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Matthews EL, Guers JJ, Ramick MG, Hosick PA. Inverse Association between Exercising Blood Pressure Response and Left Ventricular Chamber Size and Mass in Women Who Habitually Resistance Train. Healthcare (Basel) 2024; 12:353. [PMID: 38338238 PMCID: PMC10855375 DOI: 10.3390/healthcare12030353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Exercise is a major modifiable lifestyle factor that leads to temporarily increased systolic blood pressure (SBP), which is thought to influence left ventricular mass normalized to body surface area (LVM/BSA). This relationship has never been studied in women who habitually perform resistance exercise. PURPOSE To determine if a direct correlation exists between the SBP response to resistance exercise (change from rest; eSBP) and LVM/BSA in young healthy women who habitually resistance train. METHODS Leg extension resistance exercise was performed while continuously monitoring blood pressure using finger plethysmography. LVM was estimated using echocardiography. Data are shown as mean ± SD. RESULTS Thirty-one women participated (age 23 ± 3 years, height 164 ± 7 cm, body mass 63.7 ± 10.3 kg). Resting SBP (110 ± 8 mmHg, r = 0.355, p = 0.049) was shown to be directly correlated to LVM/BSA (72.0 ± 28.4 g/m2). Conversely, eSBP (30.8 ± 14.6 ∆mmHg, r = -0.437, p = 0.014) was inversely related to LVM/BSA. eSBP was not correlated to interventricular septum width (0.88 ± 0.12 cm, r = -0.137, p = 0.463) or posterior wall thickness (0.91 ± 0.15 cm, r = -0.084, p = 0.654). eSBP was inversely related to left ventricle internal diameter during diastole (LVIDd) (4.25 ± 0.33 cm, r = -0.411, p = 0.021). CONCLUSION Counter to the hypothesis, these data suggest an inverse association between eSBP during resistance exercise and LVM/BSA in healthy young women who resistance train. This relationship is due to a smaller LVIDd with greater eSBP.
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Affiliation(s)
- Evan L. Matthews
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ 07043, USA;
| | - John J. Guers
- Department of Biology, Behavioral Neuroscience and Health Sciences, Rider University, Lawrenceville, NJ 08648, USA;
| | - Meghan G. Ramick
- Department of Kinesiology, West Chester University, West Chester, PA 19383, USA;
| | - Peter A. Hosick
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ 07043, USA;
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Vianna LC, Silva BM, Nóbrega ACL. Sex differences in blood pressure responses to mental stress are abolished after a single bout of exercise: underlying hemodynamic mechanisms. J Physiol Sci 2014; 64:213-9. [PMID: 24497232 PMCID: PMC10717600 DOI: 10.1007/s12576-014-0306-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
We aimed to investigate whether the pressor responses to mental stress (MS) are exaggerated in men due to heightened cardiac responses, before and after a bout of exercise. Fifteen men and 19 women underwent a protocol consisting of blood pressure (BP), cardiac output (CO) and forearm vascular assessments at baseline and during MS, and these measurements were performed before and 60 min after a bout of exercise. Before exercise, BP response was significantly augmented in men (Δ16 ± 2 mmHg) compared to women (Δ11 ± 1 mmHg). This BP response was accompanied by greater increases in CO in men and similar vascular responses between sexes. After exercise, BP and CO responses to MS were attenuated in men and, consequently, no sex differences were observed. Vascular responses were not affected by exercise. The mechanism underlying the lack of sex differences in BP response to MS after exercise was found to be a marked attenuation in CO in men only.
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Affiliation(s)
- Lauro C Vianna
- Department of Physiology and Pharmacology, Fluminense Federal University, Rua Prof. Hernani Pires de Melo 101/106, Niterói, Rio de Janeiro, 24210-130, Brazil,
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Geographic variation in left ventricular mass and mass index: a systematic review. J Hum Hypertens 2011; 26:420-9. [PMID: 21633379 DOI: 10.1038/jhh.2011.56] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Left ventricular (LV) hypertrophy, defined as an abnormal increase in LV mass (LVM), is an important prognostic indicator and therapeutic target. LVM is often divided by body surface area to derive indexed mass; however, this does not correctly identify pathological LV hypertrophy in all people, especially when body composition is altered, or in different ethnic groups. We evaluated published ranges of echocardiographic LVM in healthy adult populations from different countries, excluding control groups, and compared them with the American Society of Echocardiography reference ranges. A total of 33 studies met the inclusion criteria. In men and women, there was wide variation in the ranges of LVM with a tendency for the upper limit to increase geographically westward; this variation remained for indexed mass. Several ranges fell outside the upper reference limits: in men, 13 of the mass ranges and 16 of indexed mass; and in women, 8 mass and 16 indexed mass. This review has shown that current guidelines may need revision as some published series suggest that greater LV mass should be considered normal. This may be explained by ethnic differences and supports the need for widely applicable and ethnically diverse reference ranges to be established.
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Sandroni C, Fenici P, Cavallaro F, Bocci MG, Scapigliati A, Antonelli M. Haemodynamic effects of mental stress during cardiac arrest simulation testing on advanced life support courses. Resuscitation 2005; 66:39-44. [PMID: 15993728 DOI: 10.1016/j.resuscitation.2004.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Revised: 12/14/2004] [Accepted: 12/29/2004] [Indexed: 12/26/2022]
Abstract
UNLABELLED We investigated the haemodynamic response to the mental stress induced by being evaluated as a team leader in simulated advanced life support (ALS) scenarios. METHODS Healthcare providers participating as candidates to ALS courses were monitored while acting as team leaders in a cardiac arrest testing scenario (CASTest). Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before, during and after the CASTest. The correlation between the haemodynamic responses and sex, age, body mass index (BMI) and marks on course multiple choice questions (MCQs) were studied using multiple linear regression. RESULTS Eighty-eight subjects (46 women, 42 men, mean age 34.9+/-6.8 years) were enrolled. Mean HR, SBP and DBP increased significantly during the CASTest and reached a peak after a phase of the scenario which included an unsuccessful defibrillation. Ten minutes after the CASTest, HR, SBP and DBP were still significantly higher than their respective baseline values. A significant positive correlation was found between the DBP and SBP response during the scenario and the BMI, and between the DBP response and the candidates' age. The haemodynamic stress response was neither correlated with the candidates' marks in the course MCQ nor with their instructor potential (IP). CONCLUSION During the testing scenario the ALS candidates showed a significant haemodynamic response to mental stress, which depended mainly on their age and BMI rather than on their knowledge and skills.
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Affiliation(s)
- Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
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Martinez-Vea A, Bardaj A, Gutierrez C, Garca C, Peralta C, Marcas L, Oliver JA. Exercise blood pressure, cardiac structure, and diastolic function in young normotensive patients with polycystic kidney disease: a prehypertensive state. Am J Kidney Dis 2005; 44:216-23. [PMID: 15264179 DOI: 10.1053/j.ajkd.2004.04.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Increased left ventricular mass (LVM) and left ventricular hypertrophy have been found in early stages of autosomal dominant polycystic kidney disease (ADPKD). The mechanisms that lead to an increase in LVM in this population are unknown. The aim of this study is to evaluate blood pressure (BP) response to exercise and very early alterations in cardiac structure and diastolic function in young normotensive patients with ADPKD. METHODS Color Doppler echocardiography and exercise treadmill testing according to the Bruce protocol were performed in 18 young normotensive patients with ADPKD and 18 healthy subjects. RESULTS LVM index was greater and isovolumic relaxation time (IVRT) was longer in patients with ADPKD than controls (93.3 +/- 21.4 versus 77.5 +/- 18.6 g/m2; P = 0.02; 100 +/- 20.2 versus 80 +/- 9.7 milliseconds; P = 0.001, respectively). Exercise capacity in metabolic equivalents was similar in both groups. Systolic BP response during exercise and recovery were similar in both groups. Diastolic BP decreased during exercise, but the magnitude of decrease was lower in patients with ADPKD than controls (P = 0.01). During recovery, patients with ADPKD showed a greater sustained diastolic BP than controls (P = 0.02). Patients with ADPKD with an exaggerated systolic BP response had a greater LVM index than those with a normal response (112.1 +/- 10.4 versus 84 +/- 19.2 g/m2; P = 0.001). Multivariate regression analysis showed that exercise systolic BP and diastolic BP were independent predictors of LVM index and IVRT, respectively. CONCLUSION Young normotensive patients with ADPKD showed increased LVM index and prolonged IVRT, which are related to exercise BP response. Exaggerated diastolic BP response during exercise suggests an impaired capacity for exercise-induced vasodilatation and may indicate a greater risk for the development of future hypertension.
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Affiliation(s)
- Alberto Martinez-Vea
- Nephrology Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
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Taylor TR, Kamarck TW, Dianzumba S. Cardiovascular reactivity and left ventricular mass: An integrative review. Ann Behav Med 2003; 26:182-93. [PMID: 14644694 DOI: 10.1207/s15324796abm2603_03] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Left ventricular hypertrophy has been shown to be an independent predictor of risk for cardiovascular morbidity and mortality. Behavioral scientists have focused on how hemodynamic factors influenced by psychosocial stress may be associated with left ventricular mass (LVM). We reviewed existing studies examining stress-related cardiovascular reactivity (CVR) and LVM, with a goal of examining the moderating role of population (age and hypertensive status) and methodological factors (task type, sample size, and study design) explaining the observed results. Twenty-one studies met the criteria for this review. Results showed only a modestly consistent relationship between CVR and LVM. Forty-three percent of the studies reported 1 or more significant results linking systolic blood pressure reactivity with LVM, and 14% of the studies showed that diastolic blood pressure reactivity was significantly related to LVM. Hypertensive status, task type, and sample size did not play a major role in moderating the relationship between LVM and CVR. A somewhat larger percentage of positive results was shown in prospective and adult studies. The association between CVR and LVM may be real, although the effect size is modest, and we discuss methodological strategies for enhancing statistical power in future investigations. Additional sampling factors (e.g., race, gender) may also impact this relationship. Finally, greater attention is warranted to the role of the psychosocial environment, as this may interact with reactivity to influence LVM.
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Jokiniitty JM, Tuomisto MT, Majahalme SK, Kähönen MAP, Turjanmaa VMH. Pulse pressure responses to psychological tasks improve the prediction of left ventricular mass: 10 years of follow-up. J Hypertens 2003; 21:789-95. [PMID: 12658026 DOI: 10.1097/00004872-200304000-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the role of casual blood pressure measurements and blood pressure responses to psychological tasks in the prediction of future left ventricular mass index (LVMI), and to determine the importance of different components of blood pressure, and the predictive value of an individual's personal characteristics and antihypertensive medication on future LVMI. METHODS At baseline, blood pressure was recorded by casual measurements; during tests it was recorded by intra-arterial monitoring. The participants were healthy, untreated 35-45-year old men. Echocardiography data both at baseline and after 10 years of follow-up were available from 65 individuals, of whom 49 (75%) were not taking antihypertensive medication at follow-up. Those not taking antihypertensive medication were included in the prediction of LVMI (g/m2). RESULTS Baseline LVMI correlated significantly with future LVMI only among the 49 unmedicated individuals (r = 0.52, P < 0.0001). The predictive value of baseline LVMI on future LVMI among them (adjusted coefficient of determination = 0.26) was not improved by the inclusion of casual blood pressure. In contrast, blood pressure responses to the psychological tasks improved the prediction of future LVMI by 4-13%. Pulse pressure was the blood pressure variable that entered the final prediction models; the correlations with future LVMI were best for pulse pressure response to habituation task (r = 0.43, P < 0.05) and to relaxation (r = 0.37, P < 0.05). CONCLUSIONS To our knowledge, this is the longest prospective follow-up to show that blood pressure responses to psychological tasks improve the prediction of LVMI compared with casual blood pressure measurements. The pulse pressure, which reflects the properties of the arterial wall, is the most significant blood pressure variable in predicting future LVMI.
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Affiliation(s)
- Jaana M Jokiniitty
- Department of Clinical Physiology, Medical School, University of Tampere, Finland.
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Blumenthal JA, Sherwood A, Gullette ECD, Georgiades A, Tweedy D. Biobehavioral approaches to the treatment of essential hypertension. J Consult Clin Psychol 2002. [PMID: 12090370 DOI: 10.1037/0022-006x.70.3.569] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite recent advances in the medical management of hypertension, chronically elevated blood pressure remains a major health problem in the United States, affecting almost 50 million Americans. It is widely recognized that lifestyle factors contribute to the development and maintenance of elevated blood pressure. This article critically reviews current approaches to the nonpharmacological treatment of high blood pressure and highlights outcome studies of exercise, weight loss and dietary modification, and stress management and relaxation therapies. Methodological issues in the assessment and treatment of hypertension are discussed, along with possible mechanisms by which lifestyle modification may reduce elevated blood pressure.
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Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Sherwood A, Gullette ECD, Hinderliter AL, Georgiades A, Babyak M, Waugh RA, Blumenthal JA. Relationship of clinic, ambulatory, and laboratory stress blood pressure to left ventricular mass in overweight men and women with high blood pressure. Psychosom Med 2002; 64:247-57. [PMID: 11914440 DOI: 10.1097/00006842-200203000-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study was designed to evaluate the relationship between left ventricular (LV) mass and blood pressure (BP) recorded in the following contexts: in the clinic, using standard auscultatory procedures, during a typical day using ambulatory BP monitoring, and in the laboratory environment during behavioral stress testing. METHODS Ninety-seven men and women with clinic systolic blood pressure (SBP) of 130 to 180 mm Hg and/or diastolic blood pressure (DBP) of 85 to 110 mm Hg and mild to moderate obesity were included in the study. Laboratory stressors included the following tasks: Public Speaking; Anger Interview; Mirror Trace; and Cold Pressor. LV mass was measured using echocardiography and adjusted for body size by dividing by height(2.7) to yield LV mass index (LVMI). RESULTS LVMI was positively correlated with clinic SBP (r = 0.24, p <.05), ambulatory SBP (r = 0.34, p <.01), and aggregated laboratory stress SBP (r = 0.28, p <.01). Of the individual stressors, only SBP responses to the Mirror Trace and Cold Pressor tasks were independently correlated with LVMI (r = 0.35 and 0.34, respectively, p values <.01). Hierarchical regression analyses revealed that laboratory stress SBP remained a significant predictor of LVMI, after controlling for BMI and clinic pressure. CONCLUSIONS These findings suggest that cardiovascular responses to behavioral stress are associated with individual differences in LVMI in men and women with high blood pressure who are overweight. Laboratory studies of behavioral stress may help promote our understanding of the pathophysiology of LVH.
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Affiliation(s)
- Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Lim PO, Donnan PT, MacDonald TM. Blood pressure determinants of left ventricular wall thickness and mass index in hypertension: comparing office, ambulatory and exercise blood pressures. J Hum Hypertens 2001; 15:627-33. [PMID: 11550109 DOI: 10.1038/sj.jhh.1001229] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2000] [Revised: 03/15/2001] [Accepted: 03/15/2001] [Indexed: 11/08/2022]
Abstract
Left ventricular (LV) mass relates positively and continuously to cardiac mortality and thus its regression is a rational therapeutic aim. Whilst the office blood pressure (BP) relates poorly to LV mass, it was unclear whether the 24-h ambulatory BP or the exercise systolic BP (ExSBP) was the stronger correlate of LV structural indices. We studied 49 hypertensive patients with a mean age of 45 (s.d. 12) years with a mean body mass index of 27.1(3.9) kg/m(2). The mean (s.d.) of office BP, ambulatory BP and ExSBP measured at the end of the first three stages of Bruce protocol treadmill exercise I, II and III were 161(20)/99(10), 140(13)/89(10), 190(30), 198(30) and 201(33) mm Hg respectively. The LV indices measured echocardiographically were LV septal thickness (IVSd) (1.1(0.2) cm), LV posterior wall thickness (LVPWd) (1.0(0.1) cm) and LV mass indexed to body surface area (LVMI) (123(30) g/m(2)). Age and gender (male) had the highest correlations with the LV indices. Of the BP measures, the stage II ExSBP's correlation with the LV indices was consistently higher than all other ExSBP, office systolic BP and 24-h systolic ambulatory BP. In a stepwise multiple regression analysis on IVSd, after adjusting for age and gender, the stage II ExSBP was independently associated with IVSd (beta= 0.018 (s.e. 0.008), P = 0.024). When only BP measures were considered as explanatory variables only stage II ExSBP was a significant predictor (P = 0.0001) of IVSd as was the case with LVPWd (P = 0.006) and LVMI (P = 0.0008). Submaximal exercise BP measured at a workload comparable to physical activity encountered in daily life correlated more closely with the left ventricular wall thickness and mass. The exercise BP should perhaps be normalised in hypertension management to optimise regression of LV hypertrophy.
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Affiliation(s)
- P O Lim
- Hypertension Research Centre, Department of Clinical Pharmacology and Therapeutics, and Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
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