shannon CA, Kistler BM, Nagelkirk PR, Del Pozzi AT. Effect of Sex and Menstrual Cycle on Skin Sensory Nerve Contribution to Local Heating. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2019; 12:1265-1279. [PMID: 31839845 PMCID: PMC6886618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to determine sex differences in the contribution of sensory nerves to rapid cutaneous thermal hyperemia. Healthy young females (n = 15, tested during both the early follicular (EF) and the mid-luteal (ML) phase of the menstrual cycle) and males (n = 15) had a 4 cm2 area of skin on one forearm and one leg treated with a eutectic mixture of local anesthetic (EMLA). EMLA sites, along with corresponding control sites, were instrumented with laser Doppler flowmetry probes and local skin heaters. Baseline (33 °C), rapid and sustained vasodilation (42 °C), and maximal vasodilation (44 °C) skin blood flow data were obtained and expressed as a percentage of maximal cutaneous vascular conductance (%CVCmax). Contribution of sensory nerve involvement was determined by comparing the EMLA site to its matched control site utilizing the formula [(% CVCmax control - % CVCmax treatment) / % CVCmax control] × 100. The contribution of sensory nerves to rapid cutaneous thermal hyperemia in the forearm was 24 ± 18 %CVCmax in males, 41 ± 17 %CVCmax in ML females (p = 0.02 vs. males), and 35 ± 17 %CVCmax in EF females (p > 0.05 vs. males). In the leg, the contribution of sensory nerves was 16 ± 15 %CVCmax in males, 34 ± 17 %CVCmax for ML females (p = 0.02 vs. males), and 28 ± 21 %CVCmax in EF females (p > 0.05 vs. males). ML females exhibited a greater contribution of sensory nerves to rapid cutaneous thermal hyperemia in the forearm and leg, possibly attributed to elevated reproductive hormones during the ML phase.
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Affiliation(s)
- Zachary T Martin
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Carley A Shannon
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Brandon M Kistler
- Department of Nutrition and Health Sciences, Ball State University, Muncie, IN, USA
| | - Paul R Nagelkirk
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Andrew T Del Pozzi
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
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31
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Abstract
OBJECTIVE Multimorbidity is a robust predictor of disability in aging adults, but the mechanisms by which multimorbidity is disabling are not clear. Most existing research focuses on disease-specific phenomena, such as diminished lung capacity in chronic obstructive pulmonary disease, which can result in functional limitations. This review takes a different approach by highlighting the potential role of a biological process-inflammation-that is common to many chronic medical conditions and thus, from a medical perspective, relatively disease nonspecific. METHOD Beginning with a description of inflammation and its measurement, this paper will provide an overview of research on inflammation as a predictor of disease risk in healthy adults and of adverse outcomes (e.g., disability) in those with multimorbidity. RESULTS The discussion of inflammation is then situated in the context of biopsychosocial influences on health, as inflammation has been shown to be sensitive to a wide range of social and psychological processes that are thought to contribute to healthy aging, including successful adaptation to multimorbidity and reduced risk of disability. CONCLUSIONS Finally, implications of this broader perspective for interventions to improve outcomes in aging adults with multimorbidity are briefly considered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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32
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Wakeham DJ, Lord RN, Talbot JS, Lodge FM, Curry BA, Dawkins TG, Simpson LL, Shave RE, Pugh CJA, Moore JP. Upward resetting of the vascular sympathetic baroreflex in middle-aged male runners. Am J Physiol Heart Circ Physiol 2019; 317:H181-H189. [PMID: 31050557 DOI: 10.1152/ajpheart.00106.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study focused on the influence of habitual endurance exercise training (i.e., committed runner or nonrunner) on the regulation of muscle sympathetic nerve activity (MSNA) and arterial pressure in middle-aged (50 to 63 yr, n = 23) and younger (19 to 30 yr; n = 23) normotensive men. Hemodynamic and neurophysiological assessments were performed at rest. Indices of vascular sympathetic baroreflex function were determined from the relationship between spontaneous changes in diastolic blood pressure (DBP) and MSNA. Large vessel arterial stiffness and left ventricular stroke volume also were measured. Paired comparisons were performed within each age category. Mean arterial pressure and basal MSNA bursts/min were not different between age-matched runners and nonrunners. However, MSNA bursts/100 heartbeats, an index of baroreflex regulation of MSNA (vascular sympathetic baroreflex operating point), was higher for middle-aged runners (P = 0.006), whereas this was not different between young runners and nonrunners. The slope of the DBP-MSNA relationship (vascular sympathetic baroreflex gain) was not different between groups in either age category. Aortic pulse wave velocity was lower for runners of both age categories (P < 0.03), although carotid β-stiffness was lower only for middle-aged runners (P = 0.04). For runners of both age categories, stroke volume was larger, whereas heart rate was lower (both P < 0.01). In conclusion, we suggest that neural remodeling and upward setting of the vascular sympathetic baroreflex compensates for cardiovascular adaptations after many years committed to endurance exercise training, presumably to maintain arterial blood pressure stability. NEW & NOTEWORTHY Exercise training reduces muscle sympathetic burst activity in disease; this is often extrapolated to infer a similar effect in health. We demonstrate that burst frequency of middle-aged and younger men committed to endurance training is not different compared with age-matched casual exercisers. Notably, well-trained, middle-aged runners display similar arterial pressure but higher sympathetic burst occurrence than untrained peers. We suggest that homeostatic plasticity and upward setting of the vascular sympathetic baroreflex maintains arterial pressure stability following years of training.
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Affiliation(s)
- Denis J Wakeham
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Jack S Talbot
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Freya M Lodge
- Cardiff and Vale University Health Board, University Hospital of Wales , Cardiff , United Kingdom
| | - Bryony A Curry
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Lydia L Simpson
- Physical Activity for Health and Well-Being Centre, School of Sport, Health and Exercise Sciences, Bangor University , Bangor , United Kingdom
| | - Rob E Shave
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff , United Kingdom.,Centre for Heart, Lung, and Vascular Health, University of British Columbia Okanagan , Kelowna, BC , Canada
| | - Christopher J A Pugh
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Jonathan P Moore
- Physical Activity for Health and Well-Being Centre, School of Sport, Health and Exercise Sciences, Bangor University , Bangor , United Kingdom
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33
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Barrero A, Schnell F, Carrault G, Kervio G, Matelot D, Carré F, Le Douairon Lahaye S. Daily fatigue-recovery balance monitoring with heart rate variability in well-trained female cyclists on the Tour de France circuit. PLoS One 2019; 14:e0213472. [PMID: 30845249 PMCID: PMC6405062 DOI: 10.1371/journal.pone.0213472] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/21/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives This study aimed to analyze the daily heart rate variability (HRV) in well-trained female cyclists during the 2017 Tour de France circuit and to relate it to the load and perceived exertion response. Methods Ten female cyclists volunteered to participate in the study. HRV was recorded with a portable heart rate monitor each morning at rest in supine (7 min.) and upright (7 min.) positions, as well as throughout each day’s stage. Pre-Tour baseline HRV recordings were made, as well as during the four weeks following completion of the Tour. Exercise daily load was assessed using the training impulse score (TRIMPS). Post-exercise rate of perceived exertion (RPE) was assessed daily using the Borg CR-10 scale. Results The results show a HRV imbalance, increase of sympathetic and decrease of vagal activities respectively, along the event that correlated with rate of perceived exertion (r = 0.46), training impulse score (r = 0.60), and kilometers (r = 046). The greatest change in HRV balance was observed the days after the greatest relative physical load. Mean heart rate and heart rate variability values returned to their baseline values one week after completion of the event. Conclusions Despite incomplete recovery from day-to-day, fatigue is not summative or augmented with each successive stage and its physical load. Just one week is sufficient to restore baseline values. Heart rate and HRV can be used as a tool to strategically plan the effort of female cyclists that participate in multi-stage events.
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Affiliation(s)
- Anna Barrero
- M2S Laboratory, University of Rennes 2, Rennes, France
- CIC-CIT INSERM UMR 1099, Rennes, France
- * E-mail:
| | - Frédéric Schnell
- University of Rennes 1, Department of Sports Medicine University Hospital of Rennes, INSERM, LTSI-UMR1099, Rennes, France
| | - Guy Carrault
- CIC-CIT INSERM UMR 1099, Rennes, France
- University of Rennes 1, Department of Sports Medicine University Hospital of Rennes, INSERM, LTSI-UMR1099, Rennes, France
| | | | | | - François Carré
- University of Rennes 1, Department of Sports Medicine University Hospital of Rennes, INSERM, LTSI-UMR1099, Rennes, France
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34
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Limberg JK, Morgan BJ, Schrage WG. Peripheral Blood Flow Regulation in Human Obesity and Metabolic Syndrome. Exerc Sport Sci Rev 2018; 44:116-22. [PMID: 27223271 DOI: 10.1249/jes.0000000000000083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jacqueline K Limberg
- 1Department of Anesthesiology, Mayo Clinic, Rochester, MN; and Departments of 2Kinesiology and 3Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI
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35
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Han S, Aydin MM, Akansel S, Usanmaz SE, Akçali C, Uludağ MO, Demirel Yilmaz E. Age- and sex-dependent alteration of functions and epigenetic modifications of vessel and endothelium related biomarkers. Turk J Biol 2018; 42:286-296. [PMID: 30814892 DOI: 10.3906/biy-1803-59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Aging is a main risk factor for development of cardiovascular diseases associated with the impairment of endothelial function in both sexes. In the present study, age-related changes in vascular responsiveness, epigenetic modifications of vessel wall, and blood biomarkers related to endothelial functions were examined in an age- and sex-dependent manner. Acetylcholine (ACh)-induced relaxations of the aorta were decreased in 3-, 6-, and 12-month-old rats compared to those in 1-month-old female rats. In males, maximum relaxations related to ACh were higher in 1- and 6-month-old rats than in 3- and 12-month-old rats. Plasma levels of nitric oxide (NO) and asymmetric dimethylarginine (ADMA) decreased with age in female rats, and total antioxidant capacity (TAC) and hydrogen sulfide (H 2S) levels displayed biphasic alterations. In male rats, plasma levels of NO, TAC, and ADMA decreased with age, and H2S levels increased. Aging also caused a sex-dependent alteration in epigenetic modification of vessels. Expressions of H3K27me2, H3K27me3, H3K36me2, and H3K36me3 were much higher in vessels of 12-month-old female rats compared to those in younger age groups. These results indicate that vascular functions, epigenetic modifications of vessels, and plasma levels of endothelium-related biomarkers are affected by age and sex. These findings could be important for the assessment of vascular status over the course of the life span.
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Affiliation(s)
- Sevtap Han
- Department of Pharmacology, Faculty of Pharmacy, Gazi University , Ankara , Turkey
| | - Muammer Merve Aydin
- Department of Biophysics, Faculty of Medicine, Ankara University , Ankara , Turkey
| | - Serdar Akansel
- Department of Medical Pharmacology, Faculty of Medicine, Ankara University , Turkey
| | - Suzan Emel Usanmaz
- Department of Medical Pharmacology, Faculty of Medicine, Ankara University , Turkey
| | - Can Akçali
- Department of Biophysics, Faculty of Medicine, Ankara University , Ankara , Turkey
| | - Mecit Orhan Uludağ
- Department of Pharmacology, Faculty of Pharmacy, Gazi University , Ankara , Turkey
| | - Emine Demirel Yilmaz
- Department of Medical Pharmacology, Faculty of Medicine, Ankara University , Turkey
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36
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Hissen SL, Sayed KE, Macefield VG, Brown R, Taylor CE. The Stability and Repeatability of Spontaneous Sympathetic Baroreflex Sensitivity in Healthy Young Individuals. Front Neurosci 2018; 12:403. [PMID: 29962929 PMCID: PMC6010576 DOI: 10.3389/fnins.2018.00403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/25/2018] [Indexed: 01/18/2023] Open
Abstract
Spontaneous sympathetic baroreflex sensitivity (BRS) is a valuable tool for assessing how well the baroreflex buffers beat-to-beat changes in blood pressure. However, there has yet to be a study involving appropriate statistical tests to examine the stability of sympathetic BRS within an experimental session and the repeatability between separate sessions. The aim of this study was to use intra-class correlations, ordinary least products regression, and Bland–Altman analyses to examine the stability and repeatability of spontaneous sympathetic BRS assessment. In addition, the influence of recording duration on values of BRS was assessed. In eighty-four healthy young individuals (49 males, 35 females), continuous measurements of blood pressure, heart rate and muscle sympathetic nerve activity (MSNA) were recorded for 10 min. In a subgroup of 13 participants (11 male, 2 female) the measurements were repeated on a separate day. Sympathetic BRS was quantified using MSNA burst incidence (BRSinc) and total MSNA (BRStotal) for the first 5-min period, the second 5-min period, and a 2-min segment taken from the second 5-min period. Intra-class correlation coefficients indicated moderate stability in sympathetic BRSinc and BRStotal between the first and second 5-min periods in males (BRSincr = 0.63, BRStotalr = 0.78) and females (BRSincr = 0.61, BRStotalr = 0.47) with no proportional bias, but with fixed bias for BRSinc in females. When comparing the first 5-min with the 2-min period (n = 76), the intra-class correlation coefficient indicated poor to moderate repeatability in sympathetic BRSinc and BRStotal for males (BRSincr = -0.01, BRStotalr = 0.70) and females (BRSincr = 0.46, BRStotalr = 0.39). However, Bland–Altman analysis revealed a fixed bias for BRStotal in males and proportional bias for BRStotal in females, with lower BRS values for 5-min recordings. In the subgroup, intra-class correlations indicated moderate repeatability for measures of BRSinc (9 male, 2 female, r = 0.63) and BRStotal (6 male, 2 female, r = 0.68) assessed using 5-min periods recorded on separate days. However, Bland–Altman analysis indicated proportional bias for BRSinc and fixed bias for BRStotal. In conclusion, measures of spontaneous sympathetic BRS are moderately stable and repeatable within and between testing sessions in healthy young adults, provided that the same length of recording is used when making comparisons.
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Affiliation(s)
- Sarah L Hissen
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | - Khadigeh El Sayed
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Vaughan G Macefield
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Rachael Brown
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Chloe E Taylor
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
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37
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Welch JF, Archiza B, Guenette JA, West CR, Sheel AW. Sex differences in diaphragmatic fatigue: the cardiovascular response to inspiratory resistance. J Physiol 2018; 596:4017-4032. [PMID: 29756638 DOI: 10.1113/jp275794] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/01/2018] [Indexed: 12/16/2022] Open
Abstract
KEY POINTS Diaphragmatic fatigue (DF) elicits a sympathetically mediated metaboreflex resulting in increased heart rate, blood pressure and limb vascular resistance. Women may be more resistant to DF compared to men, and therefore it was hypothesised that women would experience an attenuated inspiratory muscle metaboreflex during inspiratory pressure-threshold loading (PTL) performed to task failure. At the time of PTL task failure, the severity of DF was not different between sexes; however, inspiratory muscle endurance time was significantly longer in women than in men. For a given cumulative diaphragmatic force output, the severity of DF was less in women than in men. Women exhibited a blunted cardiovascular response to inspiratory resistance (i.e. metaboreflex) that may have implications for exercise tolerance. ABSTRACT Diaphragmatic fatigue (DF) elicits reflexive increases in sympathetic vasomotor outflow (i.e. metaboreflex). There is some evidence suggesting women may be more resistant to DF compared to men, and therefore may experience an attenuated inspiratory muscle metaboreflex. To this end, we sought to examine the cardiovascular response to inspiratory resistance in healthy young men (n = 9, age = 24 ± 3 years) and women (n = 9, age = 24 ± 3 years). Subjects performed isocapnic inspiratory pressure-threshold loading (PTL, 60% maximal inspiratory mouth pressure) to task failure. Diaphragmatic fatigue was assessed by measuring transdiaphragmatic twitch pressure (Pdi,tw ) using cervical magnetic stimulation. Heart rate (HR) and mean arterial pressure (MAP) were measured beat-by-beat throughout PTL via photoplethysmography, and low-frequency systolic pressure (LFSBP ; a surrogate for sympathetic vasomotor tone) calculated from arterial waveforms using power spectrum analysis. At PTL task failure, the degree of DF was similar between sexes (∼23% reduction in Pdi,tw ; P = 0.33). However, time to task failure was significantly longer in women than in men (27 ± 11 vs. 16 ± 11 min, respectively; P = 0.02). Women exhibited less of an increase in HR (13 ± 8 vs. 19 ± 12 bpm; P = 0.02) and MAP (10 ± 8 vs. 14 ± 9 mmHg; P = 0.01), and significantly lower LFSBP (23 ± 11 vs. 34 ± 8 mmHg2 ; P = 0.04) during PTL compared to men. An attenuation of the inspiratory muscle metaboreflex may influence limb and respiratory muscle haemodynamics with implications for exercise performance.
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Affiliation(s)
- Joseph F Welch
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Bruno Archiza
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Jordan A Guenette
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, Providence Health Care Research Institute, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Christopher R West
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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38
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Green DJ, Smith KJ. Effects of Exercise on Vascular Function, Structure, and Health in Humans. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a029819. [PMID: 28432115 DOI: 10.1101/cshperspect.a029819] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Physical activity has profound impacts on the vasculature in humans. Acute exercise induces immediate changes in artery function, whereas repeated episodic bouts of exercise induce chronic functional adaptation and, ultimately, structural arterial remodeling. The nature of these changes in function and structure are dependent on the characteristics of the training load and may be modulated by other factors such as exercise-induced inflammation and oxidative stress. The clinical implications of these physiological adaptations are profound. Exercise impacts on the development of atherosclerosis and on the incidence of primary and secondary cardiovascular events, including myocardial infarction and stroke. Exercise also plays a role in the amelioration of other chronic diseases that possess a vascular etiology, including diabetes and dementia. The mechanisms responsible for these effects of exercise on the vasculature are both primary and secondary in nature, in that the benefits conferred by changes in cardiovascular risk factors such as lipid profiles and blood pressure occur in concert with direct effects of arterial shear stress and mechanotransduction. From an evolutionary perspective, exercise is an essential stimulus for the maintenance of vascular health: exercise is vascular medicine.
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Affiliation(s)
- Daniel J Green
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L33AF, United Kingdom.,School of Human Sciences, The University of Western Australia, Crawley 6009, Australia.,Principal Research Fellow, National Health and Medical Research Council of Australia, Canberra 2601, Australia
| | - Kurt J Smith
- School of Human Sciences, The University of Western Australia, Crawley 6009, Australia
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39
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Abstract
Sex and gender, as biological and social factors, significantly influence health outcomes. Among the biological factors, sex differences in vascular physiology may be one specific mechanism contributing to the observed differences in clinical presentation, response to treatment, and clinical outcomes in several vascular disorders. This review focuses on the cerebrovascular bed and summarizes the existing literature on sex differences in cerebrovascular hemodynamics to highlight the knowledge deficit that exists in this domain. The available evidence is used to generate mechanistically plausible and testable hypotheses to underscore the unmet need in understanding sex-specific mechanisms as targets for more effective therapeutic and preventive strategies.
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Affiliation(s)
- Cristina Duque
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Neurology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Steven K Feske
- Division of Stroke, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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40
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Vranish JR, Holwerda SW, Young BE, Credeur DP, Patik JC, Barbosa TC, Keller DM, Fadel PJ. Exaggerated Vasoconstriction to Spontaneous Bursts of Muscle Sympathetic Nerve Activity in Healthy Young Black Men. Hypertension 2017; 71:192-198. [PMID: 29203629 DOI: 10.1161/hypertensionaha.117.10229] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/05/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022]
Abstract
Blacks have the highest prevalence of hypertension, putting them at greater risk of cardiovascular disease and death. Previous studies have reported that, relative to whites, healthy black men have augmented pressor responses to sympathoexcitatory stressors. Although important, these studies do not inform about the resting state and the influence of spontaneous changes in resting muscle sympathetic nerve activity (MSNA). Likewise, little is known about the transduction of MSNA into a vascular response at rest on a beat-to-beat basis. Accordingly, we tested the hypothesis that relative to whites, blacks would exhibit greater vasoconstriction and pressor responses following spontaneous bursts of MSNA. Mean arterial pressure, common femoral artery blood flow, and MSNA were continuously recorded during 20 minutes of supine rest in 35 young healthy men (17 blacks and 18 whites). Signal averaging was used to characterize changes in leg vascular conductance, total vascular conductance, and mean arterial pressure following spontaneous MSNA bursts. Blacks demonstrated significantly greater decreases in leg vascular conductance (blacks: -15.0±1.0%; whites: -11.5±1.2%; P=0.042) and total vascular conductance (blacks: -8.6±0.9%; whites: -5.1±0.4%; P=0.001) following MSNA bursts, which resulted in greater mean arterial pressure increases (blacks: +5.2±0.6 mm Hg; whites: +3.9±0.3 mm Hg; P=0.04). These exaggerated responses in blacks compared with whites were present whether MSNA bursts occurred in isolation (singles) or in combination (multiples) and were graded with increases in burst height. Collectively, these findings suggest that healthy young black men exhibit augmented sympathetic vascular transduction at rest and provide novel insight into potential mechanism(s) by which this population may develop hypertension later in life.
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Affiliation(s)
- Jennifer R Vranish
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Seth W Holwerda
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Benjamin E Young
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Daniel P Credeur
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Jordan C Patik
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Thales C Barbosa
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - David M Keller
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Paul J Fadel
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.).
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41
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Barnes JN. Sex-specific factors regulating pressure and flow. Exp Physiol 2017; 102:1385-1392. [PMID: 28799254 DOI: 10.1113/ep086531] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/10/2017] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the topic of this review? There are sex- and sex-hormone-specific differences in autonomic control of blood pressure, central haemodynamics and cerebral blood flow. What advances does it highlight? Sex differences in autonomic control of blood pressure may underlie other sex-specific characteristics associated with cerebral blood flow, which can, in turn, affect tissue function. Over the last decade, there have been many published reports on sex differences in blood pressure regulation between young men and young women. The autonomic nervous system is a primary contributor to both acute and long-term blood pressure regulation. Sex differences in blood pressure regulation are likely to have effects that extend beyond mean arterial pressure and that can affect blood flow and tissue function. This short review includes recent literature from our laboratory focusing on autonomic control of the circulation, specifically age- and sex-hormone-related differences in central haemodynamics and cerebral blood flow, and discusses potential clinical implications.
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Affiliation(s)
- Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, 53706, USA
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Evans JM, Wang S, Greb C, Kostas V, Knapp CF, Zhang Q, Roemmele ES, Stenger MB, Randall DC. Body Size Predicts Cardiac and Vascular Resistance Effects on Men's and Women's Blood Pressure. Front Physiol 2017; 8:561. [PMID: 28848448 PMCID: PMC5552717 DOI: 10.3389/fphys.2017.00561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/18/2017] [Indexed: 12/16/2022] Open
Abstract
Key Points Summary We report how blood pressure, cardiac output and vascular resistance are related to height, weight, body surface area (BSA), and body mass index (BMI) in healthy young adults at supine rest and standing.Much inter-subject variability in young adult's blood pressure, currently attributed to health status, may actually result from inter-individual body size differences.Each cardiovascular variable is linearly related to height, weight and/or BSA (more than to BMI).When supine, cardiac output is positively related, while vascular resistance is negatively related, to body size. Upon standing, the change in vascular resistance is positively related to size.The height/weight relationships of cardiac output and vascular resistance to body size are responsible for blood pressure relationships to body size.These basic components of blood pressure could help distinguish normal from abnormal blood pressures in young adults by providing a more effective scaling mechanism. Introduction: Effects of body size on inter-subject blood pressure (BP) variability are not well established in adults. We hypothesized that relationships linking stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) with body size would account for a significant fraction of inter-subject BP variability. Methods: Thirty-four young, healthy adults (19 men, 15 women) participated in 38 stand tests during which brachial artery BP, heart rate, SV, CO, TPR, and indexes of body size were measured/calculated. Results: Steady state diastolic arterial BP was not significantly correlated with any index of body size when subjects were supine. However, upon standing, the more the subject weighed, or the taller s/he was, the greater the increase in diastolic pressure. Systolic pressure strongly correlated with body weight and height both supine and standing. Diastolic and systolic BP were more strongly related to height, weight and body surface area than to body mass index. When supine: lack of correlation between diastolic pressure and body size, resulted from the combination of positive SV correlation and negative TPR correlation with body size. The positive systolic pressure vs. body size relationship resulted from a positive SV vs. height relationship. In response to standing: the positive diastolic blood pressure vs. body size relationship resulted from the standing-induced, positive increase in TPR vs. body size relationship. The relationships between body weight or height with SV and TPR contribute new insight into mechanisms of BP regulation that may aid in the prediction of health in young adults by providing a more effective way to scale BP with body size.
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Affiliation(s)
- Joyce M Evans
- Department of Biomedical Engineering, University of KentuckyLexington, KY, United States
| | - Siqi Wang
- Department of Biomedical Engineering, University of KentuckyLexington, KY, United States
| | - Christopher Greb
- Department of Biomedical Engineering, University of KentuckyLexington, KY, United States
| | - Vladimir Kostas
- Department of Biomedical Engineering, University of KentuckyLexington, KY, United States
| | - Charles F Knapp
- Department of Biomedical Engineering, University of KentuckyLexington, KY, United States
| | - Qingguang Zhang
- Department of Biomedical Engineering, University of KentuckyLexington, KY, United States
| | - Eric S Roemmele
- Department of Statistics, University of KentuckyLexington, KY, United States
| | - Michael B Stenger
- Wyle Science, Technology and Engineering GroupHouston, TX, United States
| | - David C Randall
- Department of Physiology, University of KentuckyLexington, KY, United States
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Sarafian D, Miles-Chan JL. The Influence of Gender and Anthropometry on Haemodynamic Status at Rest and in Response to Graded Incremental Head-Up Tilt in Young, Healthy Adults. Front Physiol 2017; 7:656. [PMID: 28101061 PMCID: PMC5209346 DOI: 10.3389/fphys.2016.00656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/14/2016] [Indexed: 01/02/2023] Open
Abstract
The body's ability to rapidly and appropriately regulate blood pressure in response to changing physiological demand is a key feature of a healthy cardiovascular system. Passively tilting the body, thereby changing central blood volume, is a well-recognized and controlled method of evaluating this ability. However, such studies usually involve single tilt angles, or intermittent tilting separated by supine, resting periods; valuable information concerning the adaptive capacity of the regulatory systems involved is therefore currently lacking. Furthermore, despite increasing recognition that men and women differ in the magnitude of their haemodynamic response to such stimuli, little is known about the degree to which gender differences in body composition and anthropometry influence these regulatory pathways, or indeed if these differences are apparent in response to graded, incremental tilting. In the present study we measured, in 23 young, healthy adults (13 men, 10 women), the continuous beat-to-beat haemodynamic response to graded, incremental tilting (0°, 20°, 40°, 60°, and back to 40°) with each tilt angle lasting 16 min. On average, we observed increases in heart rate (+41%), blood pressure (+10%), and total peripheral resistance (+16%) in response to tilting. However, whilst men showed an immediate decrease in cardiac output upon tilting (−8.9%) cardiac output in women did not change significantly from supine values. Interestingly, the decrease in stroke volume observed in women was significantly less than that observed in men (−22 vs. −36%, p < 0.05); although the present study could not determine if this difference was due to gender per se or due to differences in body size (in particular height) between the two gender groups. Such disparities in the magnitude of autonomic response may indicate (in the case of our gradual incremental tilt procedure) a better buffering capacity to progressive changes in central blood volume in women; which warrants further investigation, particularly in light of the well-recognized differences in cardiovascular disease risk between men and women.
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Affiliation(s)
- Delphine Sarafian
- Laboratory of Integrative Cardiovascular and Metabolic Physiology, Division of Physiology, Department of Medicine, University of Fribourg Fribourg, Switzerland
| | - Jennifer L Miles-Chan
- Laboratory of Integrative Cardiovascular and Metabolic Physiology, Division of Physiology, Department of Medicine, University of Fribourg Fribourg, Switzerland
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Usselman CW, Nielson CA, Luchyshyn TA, Gimon TI, Coverdale NS, Van Uum SHM, Shoemaker JK. Hormone phase influences sympathetic responses to high levels of lower body negative pressure in young healthy women. Am J Physiol Regul Integr Comp Physiol 2016; 311:R957-R963. [PMID: 27733385 DOI: 10.1152/ajpregu.00190.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/28/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023]
Abstract
We tested the hypothesis that sympathetic responses to baroreceptor unloading may be affected by circulating sex hormones. During lower body negative pressure at -30, -60, and -80 mmHg, muscle sympathetic nerve activity (MSNA), heart rate, and blood pressure were recorded in women who were taking (n = 8) or not taking (n = 9) hormonal contraceptives. All women were tested twice, once during the low-hormone phase (i.e., the early follicular phase of the menstrual cycle and the placebo phase of hormonal contraceptive use), and again during the high-hormone phase (i.e., the midluteal phase of the menstrual cycle and active phase of contraceptive use). During baroreceptor unloading, the reductions in stroke volume and resultant increases in MSNA and total peripheral resistance were greater in high-hormone than low-hormone phases in both groups. When normalized to the fall in stroke volume, increases in MSNA were no longer different between hormone phases. While stroke volume and sympathetic responses were similar between women taking and not taking hormonal contraceptives, mean arterial pressure was maintained during baroreceptor unloading in women not taking hormonal contraceptives but not in women using hormonal contraceptives. These data suggest that differences in sympathetic activation between hormone phases, as elicited by lower body negative pressure, are the result of hormonally mediated changes in the hemodynamic consequences of negative pressure, rather than centrally driven alterations to sympathetic regulation.
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Affiliation(s)
- Charlotte W Usselman
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Chantelle A Nielson
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Torri A Luchyshyn
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Tamara I Gimon
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Nicole S Coverdale
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Stan H M Van Uum
- Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, Western University, London, Ontario, Canada; and
| | - J Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada; .,Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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45
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Alhurani RE, Chahal CAA, Ahmed AT, Mohamed EA, Miller VM. Sex hormone therapy and progression of cardiovascular disease in menopausal women. Clin Sci (Lond) 2016; 130:1065-74. [PMID: 27215679 PMCID: PMC5316470 DOI: 10.1042/cs20160042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/04/2016] [Indexed: 02/07/2023]
Abstract
One of the most controversial health decisions facing women is deciding upon the use of hormonal treatments for symptoms of menopause. This brief review focuses on the historical context of use of menopausal hormone treatments (MHT), summarizes results of major observational, primary and secondary prevention studies of MHT and cardiovascular (CV) outcomes, provides evidence for how sex steroids modulate CV function and identifies challenges for future research. As medicine enters an era of personalization of treatment options, additional research into sex differences in the aetiology of CV diseases will lead to better risk identification for CV disease in women and identify whether a woman might receive CV benefit from specific formulations and doses of MHT.
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Affiliation(s)
- Rabe E Alhurani
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A. Department of Neurology, Mayo Clinic, Rochester, MN 55905, U.S.A
| | - C Anwar A Chahal
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, U.S.A
| | - Ahmed T Ahmed
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A. Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, U.S.A
| | - Essa A Mohamed
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN, U.S.A. Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, U.S.A.
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46
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Bond V, Curry BH, Adams RG, Obisesan T, Pemminati S, Gorantla VR, Kadur K, Millis RM. Cardiovascular Responses to an Isometric Handgrip Exercise in Females with Prehypertension. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:243-9. [PMID: 27500128 PMCID: PMC4960933 DOI: 10.4103/1947-2714.185032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hypertensive individuals are known to exhibit greater increases in blood pressure during an isometric handgrip exercise (IHE) than their normotensive counterparts. AIM This study tests the hypothesis that, compared to normotensive individuals, prehypertensive individuals exhibit an exaggerated response to IHE. MATERIALS AND METHODS In this study, the effects of IHE were compared in matched prehypertensive vs. normotensive healthy African-American females. Six healthy young adult African-American female university students were screened in a physician's office for blood pressure in the range of prehypertension, systolic blood pressure (SBP) 120-139 mmHg and diastolic blood pressure (DBP) 80-89 mmHg. Six young adult African-American women were also recruited to serve as a healthy normotensive control group with SBP ≤119 mmHg and DBP ≤79 mmHg. Cardiovascular fitness was determined by peak oxygen uptake (VO2 peak) measured during a progressive exercise test. RESULTS During the handgrip exercise, the prehypertensive group exhibited greater increases in SBP (from 139 ± 6 to 205 ± 11 mmHg, +48%) than the controls (from 132 ± 3 to 145 ± 3 mmHg, +10%); intergroup difference P < 0.001. The prehypertensive group also exhibited greater increases in DBP (from 77 ± 2 to 112 ± 5 mmHg, +46%) compared to the controls (from 72 ± 3 to 78 ± 4 mmHg, +8%); intergroup difference P < 0.001. The increase in systemic vascular resistance was also greater in the prehypertensive group (from 1713 ± 91 to 2807 ± 370 dyne.s.cm(-5), +64%) than in the controls (from 1668 ± 80 to 1812 ± 169 dyne.s.cm(-5), +9%); intergroup difference P < 0.05. CONCLUSION These results suggest that blood pressure measurements performed during IHE may be a useful screening tool in evaluating prehypertensive individuals for antihypertensive treatments.
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Affiliation(s)
- Vernon Bond
- Department of Recreation, Human Performance and Leisure Studies and Exercise Science and Human Nutrition Laboratory, Howard University Cancer Centre, Washington DC, USA
| | - Bryan H. Curry
- Department of Medicine, Division of Cardiology, Howard College of Medicine and Howard University Hospital, Washington DC, USA
| | - Richard G. Adams
- Department of Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Thomas Obisesan
- Department of Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Sudhakar Pemminati
- Department of Medical Pharmacology, AUA College of Medicine, Antigua and Barbuda, and Manipal University, Manipal, Karnataka, India
| | - Vasavi R. Gorantla
- Department of Behavioural Sciences and Neuroscience, AUA College of Medicine, Antigua and Barbuda
| | - Kishan Kadur
- Department of Medical Physiology, AUA College of Medicine, Antigua and Barbuda
| | - Richard M. Millis
- Department of Medical Physiology, AUA College of Medicine, Antigua and Barbuda
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47
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Joyner MJ. Preclinical and clinical evaluation of autonomic function in humans. J Physiol 2016; 594:4009-13. [PMID: 27098282 DOI: 10.1113/jp271875] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/22/2016] [Indexed: 01/06/2023] Open
Abstract
This review focuses on how to assess autonomic function in humans including various ways to measure heart rate, catecholamines, and sympathetic neural activity. The need to assess autonomic function is paramount in many experimental paradigms because of the following. (1) Autonomic dysfunction is present in common diseases like hypertension, diabetes and heart failure, and the magnitude of this dysfunction is broadly related to morbidity and mortality in these disorders. (2) The relationship between autonomic dysfunction and morbidity and mortality can be causal. (3) Interventions that modulate or reverse autonomic dysfunction can improve outcomes in the affected patients. The techniques discussed are also frequently used to understand the autonomic response to sympathoexcitatory manoeuvres like exercise, the cold pressor test or mental stress. Because these manoeuvres can engage a variety of sensory and efferent pathways, under some circumstances the physiological responses measured by many of the techniques are directionally similar, in others they are divergent. Thus any investigator seeking to study the autonomic nervous system or its contribution to either normal physiology or pathophysiological conditions must carefully balance a number of considerations to ensure that the right technique is used to address the question of interest.
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Affiliation(s)
- Michael J Joyner
- Department of Anaesthesiology, Mayo Clinic, Rochester, MN, 55902, USA
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48
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Huang M, Allen DR, Keller DM, Fadel PJ, Frohman EM, Davis SL. Impaired carotid baroreflex control of arterial blood pressure in multiple sclerosis. J Neurophysiol 2016; 116:81-7. [PMID: 27075533 DOI: 10.1152/jn.00003.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/08/2016] [Indexed: 11/22/2022] Open
Abstract
Multiple sclerosis (MS), a progressive neurological disease, can lead to impairments in the autonomic control of cardiovascular function. We tested the hypothesis that individuals with relapsing-remitting MS (n = 10; 7 females, 3 males; 13 ± 4 yr from diagnosis) exhibit impaired carotid baroreflex control of blood pressure and heart rate compared with sex, age, and body weight-matched healthy individuals (CON: n = 10; 7 females, 3 males). At rest, 5-s trials of neck pressure (NP; +40 Torr) and neck suction (NS; -60 Torr) were applied to simulate carotid hypotension and hypertension, respectively, while mean arterial pressure (MAP; finger photoplethysmography), heart rate (HR), cardiac output (CO; Modelflow), and total vascular conductance (TVC) were continuously measured. In response to NP, there was a blunted increase in peak MAP responses (MS: 5 ± 2 mmHg) in individuals with MS compared with healthy controls (CON: 9 ± 3 mmHg; P = 0.005), whereas peak HR responses were not different between groups. At the peak MAP response to NP, individuals with MS demonstrated an attenuated decrease in TVC (MS, -10 ± 4% baseline vs. CON, -15 ± 4% baseline, P = 0.012), whereas changes in CO were similar between groups. Following NS, all cardiovascular responses (i.e., nadir MAP and HR and percent changes in CO and TVC) were not different between MS and CON groups. These data suggest that individuals with MS have impaired carotid baroreflex control of blood pressure via a blunted vascular conductance response resulting in a diminished ability to increase MAP in response to a hypotensive challenge.
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Affiliation(s)
- Mu Huang
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas
| | - Dustin R Allen
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas; Kinesiology, University of Texas at Arlington, Arlington, Texas; and
| | - David M Keller
- Kinesiology, University of Texas at Arlington, Arlington, Texas; and
| | - Paul J Fadel
- Kinesiology, University of Texas at Arlington, Arlington, Texas; and
| | - Elliot M Frohman
- Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott L Davis
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas; Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
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Miller VM, Jenkins GD, Biernacka JM, Heit JA, Huggins GS, Hodis HN, Budoff MJ, Lobo RA, Taylor HS, Manson JE, Black DM, Naftolin F, Harman SM, de Andrade M. Pharmacogenomics of estrogens on changes in carotid artery intima-medial thickness and coronary arterial calcification: Kronos Early Estrogen Prevention Study. Physiol Genomics 2015; 48:33-41. [PMID: 26508701 DOI: 10.1152/physiolgenomics.00029.2015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/26/2015] [Indexed: 01/27/2023] Open
Abstract
Prior to the initiation of menopausal hormone treatment (MHT), genetic variations in the innate immunity pathway were found to be associated with carotid artery intima-medial thickness (CIMT) and coronary arterial calcification (CAC) in women (n = 606) enrolled in the Kronos Early Estrogen Prevention Study (KEEPS). Whether MHT might affect these associations is unknown. The association of treatment outcomes with variation in the same 764 candidate genes was evaluated in the same KEEPS participants 4 yr after randomization to either oral conjugated equine estrogens (0.45 mg/day), transdermal 17β-estradiol (50 μg/day), each with progesterone (200 mg/day) for 12 days each month, or placebo pills and patch. Twenty SNPs within the innate immunity pathway most related with CIMT after 4 yr were not among those associated with CIMT prior to MHT. In 403 women who completed the study in their assigned treatment group, single nucleotide polymorphisms (SNPs) within the innate immunity pathway were found to alter the treatment effect on 4 yr change in CIMT (i.e., significant interaction between treatment and genetic variation in the innate immunity pathway; P < 0.001). No SNPs by treatment effects were observed with changes of CAC >5 Agatston units after 4 yr. Results of this study suggest that hormonal status may interact with genetic variants to influence cardiovascular phenotypes, specifically, the pharmacogenomic effects within the innate immunity pathway for CIMT.
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Affiliation(s)
- Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota;
| | - Gregory D Jenkins
- Department of Health Sciences Research (Divisions of Biomedical Statistics and Informatics and Epidemiology), Mayo Clinic, Rochester, Minnesota
| | - Joanna M Biernacka
- Department of Health Sciences Research (Divisions of Biomedical Statistics and Informatics and Epidemiology), Mayo Clinic, Rochester, Minnesota
| | - John A Heit
- Department of Internal Medicine (Division of Cardiovascular Diseases), Mayo Clinic, Rochester, Minnesota
| | - Gordon S Huggins
- MCRI Center for Translational Genomics, Molecular Cardiology Research Institute, Tufts, Medical Center, Boston, Massachusetts
| | - Howard N Hodis
- Atherosclerosis Research Unit, Departments of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Rogerio A Lobo
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hugh S Taylor
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | - JoAnn E Manson
- Department of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Frederick Naftolin
- Reproductive Biology Research, New York University School of Medicine, New York, New York; and
| | - S Mitchell Harman
- Kronos Longevity Research Institute and Phoenix VA Health Care System, Phoenix, Arizona
| | - Mariza de Andrade
- Department of Health Sciences Research (Divisions of Biomedical Statistics and Informatics and Epidemiology), Mayo Clinic, Rochester, Minnesota
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50
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Bain AR, Dujic Z, Hoiland RL, Barak OF, Madden D, Drvis I, Stembridge M, MacLeod DB, MacLeod DM, Ainslie PN. Peripheral chemoreflex inhibition with low-dose dopamine: new insight into mechanisms of extreme apnea. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1162-71. [PMID: 26290106 DOI: 10.1152/ajpregu.00271.2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/11/2015] [Indexed: 01/02/2023]
Abstract
The purpose of this study was to determine the impact of peripheral chemoreflex inhibition with low-dose dopamine on maximal apnea time, and the related hemodynamic and cerebrovascular responses in elite apnea divers. In a randomized order, participants performed a maximal apnea while receiving either intravenous 2 μg·kg(-1)·min(-1) dopamine or volume-matched saline (placebo). The chemoreflex and hemodynamic response to dopamine was also assessed during hypoxia [arterial O2 tension, (PaO2 ) ∼35 mmHg] and mild hypercapnia [arterial CO2 tension (PaCO2 ) ∼46 mmHg] that mimicked the latter parts of apnea. Outcome measures included apnea duration, arterial blood gases (radial), heart rate (HR, ECG), mean arterial pressure (MAP, intra-arterial), middle (MCAv) and posterior (PCAv) cerebral artery blood velocity (transcranial ultrasound), internal carotid (ICA) and vertebral (VA) artery blood flow (ultrasound), and the chemoreflex responses. Although dopamine depressed the ventilatory response by 27 ± 41% (vs. placebo; P = 0.01), the maximal apnea duration was increased by only 5 ± 8% (P = 0.02). The PaCO2 and PaO2 at apnea breakpoint were similar (P > 0.05). When compared with placebo, dopamine increased HR and decreased MAP during both apnea and chemoreflex test (P all <0.05). At rest, dopamine compared with placebo dilated the ICA (3.0 ± 4.1%, P = 0.05) and VA (6.6 ± 5.0%, P < 0.01). During apnea and chemoreflex test, conductance of the cerebral vessels (ICA, VA, MCAv, PCAv) was increased with dopamine; however, flow (ICA and VA) was similar. At least in elite apnea divers, the small increase in apnea time and similar PaO2 at breakpoint (∼31 mmHg) suggest the apnea breakpoint is more related to PaO2 , rather than peripheral chemoreflex drive to breathe.
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Affiliation(s)
- Anthony R Bain
- Center for Heart Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada;
| | - Zeljko Dujic
- School of Medicine, University of Split, Split, Croatia
| | - Ryan L Hoiland
- Center for Heart Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | - Otto F Barak
- School of Medicine, University of Split, Split, Croatia
| | - Dennis Madden
- School of Medicine, University of Split, Split, Croatia
| | - Ivan Drvis
- School of Kinesiology, University of Zagreb, Zagreb, Croatia
| | | | - David B MacLeod
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and
| | | | - Philip N Ainslie
- Center for Heart Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
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