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Böyük F, Çalışkan S, Demirkıran A. The Relationship Between the Frontal QRS-T Angle and High Blood Pressure Response to Exercise. ISTANBUL MEDICAL JOURNAL 2023. [DOI: 10.4274/imj.galenos.2023.70846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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Biffi A, Gallo G, Fernando F, Sirico F, Signorello MG, De Martino L, Manole GE, Palermi S, Volpe M. Relationship Between Cardiorespiratory Fitness, Baseline Blood Pressure and Hypertensive Response to Exercise in the Ferrari Corporate Population. High Blood Press Cardiovasc Prev 2021; 29:81-88. [PMID: 34822139 DOI: 10.1007/s40292-021-00491-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022] Open
Abstract
AIM To evaluate the incidence and clinical significance of impaired cardiorespiratory fitness (CRF) and the association with baseline blood pressure (BP) levels and hypertensive response to exercise (HRE). METHODS A cross-sectional study was conducted on a total sample of 2058 individuals with a mean age of 38 ± 9 years, enrolled for the first time at the Ferrari corporate wellness program "Formula Benessere", including a maximal exercise stress testing (EST). BP and heart rate (HR) values were obtained from EST at rest, during exercise and recovery time. CRF was arbitrarily classified according to estimated VO2 max in optimal, normal, mildly and moderately reduced. RESULTS One-hundred and thirty-nine individuals of 2058 (6.7%) showed a moderate CRF reduction assessed by EST. Subjects with elevated resting and/or exercise BP showed a worse CRF than those with normal BP levels, also after the adjustment for age, sex, body mass index, smoking habits, peak SBP and DBP. Seventy-seven individuals (3.7%) showed an HRE during EST, with normal baseline BP levels. CONCLUSION About 7% of a corporate population showed a significantly reduced CRF, assessed by EST. Individuals with lower levels of CRF have higher resting and/or peak exercising BP values after adjusting for co-variables. This study expands the role of EST outside of traditional ischemic CVD evaluation, towards the assessment of reduced CRF and HRE in the general population, as a possible not evaluated CV risk factor.
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Affiliation(s)
- Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Giovanna Gallo
- Cardiology Unit, Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Fredrick Fernando
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Felice Sirico
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | | | - Lorena De Martino
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - George Emil Manole
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Stefano Palermi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Massimo Volpe
- Cardiology Unit, Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Carneiro HA, Song RJ, Lee J, Schwartz B, Vasan RS, Xanthakis V. Association of Blood Pressure and Heart Rate Responses to Submaximal Exercise With Incident Heart Failure: The Framingham Heart Study. J Am Heart Assoc 2021; 10:e019460. [PMID: 33759543 PMCID: PMC8174367 DOI: 10.1161/jaha.120.019460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Exercise stress tests are conventionally performed to assess risk of coronary artery disease. Using the FHS (Framingham Heart Study) Offspring cohort, we related blood pressure (BP) and heart rate responses during and after submaximal exercise to the incidence of heart failure (HF). Methods and Results We evaluated Framingham Offspring Study participants (n=2066; mean age, 58 years; 53% women) who completed 2 stages of an exercise test (Bruce protocol) at their seventh examination (1998-2002). We measured pulse pressure, systolic BP, diastolic BP, and heart rate responses during stage 2 exercise (2.5 mph at 12% grade). We calculated the changes in systolic BP, diastolic BP, and heart rate from stage 2 to recovery 3 minutes after exercise. We used Cox proportional hazards regression to relate each standardized exercise variable (during stage 2, and at 3 minutes of recovery) individually to HF incidence, adjusting for standard risk factors. On follow-up (median, 16.8 years), 85 participants developed new-onset HF. Higher exercise diastolic BP was associated with higher HF with reduced ejection fraction (ejection fraction <50%) risk (hazard ratio [HR] per SD increment, 1.26; 95% CI, 1.01-1.59). Lower stage 2 pulse pressure and rapid postexercise recovery of heart rate and systolic BP were associated with higher HF with reduced ejection fraction risk (HR per SD increment, 0.73 [95% CI, 0.57-0.94]; 0.52 [95% CI, 0.35-0.76]; and 0.63 [95% CI, 0.47-0.84], respectively). BP and heart rate responses to submaximal exercise were not associated with risk of HF with preserved ejection fraction (ejection fraction ≥50%). Conclusions Accentuated diastolic BP during exercise with slower systolic BP and heart rate recovery after exercise are markers of HF with reduced ejection fraction risk.
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Affiliation(s)
- Herman A Carneiro
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Rebecca J Song
- Department of Epidemiology Boston University School of Public Health Boston MA
| | - Joowon Lee
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
| | - Brian Schwartz
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Ramachandran S Vasan
- Department of Epidemiology Boston University School of Public Health Boston MA.,Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston UniversityCenter for Computing and Data Sciences Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA
| | - Vanessa Xanthakis
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA.,Department of Biostatistics Boston University School of Public Health Boston MA
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Delgado-Floody P, Alvarez C, Caamaño-Navarrete F, Jerez-Mayorga D, Latorre-Román P. Influence of Mediterranean diet adherence, physical activity patterns, and weight status on cardiovascular response to cardiorespiratory fitness test in Chilean school children. Nutrition 2019; 71:110621. [PMID: 31874334 DOI: 10.1016/j.nut.2019.110621] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/27/2019] [Accepted: 10/06/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to determine the association between Mediterranean diet adherence, physical activity (PA) patterns (i.e., screen time and PA after school), and weight status with the cardiovascular response following a cardiorespiratory fitness test. METHODS Participants were 605 school children: 272 girls (11.79 ± 0.93 y old) and 333 boys (12.06 ± 1.03 y old). Body mass index, waist circumference (WC), food habits, and PA patterns were evaluated. Heart rate (HR), and systolic (SBP) and diastolic (DBP) blood pressures were assessed before and immediately after the 20-m shuttle run test and the changes induced were calculated (Δ = post/pretest). RESULTS The cardiovascular response was higher in obese than normal weight and overweight children in terms of HR (P = 0.007) and SBP (P < 0.001). The ΔSBP presented inverse association with WC (β = -0.09; 95% confidence interval [CI], -0.17 to -0.01; P = 0.026), food habits (β = -0.65; 95% CI, -0.81 to -0.49; P < 0.001), PA after school (β = -7.03; 95% CI, -7.84 to -6.22; P < 0.001) and PA patterns (β = -5.96; 95% CI, -6.40 to -5.52, P < 0.001). ΔDBP was not associated with food habits or PA patterns (P > 0.005). Finally, ΔHR reported inverse association with PA patterns (β = -1.67; 95% CI, -3.18 to -0.17; P = 0.029). CONCLUSION School children with obesity showed a higher cardiovascular response in HR and SBP than normal weight and overweight peers. Moreover, the increment of the SBP presented inverse association with food habits and PA patterns.
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Affiliation(s)
- Pedro Delgado-Floody
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco, Chile.
| | - Cristian Alvarez
- Quality of Life and Wellness Research Group, Department of Physical Activity Sciences, Unniverisidad de Los Lagos, Osorno, Chile
| | - Felipe Caamaño-Navarrete
- Physical Education Pedagogy, Faculty of Education, Universidad Católica de Temuco, Temuco, Chile
| | | | - Pedro Latorre-Román
- Department of Didactics of Corporal Expression, Universidad de Jaén, Jaén, Spain
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5
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Assessment of vascular inflammation and subclinical nephropathy in exaggerated blood pressure response to exercise test. Blood Press Monit 2019; 24:114-119. [DOI: 10.1097/mbp.0000000000000378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Keller K, Stelzer K, Ostad MA, Post F. Impact of exaggerated blood pressure response in normotensive individuals on future hypertension and prognosis: Systematic review according to PRISMA guideline. Adv Med Sci 2017; 62:317-329. [PMID: 28511070 DOI: 10.1016/j.advms.2016.11.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/09/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Arterial hypertension (aHT) is the leading risk factor for morbidity and mortality worldwide. Blood pressure (BP) deviation at rest is well defined and accompanies risk for cardiovascular events and cardiovascular mortality. A growing body of evidence emphasises that an exaggerated blood pressure response (EBPR) in cardiopulmonary exercise testing (CPET) could help to identify seemingly cardiovascular healthy and normotensive subjects, who have an increased risk of developing aHT and cardiovascular events in the future. MATERIALS AND METHODS The PubMed online database was searched for published studies reporting exercise-related BP and both the risk of aHT and cardiovascular events in the future. RESULTS We identified 18 original studies about EBPR in CPET, which included a total of 35,151 normotensive individuals for prediction of new onset of aHT in the future and 11 original studies with 43,012 enrolled subjects with the endpoint of cardiovascular events in the future. Although an EBPR under CPET is not well defined, a large number of studies emphasise that EBPR in CPET is associated with both new-onset aHT and cardiovascular events in the future. CONCLUSIONS A growing number of studies support the hypothesis that EBPR in CPET may be a diagnostic tool to identify subjects with an elevated risk of developing aHT and cardiovascular events in the future.
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Assessment of 25-OH vitamin D levels and abnormal blood pressure response in female patients with cardiac syndrome X. Anatol J Cardiol 2016; 16:961-966. [PMID: 27271477 PMCID: PMC5324918 DOI: 10.14744/anatoljcardiol.2016.6862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Vitamin D deficiency is associated with coronary artery disease, hypertension, heart failure, endothelial dysfunction, and metabolic syndrome. The pathophysiology of cardiac syndrome X (CSX) involves many pathways that are influenced by vitamin D levels. This study aimed to investigate the relationship between vitamin D deficiency and abnormal blood pressure response to exercise in patients with CSX. Methods: This was a cross-sectional and observational study. Fifty females with normal epicardial coronary arteries who presented with typical symptoms of rest or effort angina and 41 healthy age-matched female controls, were included. Patients with cardiomyopathy, severe valvular disease, congenital heart disease, and left ventricular hypertrophy were excluded. All patients underwent stress electrocardiography examination and 25-hydroxy (OH) vitamin D level measurements. Results: Levels of 25-OH vitamin D were significantly lower in CSX patients (9.8±7.3 ng/mL vs. 18.1±7.9 ng/mL; p<0.001). Systolic blood pressure (SBP) (188±15 mm Hg vs. 179±17 mm Hg; p=0.013) and diastolic blood pressure (DBP) (98±9 mm Hg vs. 88±9 mm Hg; p<0.001) during peak exercise were higher in CSX patients. Levels of 25-OH vitamin D were negatively correlated with peak SBP (r=–0.310, p=0.004) and peak DBP (r=–0.535, p<0.001) during exercise. To discard the multicollinearity problem, two different models were used for multivariate analyses. In the first model, metabolic equivalents (METs) (p=0.003) and 25-OH vitamin D levels (p=0.001) were independent predictors. METs (p=0.007), 25-OH vitamin D levels (p=0.008), and peak DBP were determined as independent predictors in the second multivariate model. Conclusion: In patients with CSX, 25-OH vitamin D levels were lower than those in controls; moreover, 25-OH vitamin D deficiency was also associated with higher levels of peak DBP during exercise. (Anatol J Cardiol 2016; 16: 961-6)
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Association between cardiorespiratory fitness and submaximal systolic blood pressure among young adult men: a reversed J-curve pattern relationship. J Hypertens 2016; 33:2239-44. [PMID: 26372317 DOI: 10.1097/hjh.0000000000000715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Exercise blood pressure is a marker of future cardiovascular morbidity and mortality among individuals with or without high resting BP or any other cardiovascular disease (CVD) signs and symptoms at present. The purpose of this study was to evaluate the association between SBP during submaximal exercise and cardiorespiratory fitness (CRF) among young men. Further, we investigated the trend displayed by submaximal SBP (SSBP) across different levels of CRF. METHODS Graded exercise test (GXT) using a Modified Bruce protocol was performed on 204 men; SSBP was recorded at each stage of the protocol. Quintiles of CRF were established on the basis of peak oxygen consumption (VO2), with the first quintile (Q) being the lowest fit group and fifth Q the most fit. RESULTS The mean VO2 peaks in Q 1 through 5 were 32.3, 39.1, 43.4, 48.1 and 55.5 ml/kg per min, respectively. In a model adjusted for age, race, body fat percentage, resting SBP, alcohol intake and smoking, the largest difference in SSBP was observed between men in Q 1 and 2, with 7.6 mmHg (P = 0.05), 9.4 mmHg (P = 0.02) and 9.5 mmHg (P = 0.04) lower SSBP at minutes 6, 8 and 10 of GXT, respectively. SSBP plateaus at Q 3, followed by an increase in the higher Qs, although still lower than Q1. CONCLUSION There was a reverse J-curve pattern relationship between SSBP and CRF, with the lowest SSBP among men with fair or good CRF and highest among those with poor CRF. VIDEO ABSTRACT http://links.lww.com/HJH/A538.
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Assessing cutoff values for increased exercise blood pressure to predict incident hypertension in a general population. J Hypertens 2016; 33:1386-93. [PMID: 25807218 DOI: 10.1097/hjh.0000000000000568] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Cutoff values for increased exercise blood pressure (BP) are not established in hypertension guidelines. The aim of the study was to assess optimal cutoff values for increased exercise BP to predict incident hypertension. METHODS Data of 661 normotensive participants (386 women) aged 25-77 years from the Study of Health in Pomerania (SHIP-1) with a 5-year follow-up were used. Exercise BP was measured at a submaximal level of 100 W and at maximum level of a symptom-limited cycle ergometry test. Cutoff values for increased exercise BP were defined at the maximum sum of sensitivity and specificity for the prediction of incident hypertension. The area under the receiver-operating characteristic curve (AUC) and net reclassification index (NRI) were calculated to investigate whether increased exercise BP adds predictive value for incident hypertension beyond established cardiovascular risk factors. RESULTS In men, values of 160 mmHg (100 W level; AUC = 0.7837; NRI = 0.534, P < 0.001) and 210 mmHg (maximum level; AUC = 0.7677; NRI = 0.340, P = 0.003) were detected as optimal cutoff values for the definition of increased exercise SBP. A value of 190 mmHg (AUC = 0.8347; NRI = 0.519, P < 0.001) showed relevance for the definition of increased exercise SBP in women at the maximum level. CONCLUSION According to our analyses, 190 and 210 mmHg are clinically relevant cutoff values for increased exercise SBP at the maximum exercise level of cycle ergometry test for women and men, respectively. In addition, for men, our analyses provided a cutoff value of 160 mmHg for increased exercise SBP at the 100 W level.
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Prasad VK, Drenowatz C, Hand GA, Lavie CJ, Sui X, Demello M, Blair SN. Cardiorespiratory Fitness, Body Fatness, and Submaximal Systolic Blood Pressure Among Young Adult Women. J Womens Health (Larchmt) 2015; 25:897-903. [PMID: 26625192 DOI: 10.1089/jwh.2015.5307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We examined the independent and combined associations of cardiorespiratory fitness (CRF), body fat (BF) percentage (BF%), and body mass index (BMI) with submaximal systolic blood pressure (SSBP) among young adult women. MATERIALS AND METHODS Analyses included a sample of 211 normotensive women with a BMI between 20 and 35 kg/m(2); BF% was calculated using total BF measured from dual X-ray absorptiometry, CRF was assessed using a graded exercise test, and SSBP was measured at each stage. RESULTS There was a significant direct association of SSBP with BF% and BMI, whereas an inverse association between SSBP and CRF when adjusted for the covariates. There was no significant association between SSBP and BF% across the stages 1-3 with a borderline significant association at stage 4 when further adjusted for CRF, whereas no association at any of the stages when adjusted for BMI. A borderline significant association between SSBP and BMI was found at stage 1 and significant association at stages 2-4 when additionally adjusted for CRF, whereas the association disappeared at stages 1-2 when adjusted for BF%. The inverse association between SSBP and CRF was eliminated at stages 3-4 when further adjusted for BF% with borderline significant association at stages 1-2. The associations remained significant at the stages 1-2 but not at stages 3-4 after adjusting for BMI. CONCLUSION CRF, BF%, and BMI seem to have critical roles in determining SSBP with CRF and BF% being more potent at lower intensity exercise, whereas BMI was more strongly associated at higher intensity exercise.
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Affiliation(s)
- Vivek Kumar Prasad
- 1 Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Clemens Drenowatz
- 1 Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Gregory A Hand
- 2 School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University , Morgantown, West Virginia
| | - Carl J Lavie
- 3 Ochner Clinical Sch-UQ School of Medicine , New Orleans, Louisiana
| | - Xuemei Sui
- 1 Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Madison Demello
- 1 Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Steven N Blair
- 1 Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,4 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
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Tzemos N, Lim PO, Mackenzie IS, MacDonald TM. Exaggerated Exercise Blood Pressure Response and Future Cardiovascular Disease. J Clin Hypertens (Greenwich) 2015; 17:837-844. [PMID: 26235814 PMCID: PMC8032021 DOI: 10.1111/jch.12629] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 01/03/2024]
Abstract
Exaggerated blood pressure (BP) response to exercise predicts future hypertension. However, there is considerable lack of understanding regarding the mechanism of how this abnormal response is generated, and how it relates to the future establishment of cardiovascular disease. The authors studied 82 healthy male volunteers without cardiovascular risk factors. The participants were categorized into two age-matched groups depending on their exercise systolic BP (ExSBP) rise after 3 minutes of exercise using a submaximal step test: exaggerated ExSBP group (hyper-responders [peak SBP ≥ 180 mm Hg]) and low ExSBP responder group (hypo-responders [peak SBP <180 mm Hg]). Forearm venous occlusion plethysmography and intra-arterial infusions of acetylcholine (ACh), N(G)-monomethyl-L-arginine (L-NMMA), sodium nitroprusside (SNP), and norepinephrine (NE) were used to assess vascular reactivity. Proximal aortic compliance was assessed with ultrasound, and neurohormonal blood sampling was performed at rest and during peak exercise. The hyper-responder group exhibited a significantly lower increase in forearm blood flow (FBF) with ACh compared with the hypo-responder group (ΔFBF 215% [14] vs 332.3% [28], mean [standard error of the mean]; P<.001), as well as decreased proximal aortic compliance. The vasoconstrictive response to L-NMMA was significantly impaired in the hyper-responder group in comparison to the hypo-responder group (ΔFBF -40.2% [1.6] vs -50.2% [2.6]; P<.05). In contrast, the vascular response to SNP and NE were comparable in both groups. Peak exercise plasma angiotensin II levels were significantly higher in the hyper-responder group (31 [1] vs 23 [2] pg/mL, P=.01). An exaggerated BP response to exercise is related to endothelial dysfunction, decreased proximal aortic compliance, and increased exercise-related neurohormonal activation, the constellation of which may explain future cardiovascular disease.
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Affiliation(s)
- Nikolaos Tzemos
- Institute of Cardiovascular and Medical SciencesBritish Heart FoundationGlasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Pitt O. Lim
- Hypertension Research CentreMedical Research InstituteNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Isla S. Mackenzie
- Hypertension Research CentreMedical Research InstituteNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Thomas M. MacDonald
- Hypertension Research CentreMedical Research InstituteNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
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Doumas M, Faselis C, Kokkinos P. Exaggerated Blood Pressure Response to Exercise: Will It Ever Be Ready for Prime Time? J Clin Hypertens (Greenwich) 2015; 17:845-7. [PMID: 26234157 DOI: 10.1111/jch.12630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Doumas
- Department of Veterans Affairs and George Washington University, Washington, DC
| | - Charles Faselis
- Department of Veterans Affairs and George Washington University, Washington, DC
| | - Peter Kokkinos
- Department of Veterans Affairs and George Washington University, Washington, DC
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Berger A, Grossman E, Katz M, Kivity S, Klempfner R, Segev S, Goldenberg I, Sidi Y, Maor E. Exercise blood pressure and the risk for future hypertension among normotensive middle-aged adults. J Am Heart Assoc 2015; 4:jah3935. [PMID: 25904593 PMCID: PMC4579952 DOI: 10.1161/jaha.114.001710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The aim of the present study was to examine whether exercise blood pressure can be used to predict the development of hypertension in normotensive middle‐aged adults. Methods and Results We investigated 7082 normotensive subjects who were annually screened in a tertiary medical center and completed maximal treadmill exercise tests at each visit. After the initial 3 years, subjects were divided into approximate quartiles according to their average exercise systolic and diastolic blood pressure responses (≤158; 158 to 170; 170 to 183; ≥183 mm Hg for systolic blood pressure and ≤73; 73 to 77; 77 to 82; ≥82 mm Hg for diastolic blood pressure). Mean age of the study population was 48±9 years and 73% were men. Average baseline resting blood pressure was 120/77±12/7 mm Hg. During a follow‐up of 5±3 years, 1036 (14.6%) subjects developed hypertension. The cumulative probability of new‐onset hypertension at 5 years was significantly increased with increasing quartiles of exercise systolic blood pressure (5%, 9%, 17%, and 35%, respectively; P<0.001), with a similar association shown for diastolic blood pressure. After adjustment for baseline resting blood pressure and clinical parameters, each 5‐mm Hg increments in exercise either systolic or diastolic blood pressures were independently associated with respective 11% (P<0.001) and 30% (P<0.001) increased risk for the development of hypertension. Conclusions In normotensive middle‐aged individuals, blood pressure response to exercise is associated with future development of hypertension.
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Affiliation(s)
- Assaf Berger
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.)
| | - Ehud Grossman
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel (E.G.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Moshe Katz
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.)
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel (S.K., Y.S.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Robert Klempfner
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel (S.S.)
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Yehezkel Sidi
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel (S.K., Y.S.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.) Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel (E.M.)
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Abstract
Irrespective of apparent 'normal' resting blood pressure (BP), some individuals may experience an excessive elevation in BP with exercise (i.e. systolic BP ≥210 mm Hg in men or ≥190 mm Hg in women or diastolic BP ≥110 mm Hg in men or women), a condition termed exercise hypertension or a 'hypertensive response to exercise' (HRE). An HRE is a relatively common condition that is identified during standard exercise stress testing; however, due to a lack of information with respect to the clinical ramifications of an HRE, little value is usually placed on such a finding. In this review, we discuss both the clinical importance and underlying physiological contributors of exercise hypertension. Indeed, an HRE is associated with an increased propensity for target organ damage and also predicts the future development of hypertension, cardiovascular events and mortality, independent of resting BP. Moreover, recent work has highlighted that some of the elevated cardiovascular risks associated with an HRE may be related to high-normal resting BP (pre-hypertension) or ambulatory 'masked' hypertension and that an HRE may be an early warning signal of abnormal BP control that is otherwise undetected with clinic BP. Whilst an HRE may be amenable to treatment via pharmacological and lifestyle interventions, the exact physiological mechanism of an HRE remains elusive, but it is likely a manifestation of multiple factors including large artery stiffness, increased peripheral resistance, neural circulatory control and metabolic irregularity. Future research focus may be directed towards determining threshold values to denote the increased risk associated with an HRE and further resolution of the underlying physiological factors involved in the pathogenesis of an HRE.
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Affiliation(s)
- Martin G Schultz
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tas., Australia
| | - James E Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tas., Australia
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Nary FC, Santos RD, Laurinavicius AG, Conceição RDDO, Carvalho JAMD. Relevance of prehypertension as a diagnostic category in asymptomatic adults. EINSTEIN-SAO PAULO 2014; 11:303-9. [PMID: 24136756 PMCID: PMC4878588 DOI: 10.1590/s1679-45082013000300008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/03/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the association of prehypertension with metabolic, inflammatory and cardiovascular risk profile in asymptomatic individuals. METHODS Between 2006 and 2009, 11,011 asymptomatic adults (mean age: 43 years; 22% females), underwent a check-up protocol. They were divided into 3 groups: normotensive group (arterial pressure=120/80mmHg), prehypertensive group (arterial pressure >120/80mmHg and <140/90mmHg) and hypertensive group (arterial pressure>140/90mmHg or prior diagnosis of hypertension). Each group metabolic and cardiovascular group profile was assessed. RESULTS The prevalence of normotension, prehypertension and hypertension was 27.9%, 53.9% and 18.2%, respectively. Prehypertensive individuals were older (mean age: 42.7 versus 40 years; p<0.001) than normotensive patients, and had higher body mass index (mean: 26.7kg/m² versus 24kg/m²; p<0.001), higher plasma triglycerides levels (mean: 139mg/dL versus 108mg/dL; p<0.001), higher LDL-choleterol levels (mean: 128mg/dL versus 117mg/dL; p<0.001), and lower HDL-cholesterol (mean: 46.7mg/dL versus 52.7mg/dL; p<0.001). Prehypertensive individuals were more likely to have impaired fasting glucose (OR: 1.69; 95%CI: 1.39-2.04), overweight and obesity - body mass index >25kg/m² (OR: 2.48; 95%CI: 2.24-2.74), hepatic steatosis: (OR: 2.23; 95%CI: 1.97-2.53), metabolic syndrome (OR: 3.05; 95%CI: 2.67-3.49), and high-sensitivity C-reactive protein levels>2mg/L (OR: 1.52; 95%CI: 1.35-1.71). CONCLUSION Prehypertension is associated with an increased prevalence of metabolic syndrome, hepatic steatosis and subclinical inflammation.
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Turmel J, Poirier P, Bougault V, Blouin E, Belzile M, Boulet LP. Cardiorespiratory screening in elite endurance sports athletes: the Quebec study. PHYSICIAN SPORTSMED 2012; 40:55-65. [PMID: 23528622 DOI: 10.3810/psm.2012.09.1982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiorespiratory disorders are common in athletes. However, these conditions are often underdiagnosed, which potentially results in impaired performance and increased health risks. The aim of this study was to evaluate, in a research setting, the prevalence of cardiorespiratory disorders in athletes in order to determine the potential value of a screening program. METHODS One hundred thirty-three athletes were studied. Each subject underwent a physical examination. A eucapnic voluntary hyperventilation (EVH) test and a methacholine inhalation test were performed to confirm the diagnosis of asthma. A cardiovascular evaluation was also performed, including maximal exercise test with electrocardiogram, 24-hour ambulatory blood pressure monitoring, 24-hour Holter monitoring, and blood sampling. RESULTS Seventy-four (56%) athletes had airway hyperresponsiveness to EVH or the methacholine inhalation test. Among those with airway hyperresponsiveness, 45 (61%) athletes were only hyperresponsive to EVH, and 10 (14%) were only hyperresponsive to the methacholine inhalation test (using the criteria of a PC20 ≤ 4 mg/mL). Thirty-two (24%) athletes had a known diagnosis of asthma, while 34 (26%) athletes received a new asthma diagnosis. Ninety-seven (73%) athletes were sensitized to common airborne allergens. Forty-seven (35%) athletes completed the cardiovascular evaluation. Three (6%) and 7 (15%) athletes had a previous or new diagnosis of cardiovascular disease, respectively. Resting systemic hypertension was documented in 2 (4%) athletes and exaggerated blood pressure response to exercise was found in 12 (26%) athletes. CONCLUSION This cardiorespiratory screening data set in athletes showed a high prevalence of exercise-induced asthma and exercise hypertension, which in many cases were not previously diagnosed.
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Affiliation(s)
- Julie Turmel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
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Thanassoulis G, Lyass A, Benjamin EJ, Larson MG, Vita JA, Levy D, Hamburg NM, Widlansky ME, O'Donnell CJ, Mitchell GF, Vasan RS. Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study. Circulation 2012; 125:2836-43. [PMID: 22572915 DOI: 10.1161/circulationaha.111.063933] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise blood pressure (BP) is an important marker of left ventricular hypertrophy, incident hypertension, and future cardiovascular events. Although impaired vascular function is hypothesized to influence the BP response during exercise, limited data exist on the association of vascular function with exercise BP in the community. METHODS AND RESULTS Framingham Offspring cohort participants (n=2115, 53% women, mean age 59 years) underwent a submaximal exercise test (first 2 stages of the Bruce protocol), applanation tonometry, and brachial artery flow-mediated dilation testing. We related exercise systolic and diastolic BP at second stage of the Bruce protocol to standard cardiovascular risk factors and to vascular function measures. In multivariable linear regression models, exercise systolic BP was positively related to age, standing BP, standing heart rate, smoking, body mass index, and the total cholesterol-to-high-density cholesterol ratio (P≤0.01 for all). Similar associations were observed for exercise diastolic BP. Carotid-femoral pulse wave velocity (P=0.02), central pulse pressure (P<0.0001), mean arterial pressure (P=0.04), and baseline brachial flow (P=0.002) were positively associated with exercise systolic BP, whereas flow-mediated dilation was negatively associated (P<0.001). For exercise diastolic BP, forward pressure wave amplitude was negatively related (P<0.0001), whereas mean arterial pressure was positively related (P<0.0001). CONCLUSIONS Increased arterial stiffness and impaired endothelial function are significant correlates of a higher exercise systolic BP response. Our findings suggest that impaired vascular function may contribute to exaggerated BP responses during daily living, resulting in repetitive increments in load on the heart and vessels and increased cardiovascular disease risk.
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Affiliation(s)
- George Thanassoulis
- National Institutes of Health/National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA 01702, USA
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Hemodynamic variables during exercise in childhood and resting systolic blood pressure levels 6 years later in adolescence: the European Youth Heart Study. J Hum Hypertens 2010; 25:608-14. [PMID: 21068765 DOI: 10.1038/jhh.2010.103] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to analyze whether systolic blood pressure (SBP), heart rate (HR) and rate pressure product (RPP) during exercise in childhood can predict resting SBP levels in adolescence independent of resting SBP and conventional cardiovascular risk factors. We studied this in a sample of Danish children followed longitudinally for 6 years. The study comprised 226 children randomly sampled at age 9, who had their blood pressure and HR measured during ergometer exercise to exhaustion and was reassessed in adolescence. SBP and RPP during exercise in stage two of the test were positively associated with future resting SBP, independent of resting SBP in childhood (P=0.045 and P=0.013, respectively). After additional adjustment for conventional cardiovascular risk factors the associations with SBP and RPP during stage two on future resting SBP only slightly materially change, although only RPP remained significant (P=0.059 and P=0.012, respectively). No significant independent associations were observed for HR during exercise, but associations were in the same direction. Our results supports that measuring SBP and RPP, during a standard acute ergometer exercise test in children, improves the prediction of future SBP levels during rest in adolescence independent of resting SBP and conventional cardiovascular risk factors.
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Electrocardiographic exercise stress testing: an update beyond the ST segment. Int J Cardiol 2006; 116:285-99. [PMID: 16837082 DOI: 10.1016/j.ijcard.2006.04.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 03/31/2006] [Accepted: 04/13/2006] [Indexed: 11/20/2022]
Abstract
Routine exercise testing is frequently ordered to evaluate a patient's cardiovascular performance. The test is more direct and less expensive than imaging technology, and derives valuable information. New variables such as dyspnea and heart rate recovery, as well as integrated scores, provide incremental value to conventional analysis of exercise-induced angina or electrocardiographic changes. Considerations relating to test accuracy in women need to be weighed. This paper seeks to make physicians aware of the current status of the test, and improve their understanding of and ability to integrate new variables and scores to more effectively manage their patients.
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