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Ghidoni C, Kruzik M, Rossi VA, Caselli S, Schmied CM, Niederseer D. Definitions for Hypertensive Response to Exercise. Cardiol Rev 2024; 32:273-278. [PMID: 36729898 DOI: 10.1097/crd.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Broad evidence indicates that hypertensive response to exercise (HRE) is associated with future hypertension (aHT) at rest and cardiovascular morbidity and mortality. Nevertheless, a consensus on the definition of HRE is lacking and the comparability of the available data is difficult due to a wide variation of definitions used. This review aims to harmonize currently available definitions of HRE in normotensive and athletic populations and to propose a generally valid cut-off applicable in everyday clinical practice. A literature search on PubMed and Embase was conducted to assemble and analyze the most recent data. Various definitions of HRE were identified and linked with future cardiovascular diseases. Forty-one studies defined HRE at a peak systolic blood pressure (SBP) above or equal to 200 mmHg in men and 25 studies for 190 mmHg in women. Peak diastolic blood pressure (DBP) between 90 and 110 mmHg was reported in 14 studies, relative DBP increase in four. Eight studies defined HRE as SBP between 160 and 200 mmHg at 100 watts. 17 studies performed submaximal exercise testing, while two more looked at BP during recovery. A plethora of other definitions was identified. In athletes, total workload and average blood pressure during exercise were considerably higher. Based on the presented data, the most commonly used definition of HRE at peak exercise is 210/105 mmHg for men, 190/105 mmHg for women, and 220/210 mmHg for athletes. Furthermore, a uniform exercise testing protocol, a position statement by leading experts to unify the definition of HRE, and prospective studies are warranted to confirm these cut-offs and the associated morbidity and mortality.
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Affiliation(s)
- Céline Ghidoni
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Kruzik
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefano Caselli
- Cardiovascular Center Zurich, Hirslanden Klinik im Park, Zurich, Switzerland
| | - Christian M Schmied
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Pesova P, Jiravska Godula B, Jiravsky O, Jelinek L, Sovova M, Moravcova K, Ozana J, Gajdusek L, Miklik R, Sknouril L, Neuwirth R, Sovova E. Exercise-Induced Blood Pressure Dynamics: Insights from the General Population and the Athletic Cohort. J Cardiovasc Dev Dis 2023; 10:480. [PMID: 38132648 PMCID: PMC10743421 DOI: 10.3390/jcdd10120480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Blood pressure (BP) dynamics during graded exercise testing provide important insights into cardiovascular health, particularly in athletes. These measurements, taken during intense physical exertion, complement and often enhance our understanding beyond traditional resting BP measurements. Historically, the challenge has been to distinguish 'normal' from 'exaggerated' BP responses in the athletic environment. While basic guidelines have served their purpose, they may not fully account for the complex nature of BP responses in today's athletes, as illuminated by contemporary research. This review critically evaluates existing guidelines in the context of athletic performance and cardiovascular health. Through a rigorous analysis of the current literature, we highlight the multifaceted nature of exercise-induced BP fluctuations in athletes, emphasising the myriad determinants that influence these responses, from specific training regimens to inherent physiological nuances. Our aim is to advocate a tailored, athlete-centred approach to BP assessment during exercise. Such a paradigm shift is intended to set the stage for evidence-based guidelines to improve athletic training, performance and overall cardiovascular well-being.
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Affiliation(s)
- Petra Pesova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
| | - Bogna Jiravska Godula
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
| | - Otakar Jiravsky
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Libor Jelinek
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Marketa Sovova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Katarina Moravcova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Jaromir Ozana
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Libor Gajdusek
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Roman Miklik
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Libor Sknouril
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
| | - Radek Neuwirth
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Eliska Sovova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
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Premature Cardiovascular Misdiagnosis of Senior Endurance-Trained Athletes. HEARTS 2023. [DOI: 10.3390/hearts4010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
A mature Caucasian patient, an endurance-trained triathlete (age group), had a routine ECG. The patient was immediately referred to Emergency based on supposed ECG abnormalities indicating a heart attack. This diagnosis was quickly dismissed based on no symptoms, heart rate of 50 BPM, athletic status, excellent health, and no prior cardiovascular problems. The patient had a history of severe white coat hypertension and underwent a further stress test and echocardiogram. The stress test showed exaggerated systolic blood pressures (over 225 mmHg) and high in-clinic basal blood pressures (160/90 mmHg), and the patient was diagnosed as hypertensive with exercise blood pressure close to stroke territory. He was told to stop racing, reduce training, and was prescribed antihypertensive drugs (which he did not take). Subsequent at-home 24 h (values close to 120/80 mmHg) and stress blood pressure measurements reversed that decision when considered in combination with an excellent echocardiogram result. The literature clearly describes endurance-trained athletes with systolic pressures over 225 mmHg Hg as being conditioned with no pathological aspects. Endurance-trained athletes should be examined as special cases in the field of cardiovascular medicine as trained physiological responses often present as cardiac abnormalities, and misdiagnosis can inappropriately change the athlete’s life.
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Heimark S, Eitzen I, Vianello I, Bøtker-Rasmussen KG, Mamen A, Hoel Rindal OM, Waldum-Grevbo B, Sandbakk Ø, Seeberg TM. Blood Pressure Response and Pulse Arrival Time During Exercise Testing in Well-Trained Individuals. Front Physiol 2022; 13:863855. [PMID: 35899026 PMCID: PMC9309297 DOI: 10.3389/fphys.2022.863855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing. Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests. Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r2 of 0.81 ± 17. Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Sondre Heimark,
| | - Ingrid Eitzen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Isabella Vianello
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Asgeir Mamen
- Kristiania University College, School of Health Sciences, Oslo, Norway
| | | | | | - Øyvind Sandbakk
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine M. Seeberg
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
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Jurasz M, Boraczyński M, Laskin JJ, Kamelska-Sadowska AM, Podstawski R, Jaszczur-Nowicki J, Nowakowski JJ, Gronek P. Acute Cardiorespiratory and Metabolic Responses to Incremental Cycling Exercise in Endurance- and Strength-Trained Athletes. BIOLOGY 2022; 11:biology11050643. [PMID: 35625371 PMCID: PMC9138148 DOI: 10.3390/biology11050643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine the acute effects of a progressive submaximal cycling exercise on selected cardiorespiratory and metabolic variables in endurance and strength trained athletes. The sample comprised 32 participants aged 22.0 ± 0.54 years who were assigned into three groups: an endurance trained group (END, triathletes, n = 10), a strength trained group (STR, bodybuilders, n = 10), and a control group (CON, recreationally active students, n = 12). The incremental cycling exercise was performed using a progressive protocol starting with a 3 min resting measurement and then a 50 W workload with subsequent constant increments of 50 W every 3 min until 200 W. The following cardiometabolic variables were evaluated: heart rate (HR), oxygen uptake (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER), systolic and diastolic blood pressure (SBP and DBP), and blood lactate (BLa−). We found the between-group differences in metabolic variables (the average RER and BLa−) were statistically significant (Tukey’s HSD test: CON vs. STR, p < 0.01 and p < 0.05, respectively; CON vs. END, p < 0.001; END vs. STR, p < 0.001). RER and BLa− differences in all groups depended on the workload level (G-G-epsilon = 0.438; p < 0.004 and G-G-epsilon = 0.400; p < 0.001, respectively). There were no significant differences in cardiorespiratory variables between endurance- and strength-trained groups. In conclusion, this study demonstrated that acute cardiorespiratory responses at each of the four submaximal workloads were comparable in endurance- compared to strength-trained athletes, but significantly different compared to recreationally active men. However, there were significant differences in the metabolic responses of RER and BLa−. Based on our findings we recommend that endurance-trained athletes follow a concurrent training program, combined strength and endurance training, to improve neuromuscular parameters and thus optimize their economy of movement and endurance-specific muscle power capacity.
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Affiliation(s)
- Maciej Jurasz
- Department of Sport Medicine and Traumatology, Poznań University of Physical Education, 61-871 Poznań, Poland;
| | - Michał Boraczyński
- Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
- Correspondence: ; Tel.: +48-533-101-720
| | - James J. Laskin
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT 59812, USA;
| | - Anna M. Kamelska-Sadowska
- Department of Rehabilitation and Orthopedics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 11-082 Olsztyn, Poland;
- Clinic of Rehabilitation, Provincial Specialist Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Robert Podstawski
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland; (R.P.); (J.J.-N.)
| | - Jarosław Jaszczur-Nowicki
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland; (R.P.); (J.J.-N.)
| | - Jacek J. Nowakowski
- Department of Ecology and Environmental Protection, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland;
| | - Piotr Gronek
- Laboratory of Healthy Aging, Department of Dance, Poznań University of Physical Education, 61-871 Poznań, Poland;
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