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Mizuno M, Hotta N, Ishizawa R, Kim HK, Iwamoto G, Vongpatanasin W, Mitchell JH, Smith SA. The Impact of Insulin Resistance on Cardiovascular Control During Exercise in Diabetes. Exerc Sport Sci Rev 2021; 49:157-167. [PMID: 33965976 PMCID: PMC8195845 DOI: 10.1249/jes.0000000000000259] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Patients with diabetes display heightened blood pressure response to exercise, but the underlying mechanism remains to be elucidated. There is no direct evidence that insulin resistance (hyperinsulinemia or hyperglycemia) impacts neural cardiovascular control during exercise. We propose a novel paradigm in which hyperinsulinemia or hyperglycemia significantly influences neural regulatory pathways controlling the circulation during exercise in diabetes.
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Affiliation(s)
- Masaki Mizuno
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Norio Hotta
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
- College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Rie Ishizawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Han-Kyul Kim
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Gary Iwamoto
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Jere H. Mitchell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Scott A. Smith
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
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Ishizawa R, Kim HK, Hotta N, Iwamoto GA, Mitchell JH, Smith SA, Vongpatanasin W, Mizuno M. TRPV1 (Transient Receptor Potential Vanilloid 1) Sensitization of Skeletal Muscle Afferents in Type 2 Diabetic Rats With Hyperglycemia. Hypertension 2021; 77:1360-1371. [PMID: 33641357 DOI: 10.1161/hypertensionaha.120.15672] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Rie Ishizawa
- From the Departments of Applied Clinical Research (R.I., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas
| | - Han-Kyul Kim
- Internal Medicine (H.-K.K., J.H.M., S.A.S., W.V., M.M.), University of Texas Southwestern Medical Center, Dallas
| | - Norio Hotta
- College of Life and Health Sciences, Chubu University, Kasugai, Japan (N.H.)
| | - Gary A Iwamoto
- Cell Biology (G.A.I.), University of Texas Southwestern Medical Center, Dallas
| | - Jere H Mitchell
- Internal Medicine (H.-K.K., J.H.M., S.A.S., W.V., M.M.), University of Texas Southwestern Medical Center, Dallas
| | - Scott A Smith
- From the Departments of Applied Clinical Research (R.I., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas.,Internal Medicine (H.-K.K., J.H.M., S.A.S., W.V., M.M.), University of Texas Southwestern Medical Center, Dallas
| | - Wanpen Vongpatanasin
- Internal Medicine (H.-K.K., J.H.M., S.A.S., W.V., M.M.), University of Texas Southwestern Medical Center, Dallas
| | - Masaki Mizuno
- From the Departments of Applied Clinical Research (R.I., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas.,Internal Medicine (H.-K.K., J.H.M., S.A.S., W.V., M.M.), University of Texas Southwestern Medical Center, Dallas
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Kim HK, Hotta N, Ishizawa R, Iwamoto GA, Vongpatanasin W, Mitchell JH, Smith SA, Mizuno M. Exaggerated pressor and sympathetic responses to stimulation of the mesencephalic locomotor region and exercise pressor reflex in type 2 diabetic rats. Am J Physiol Regul Integr Comp Physiol 2019; 317:R270-R279. [PMID: 31091155 DOI: 10.1152/ajpregu.00061.2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cardiovascular responses to exercise are potentiated in patients with type 2 diabetes mellitus (T2DM). However, the underlying mechanisms causing this abnormality remain unknown. Central command (CC) and the exercise pressor reflex (EPR) are known to contribute significantly to cardiovascular control during exercise. Thus these neural signals are viable candidates for the generation of the abnormal circulatory regulation in this disease. We hypothesized that augmentations in CC as well as EPR function contribute to the heightened cardiovascular responses during exercise in T2DM. To test this hypothesis, changes in mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA) in response to electrical stimulation of mesencephalic locomotor region (MLR), a putative component of the central command pathway, and activation of the EPR, evoked by electrically induced hindlimb muscle contraction, were examined in decerebrate animals. Sprague-Dawley rats were given either a normal diet (control) or a high-fat diet (14-16 wk) in combination with two low doses (35 mg/kg week 1, 25 mg/kg week 2) of streptozotocin (T2DM). The changes in MAP and RSNA responses to MLR stimulation were significantly greater in T2DM compared with control (2,739 ± 123 vs. 1,298 ± 371 mmHg/s, 6,326 ± 1,621 vs. 1,390 ± 277%/s, respectively, P < 0.05). Similarly, pressor and sympathetic responses to activation of the EPR in diabetic animals were significantly augmented compared with control animals (436 ± 74 vs. 134 ± 44 mmHg/s, 645 ± 135 vs. 139 ± 65%/s, respectively, P < 0.05). These findings provide the first evidence that CC and the EPR may generate the exaggerated rise in sympathetic activity and blood pressure during exercise in T2DM.
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Affiliation(s)
- Han-Kyul Kim
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Norio Hotta
- Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Rie Ishizawa
- Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gary A Iwamoto
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jere H Mitchell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott A Smith
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Masaki Mizuno
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
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Hypertensive response to exercise: mechanisms and clinical implication. Clin Hypertens 2016; 22:17. [PMID: 27468357 PMCID: PMC4962449 DOI: 10.1186/s40885-016-0052-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/20/2016] [Indexed: 11/24/2022] Open
Abstract
A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully elucidated. Endothelial dysfunction and increased stiffness of large artery contribute to development of HRE. From neurohormonal aspects, excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE. Increasing evidences indicates that a HRE is associated with functional and structural abnormalities of left ventricle, especially when accompanied by increased central blood pressure. A HRE harbors prognostic significance in future development of hypertension and increased cardiovascular events, particularly if a HRE is documented in moderate intensity of exercise. As supported by previous studies, a HRE is not a benign phenomenon, however, currently, whether to treat a HRE is controversial with uncertain treatment strategy. Considering underlying mechanisms, angiotensin receptor blockers and beta blockers can be suggested in individuals with HRE, however, evidences for efficacy and outcomes of treatment of HRE in individuals without hypertension is scarce and therefore warrants further studies.
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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; 17:837-44. [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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Exercise blood pressure: clinical relevance and correct measurement. J Hum Hypertens 2014; 29:351-8. [DOI: 10.1038/jhh.2014.84] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 11/08/2022]
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Cardoso CRL, Salles GF. Is blood pressure response to exercise mediated by abnormal glucose and lipid metabolism in normotensive individuals? Hypertens Res 2013; 36:494-5. [DOI: 10.1038/hr.2013.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Miyai N, Shiozaki M, Yabu M, Utsumi M, Morioka I, Miyashita K, Arita M. Increased mean arterial pressure response to dynamic exercise in normotensive subjects with multiple metabolic risk factors. Hypertens Res 2013; 36:534-9. [PMID: 23344132 DOI: 10.1038/hr.2012.215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Metabolic syndrome (MS) may influence vascular reactivity and might cause an excessive increase in blood pressure (BP) during dynamic exercise. We examined this hypothesis in 698 normotensive men (mean age: 43 years) free of cardiovascular disease, diabetes mellitus and renal disease. The response of BP to exercise was assessed by the mean arterial pressure (MAP) during bicycle ergometry. The MAP values were expressed as z-scores normalized to the relative increases in heart rate. High-normal BP, dyslipidemia and hyperglycemia were diagnosed according to the Japan-specific MS criteria. The z-score of MAP was significantly higher in subjects with high-normal BP (+0.57, P<0.001), dyslipidemia (+0.18, P<0.001) and hyperglycemia (+0.24, P<0.001) than in those without MS component (-0.38). In the high-normal BP subjects, the addition of dyslipidemia and/or hyperglycemia was associated with a progressive increase in the z-score of exercise MAP, whereas no such association was observed in the normal-BP subjects (P=0.033, two-way ANOVA). Multivariate regression analysis revealed that a greater number of MS components (β=0.102, P=0.010) was an independent determinant of increased MAP z-score after adjustment for potential confounders, including age (β=0.123, P<0.001), body mass index (β=0.145, P<0.001) and high-normal BP (β=0.410, P<0.001). These results suggest that accumulation of MS components may alter vascular structure and function and lead to the significant elevation of MAP during dynamic exercise even before clinical manifestation of arterial hypertension.
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Affiliation(s)
- Nobuyuki Miyai
- School of Health and Nursing Science, Wakayama Medical University, Wakayama, Japan.
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Blunted heart rate recovery is associated with exaggerated blood pressure response during exercise testing. Heart Vessels 2012; 28:750-6. [DOI: 10.1007/s00380-012-0298-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/28/2012] [Indexed: 01/20/2023]
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Tsioufis C, Kasiakogias A, Tsiachris D, Kordalis A, Thomopoulos C, Giakoumis M, Bounas P, Pittaras A, Michaelides A, Stefanadis C. Metabolic syndrome and exaggerated blood pressure response to exercise in newly diagnosed hypertensive patients. Eur J Prev Cardiol 2011; 19:467-73. [DOI: 10.1177/1741826711410819] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Running evidence supports a prognostic value of an exaggerated blood pressure response to exercise (EBPR). The impact of the metabolic syndrome (MS) on EBPR in hypertensive patients has not been investigated. Design: A cross-sectional study in the setting of an outpatient hypertension clinic. Methods: In total, 325 non-diabetic patients with newly diagnosed hypertension were divided into two groups based on the presence ( n = 95) or absence ( n = 230) of the MS as defined with NCEP-ATP III criteria. All subjects underwent ambulatory blood pressure monitoring, echocardiography and exercise treadmill testing. Results: Hypertensive patients with MS exhibited higher prevalence of EBPR (by 17%, p = 0.002) and peak exercise systolic BP (by 10.4 mmHg, p = 0.001) irrespectively of confounders. Metabolic equivalents were higher in hypertensives with MS (by 0.6 ml/kg/min, p = 0.048), but the difference lost significance after adjusting for confounders, including body mass index. Logistic regression analysis identified the MS as an independent predictor of an EBPR ( p = 0.016). Hypertensive patients with MS had a 2.3-fold risk of exhibiting EBPR compared to those without MS. However, individual components of MS altogether as well as each one separately failed to predict EBPR. Conclusions: Presence of MS in newly diagnosed hypertensive patients is associated with increased peak exercise BP and a higher frequency of EBPR over and above its separate elements.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Dimitris Tsiachris
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Athanasios Kordalis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Thomopoulos
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Michalis Giakoumis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Pavlos Bounas
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Andreas Pittaras
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Andreas Michaelides
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
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Møller NC, Grøntved A, Wedderkopp N, Ried-Larsen M, Kristensen PL, Andersen LB, Froberg K. Cardiovascular disease risk factors and blood pressure response during exercise in healthy children and adolescents: the European Youth Heart Study. J Appl Physiol (1985) 2010; 109:1125-32. [PMID: 20634358 DOI: 10.1152/japplphysiol.00316.2010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Raised blood pressure (BP) response during exercise independently predicts future hypertension. Subjects with higher BP in childhood also have elevated BP later in life. Therefore, the factors related to the regulation of exercise BP in children needs to be well understood. We hypothesized that physiological cardiovascular disease (CVD) risk factors would influence BP response during exercise in children and adolescents. This is a cross-sectional study of 439 Danish third-grade children and 364 ninth-grade adolescents. Systolic blood pressure (SBP) was measured with sphygmomanometer during a maximal aerobic fitness test. Examined CVD risk factors were high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol, triglyceride, homeostasis model of assessment of insulin resistance (HOMA-IR) score, body mass index (BMI), waist circumference, and aerobic fitness. A random effect model was used to test the hypotheses. In boys, HOMA-IR score and BMI were positively related to SBP response during exercise (β = 1.03, P = 0.001, and β = 0.58, P = 0.017, respectively). The effects sizes of HOMA-IR score and BMI and the significance levels only changed slightly (β = 0.91, P = 0.004, and β = 0.43, P = 0.08, respectively) when the two variables were added in the same model. A significant positive association was observed between aerobic fitness and SBP response in girls (β = 3.13 and P = 0.002). HOMA-IR score and BMI were found to be positively related to the SBP response in male children and youth. At least partly, adiposity and insulin sensitivity seem to influence exercise SBP through different mechanisms. The positive relationship observed between aerobic fitness and SBP response in girls remains unexplainable for us, although post hoc analyses revealed that it was the case in the ninth graders only.
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Affiliation(s)
- Niels C Møller
- Centre for Research in Childhood Health, Institute of Sports Science and Clinical Biomechanics, Univ. of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
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