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Edwards JJ, Coleman DA, Ritti-Dias RM, Farah BQ, Stensel DJ, Lucas SJE, Millar PJ, Gordon BDH, Cornelissen V, Smart NA, Carlson DJ, McGowan C, Swaine I, Pescatello LS, Howden R, Bruce-Low S, Farmer CKT, Leeson P, Sharma R, O'Driscoll JM. Isometric Exercise Training and Arterial Hypertension: An Updated Review. Sports Med 2024; 54:1459-1497. [PMID: 38762832 PMCID: PMC11239608 DOI: 10.1007/s40279-024-02036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/20/2024]
Abstract
Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Damian A Coleman
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Raphael M Ritti-Dias
- Graduate Program in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
| | - Breno Q Farah
- Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Sam J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Philip J Millar
- Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, ON, Canada
| | - Ben D H Gordon
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Debra J Carlson
- School of Health, Medical and Applied Sciences, CQ University, North Rockhampton, QLD, Australia
| | - Cheri McGowan
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Ian Swaine
- Sport Science, University of Greenwich, London, UK
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, 06269, USA
| | - Reuben Howden
- Department of Applied Physiology, Health and Clinical Sciences, UNC Charlotte, Charlotte, NC, 28223, USA
| | - Stewart Bruce-Low
- Department of Applied Sport and Exercise Science, University of East London, London, UK
| | | | - Paul Leeson
- Oxford Clinical Cardiovascular Research Facility, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Rajan Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK.
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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Filchenko I, Mürner N, Dekkers MPJ, Baillieul S, Duss SB, Brill AK, Horvath T, Heldner MR, Rexhaj E, Bernasconi C, Bassetti CLA, Schmidt MH. Blood pressure variability, nocturnal heart rate variability and endothelial function predict recurrent cerebro-cardiovascular events following ischemic stroke. Front Cardiovasc Med 2023; 10:1288109. [PMID: 38034378 PMCID: PMC10687449 DOI: 10.3389/fcvm.2023.1288109] [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: 09/03/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Cardiovascular parameters characterizing blood pressure (BP), heart rate (HR), endothelial function and arterial stiffness predict cerebro-cardiovascular events (CCVE) in the general population. Considering the paucity of data in stroke patients, we assessed these parameters as potential predictors of recurrent CCVE at acute stroke stroke. Patients and methods This is a secondary outcome analysis of a prospective observational longitudinal Sleep Deficiency & Stroke Outcome Study (ClinicalTrials.gov Identifier: NCT02559739). The study consecutively recruited acute ischemic stroke patients. Cardiovascular parameters (blood pressure variability [BPV], heart rate variability [HRV], endothelial function, and arterial stiffness) were assessed within the first week post-stroke. Future CCVE were recorded over a 3-year follow-up. Multivariate Cox regression analysis was used to investigate the prognostic value of 48 cardiovascular parameters regarding CCVE risk. Results Out of 447 recruited patients, 359 were included in this analysis. 20% of patients developed a future CCVE. A high variability of systolic BP (n = 333) and nocturnal HR (non-linear parameters; n = 187) at acute stroke predicted CCVE risk after adjustment for demographic parameters, cardiovascular risk factors and mean BP or HR, respectively. Endothelial dysfunction (n = 105) at acute stroke predicted CCVE risk after adjustment for age and sex, but not after adjustment for cardiovascular risk factors. Diurnal HR and arterial stiffness at acute stroke were not associated with CCVE risk. Conclusion High blood pressure variability, high nocturnal HRV and endothelial function contribute to the risk for future CCVE after stroke.
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Affiliation(s)
- Irina Filchenko
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Nicolas Mürner
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martijn P. J. Dekkers
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastien Baillieul
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Simone B. Duss
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne-Kathrin Brill
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Horvath
- Stroke Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Stroke Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corrado Bernasconi
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudio L. A. Bassetti
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus H. Schmidt
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Ohio Sleep Medicine Institute, Dublin, OH, United States
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Echocardiographic Evaluation of the Cardiac Chambers in Asthmatic Patients: The BADA (Blood Pressure Levels, Clinical Features and Markers of Subclinical Cardiovascular Damage of Asthma Patients) Study-ECO. J Pers Med 2022; 12:jpm12111847. [PMID: 36579553 PMCID: PMC9694451 DOI: 10.3390/jpm12111847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
The "Blood pressure levels, clinical features and markers of subclinical cardiovascular Damage of Asthma patients" (BADA) study is aimed at defining the cardiovascular risk profile and the markers of subclinical and clinical vascular and cardiac damage in asthmatic patients. Very few studies have assessed asthmatic patients without concomitant heart disease through a transthoracic echocardiogram. The goal of the present study is to investigate the prevalence of morphology and/or function changes in the cardiac chambers of a sample of 86 patients with chronic asthma, referred to the dedicated outpatient unit of the Division of Respiratory Diseases of the AOUP "P. Giaccone" of the University of Palermo, and the results obtained were compared with those of a control group without respiratory or cardiovascular diseases. Patients with asthma showed a marked and widespread involvement of the four cardiac chambers compared with the controls: enlargement of the two atria, greater left ventricular remodeling with interventricular septal thickening, increased indexed left ventricular mass with a significantly greater percentage of patients with overt left ventricular hypertrophy, worse left ventricular diastolic function proven by the significant difference in the E/A ratio, and worse right ventricular systolic function with global right ventricular dysfunction estimated by the Myocardial Performance Index (Tei Index). Multivariate regression analysis, after adjustment for essential hypertension, hypertension severity, diabetes, Body Mass Index, and creatinine clearance, seems to indicate that the indexed left ventricular mass, right atrial volume, and right ventricular Tei index (but not left ventricular hypertrophy) correlate significantly with asthma, severe asthma, and FEV1 (and to a lesser extent with asthma duration). No correlation is apparent between inhaled therapy (ICS, SABA) and myocardial involvement. These results seem to confirm that a more in-depth cardiovascular evaluation in patients with chronic respiratory disease allows the identification of unrecognized cardiovascular involvement. A transthoracic echocardiogram performed in asthmatic patients without clinically overt signs or symptoms of cardiovascular impairment has identified some features indicative of an early subclinical cardiac impairment not found in the control group. These findings, considering also the higher frequency of hypertension in the asthma group, deserve further validation in the future.
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Di Raimondo D, Musiari G, Casuccio A, Colomba D, Rizzo G, Pirera E, Pinto A, Tuttolomondo A. Cardiac Remodeling According to the Nocturnal Fall of Blood Pressure in Hypertensive Subjects: The Whole Assessment of Cardiac Abnormalities in Non-Dipper Subjects with Arterial Hypertension (Wacanda) Study. J Pers Med 2021; 11:jpm11121371. [PMID: 34945843 PMCID: PMC8704210 DOI: 10.3390/jpm11121371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 01/31/2023] Open
Abstract
Objective: Several epidemiological studies suggest that the preservation of the physiological circadian rhythm of blood pressure or its disruption affects the extent of the organ damage developed by the patient. If we classify the circadian rhythm of blood pressure into four nocturnal profiles, significant differences emerge in terms of organ damage burden and prognosis: reverse dippers have the worst prognosis while dippers and mild dippers fall into an intermediate risk range. The risk profile of extreme dippers is still debated, and the available data are very conflicting and inconclusive. Starting from this gap of knowledge, we aimed to evaluate, retrospectively, in a cohort of hypertensive subjects, the degree of cardiac involvement in relation to the different nocturnal blood pressure profiles. Methods: We retrospectively evaluated 900 patients with essential hypertension, of whom 510 met our study criteria. We graded the 510 patients in relation to the percentage of reduction in mean systolic blood pressure (SBP) at night-time compared with day-time, considering this as a continuous variable, and then compared the extreme quintiles with each other and with the middle quintile (considered as reference). Results: Patients with less (or no) reduction in nocturnal SBP (reverse dipper) showed a higher level of organ damage and comorbidities. With regard to echocardiographic indexes, patients with maximum nocturnal pressure reduction (extreme dipper) showed a lower level of remodeling and/or impairment of E/e’ ratio, Right Atrium Area, Basal Right Ventricular Diameter, Inferior Vena Cava Average Diameter, and Tricuspidal Anular Plane Systolic Excursion compared also with hypertensive patients with a physiological nocturnal pressure reduction, even after correction for the main confounders. Conclusions: These data suggest that extreme dippers may constitute the subgroup of hypertensive patients with the lowest 24-h pressure load and, therefore, less cardiac remodeling.
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Anderson DE, Reeves AN, Mehling WE, Chesney MA. Capnometric feedback training decreases 24-h blood pressure in hypertensive postmenopausal women. BMC Cardiovasc Disord 2021; 21:447. [PMID: 34535068 PMCID: PMC8447506 DOI: 10.1186/s12872-021-02240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High normal resting pCO2 is a risk factor for salt sensitivity of blood pressure (BP) in normotensive humans and has been associated with higher resting systolic BP in postmenopausal women. To date, however, no known studies have investigated the effects of regular practice of voluntary mild hypocapnic breathing on BP in hypertensive patients. The objective of the present research was to test the hypothesis that capnometric feedback training can decrease both resting pCO2 and 24-h BP in a series of mildly hypertensive postmenopausal women. METHODS A small portable end tidal CO2 (etCO2) monitor was constructed and equipped with software that determined the difference between the momentary etCO2 and a pre-programmed criterion range. The monitor enabled auditory feedback for variations in CO2 outside the criterion range. 16 mildly hypertensive postmenopausal women were individually trained to sustain small decreases in etCO2 during six weekly sessions in the clinic and daily sessions at home. 24-h BP monitoring was conducted before and after the intervention, and in 16 prehypertensive postmenopausal women in a control group who did not engage in the capnometric training. RESULTS Following the intervention, all 16 capnometric training participants showed decreases in resting etCO2 (- 4.3 ± 0.4 mmHg; p < .01) while 15 showed decreases in 24-h systolic BP (- 7.6 ± 2.0 mmHg; p < .01). No significant changes in either measure was observed in the control group. In addition, nighttime (- 9.5 ± 2.6; p < .01) and daytime (- 6.7 ± 0.2 mmHg) systolic BP were both decreased following capnometric training, while no significant changes in nighttime (- 2.8 ± 2.2 mmHg; p = .11) or daytime (- 0.7 ± 1.0 mmHg; p ≤ .247) systolic BP were observed in the control group. CONCLUSIONS These findings support the hypothesis that regular practice of mild hypocapnic breathing that decreases resting etCO2 reliably decreases 24-h blood pressure in hypertensive postmenopausal women. The extent to which these effects persist beyond the training period or can be observed in other hypertensive subgroups remains to be investigated.
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Affiliation(s)
- David E Anderson
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, 415-613-7343, USA
| | - Alexis N Reeves
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, 415-613-7343, USA
| | - Wolf E Mehling
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Margaret A Chesney
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, 415-613-7343, USA.
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Zhong L, Deng W, Zheng W, Yu S, Huang X, Wen Y, Chiu PCN, Lee CL. The relationship between circadian blood pressure variability and maternal/perinatal outcomes in women with preeclampsia with severe features. Hypertens Pregnancy 2020; 39:405-410. [PMID: 32744911 DOI: 10.1080/10641955.2020.1797777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether circadian blood pressure (BP) variation of women with preeclampsia (PE) with severe features was associated with adverse maternal/perinatal outcomes. METHODS 173 women with PE with severe features were recruitedand categorized into three groups: dipper, non-dipper and reverse dipper type BP group.. Maternal and perinatal outcomes were compared among groups. RESULTS There were significant differences in gestational ages, premature delivery, retinopathy, HELLP syndrome, mean birth weight, rate of low birth weight infants and fetal growth restriction. CONCLUSION Aberrant circadian pattern of BP in women with PE with severe features was associated with several adverse maternal/perinatal outcomes.
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Affiliation(s)
- Liuying Zhong
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Wenfeng Deng
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Weihan Zheng
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Shuting Yu
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Xiaosi Huang
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Yaohong Wen
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Philip C N Chiu
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong , Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital , Guangdong, P.R. China
| | - Cheuk-Lun Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong , Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital , Guangdong, P.R. China
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Di Raimondo D, Musiari G, Benfante A, Battaglia S, Rizzo G, Tuttolomondo A, Scichilone N, Pinto A. Prevalence of Arterial Hypertension and Characteristics of Nocturnal Blood Pressure Profile of Asthma Patients According to Therapy and Severity of the Disease: The BADA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186925. [PMID: 32971927 PMCID: PMC7557609 DOI: 10.3390/ijerph17186925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects. METHODS The BADA (blood pressure levels, clinical features and markers of subclinical cardiovascular damage of asthma patients) study is aimed to evaluate the prevalence of the cardiovascular comorbidities of asthma and their impact on the clinical outcome. The main exclusion criteria were the presence of other respiratory diseases, current smoking, any contraindication to ambulatory blood pressure monitoring (ABPM). RESULTS The overall percentage of asthmatics having also hypertension was 75% (30 patients) vs. 45% (18 patients) of the control group (p: 0.012). Reduced level of FEV1 (but not inhaled steroid therapy) was associated to newly-diagnosed hypertension (p: 0.0002), higher day SBP levels (p: 0.003), higher day DBP levels (p: 0.03), higher 24 h-SBP levels (p: 0.005) and higher 24h-DBP levels (p: 0.03). The regression analysis performed taking into account sex, age, diabetes, fasting glucose, and body mass index confirms the independent role played by asthma: odds ratio (OR): 3.66 (CI: 1.29-11.1). CONCLUSIONS hypertension is highly prevalent in asthma; the use of ABPM has allowed the detection of a considerable number of unrecognized hypertensives.
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Affiliation(s)
- Domenico Di Raimondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
- Correspondence: ; Tel.: +39-091-655-2180
| | - Gaia Musiari
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Giuliana Rizzo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
| | - Antonino Tuttolomondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Antonio Pinto
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
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Di Raimondo D, Musiari G, Pinto A. Nocturnal blood pressure patterns and cardiac damage: there is still much to learn. Hypertens Res 2019; 43:246-248. [PMID: 31831885 DOI: 10.1038/s41440-019-0372-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Domenico Di Raimondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
| | - Gaia Musiari
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Antonio Pinto
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
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Selective ablation of TRPV1 by intrathecal injection of resiniferatoxin in rats increases renal sympathoexcitatory responses and salt sensitivity. Hypertens Res 2018; 41:679-690. [PMID: 30006640 DOI: 10.1038/s41440-018-0073-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 01/28/2023]
Abstract
This study tested the hypothesis that selective ablation of transient receptor potential vanilloid type 1 (TRPV1)-positive nerve fibers by intrathecal injection of resiniferatoxin (RTX) enhances renal sympathoexcitatory responses and salt sensitivity. Intrathecal injection of RTX (1.8 μg/kg) to the levels of lower thoracic and upper lumbar spinal cord (T8-L3) increased mean arterial pressure (MAP) in rats fed a normal (NS, 1% NaCl) or high-sodium (HS, 8% NaCl) diet for 4 weeks compared to vehicle-treated rats (NS: 121 ± 2 vs. 111 ± 2; HS: 154 ± 2 vs. 134 ± 2 mm Hg, both P < 0.05), with a greater increase in HS compared to NS rats (9 ± 1% vs. 15 ± 1%, P < 0.05). TRPV1 contents were decreased in T8-L3 segments of spinal dorsal horn but not in corresponding dorsal root ganglia and the kidney following RTX treatment (P < 0.05). Selective activation of GABA-A receptors with intrathecal T8-L3 segment-injection of muscimol (3 nmol/kg) decreased renal sympathetic nerve activity and increased urinary excretion in both NS and HS rats, with a greater effect in RTX-treated compared to vehicle-treated rats (P < 0.05). Chronic activation of GABA-A receptors with muscimol (50 mg/kg/day × 2, p.o.) abolished RTX treatment-induced pressor effects in NS and HS rats. GAD65/67, a GABA synthetase, in the spinal cord was downregulated and tyrosine hydroxylase in the kidney upregulated in NS or HS rats treated with RTX (P < 0.05). Thus, selective ablation of TRPV1-positive central terminals of sensory neurons plays a prohypertensive role possibly via inhibition of spinal GABA system especially with HS intake, suggesting that activation of TRPV1 in central terminals of sensory neurons may convey an antihypertensive effect.
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Di Raimondo D, Miceli G, Musiari G, Tuttolomondo A, Pinto A. New insights about the putative role of myokines in the context of cardiac rehabilitation and secondary cardiovascular prevention. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:300. [PMID: 28856140 DOI: 10.21037/atm.2017.07.30] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Exercise training prevents the onset and the development of many chronic diseases, acting as an effective tool both for primary and for secondary prevention. Various mechanisms that may be the effectors of these beneficial effects have been proposed during the past decades: some of these are well recognized, others less. Muscular myokines, released during and after muscular contraction, have been proposed as key mediators of the systemic effects of the exercise. Nevertheless the availability of an impressive amount of evidence regarding the systemic effects of muscle-derived factors, few studies have examined key issues: (I) if skeletal muscle cells themselves are the main source of cytokine during exercise; (II) if the release of myokines into the systemic circulation reach an adequate concentration to provide significant effects in tissues far from skeletal muscle; (III) what may be the role carried out by muscular cytokine regarding the well-known benefits induced by regular exercise, first of all the anti-inflammatory effect of exercise. Furthermore, a greater part of our knowledge regarding myokines derives from the muscle of healthy subjects. This knowledge may not necessarily be transferred per se to subjects with chronic diseases implicating a direct or indirect muscular dysfunction and/or a chronic state of inflammation with persistent immune-inflammatory activation (and therefore increased circulating levels of some cytokines): cachexia, sarcopenia due to multiple factors, disability caused by neurological damage, chronic congestive heart failure (CHF) or coronary artery disease (CAD). A key point of future studies is to ascertain how is modified the muscular release of myokines in different categories of unhealthy subjects, both at baseline and after rehabilitation. The purpose of this review is to discuss the main findings on the role of myokines as putative mediators of the therapeutic benefits obtained through regular exercise in the context of secondary cardiovascular prevention.
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Affiliation(s)
- Domenico Di Raimondo
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Giuseppe Miceli
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Gaia Musiari
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Antonino Tuttolomondo
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Antonio Pinto
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
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McMahon A, McNulty H, Hughes CF, Strain JJ, Ward M. Novel Approaches to Investigate One-Carbon Metabolism and Related B-Vitamins in Blood Pressure. Nutrients 2016; 8:E720. [PMID: 27845713 PMCID: PMC5133106 DOI: 10.3390/nu8110720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023] Open
Abstract
Hypertension, a major risk factor for heart disease and stroke, is the world's leading cause of preventable, premature death. A common polymorphism (677C→T) in the gene encoding the folate metabolizing enzyme methylenetetrahydrofolate reductase (MTHFR) is associated with increased blood pressure, and there is accumulating evidence demonstrating that this phenotype can be modulated, specifically in individuals with the MTHFR 677TT genotype, by the B-vitamin riboflavin, an essential co-factor for MTHFR. The underlying mechanism that links this polymorphism, and the related gene-nutrient interaction, with hypertension is currently unknown. Previous research has shown that 5-methyltetrahydrofolate, the product of the reaction catalysed by MTHFR, appears to be a positive allosteric modulator of endothelial nitric oxide synthase (eNOS) and may thus increase the production of nitric oxide, a potent vasodilator. Blood pressure follows a circadian pattern, peaking shortly after wakening and falling during the night, a phenomenon known as 'dipping'. Any deviation from this pattern, which can only be identified using ambulatory blood pressure monitoring (ABPM), has been associated with increased cardiovascular disease (CVD) risk. This review will consider the evidence linking this polymorphism and novel gene-nutrient interaction with hypertension and the potential mechanisms that might be involved. The role of ABPM in B-vitamin research and in nutrition research generally will also be reviewed.
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Affiliation(s)
- Amy McMahon
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine BT52 1SA, UK.
| | - Helene McNulty
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine BT52 1SA, UK.
| | - Catherine F Hughes
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine BT52 1SA, UK.
| | - J J Strain
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine BT52 1SA, UK.
| | - Mary Ward
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine BT52 1SA, UK.
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Santilli F, Simeone P, D'Ardes D, Davì G. The deadly line linking sympathetic overdrive, dipping status and vascular risk: critical appraisal and therapeutic implications. Hypertens Res 2016; 39:404-6. [PMID: 26984299 DOI: 10.1038/hr.2016.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Francesca Santilli
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
| | - Paola Simeone
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
| | - Damiano D'Ardes
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
| | - Giovanni Davì
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
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