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Martin ZT, Al-Daas IO, Cardenas N, Kolade JO, Merlau ER, Vu JK, Brown KK, Brothers RM. Peripheral and Cerebral Vasodilation in Black and White Women: Examining the Impact of Psychosocial Stress Exposure Versus Internalization and Coping. Hypertension 2023; 80:2122-2134. [PMID: 37534492 PMCID: PMC10530116 DOI: 10.1161/hypertensionaha.123.21230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Black women have among the highest rates of cardiovascular and cerebrovascular disease prevalence and mortality in part due to blunted vascular function. Psychosocial stress likely also contributes but its relationship to vascular function remains incompletely understood. Recent studies suggest that stress internalization and coping strategies are more important than stress exposures alone. We hypothesized that Black women would have blunted peripheral and cerebral vasodilation and that, among Black women, this would be inversely related with psychosocial stress internalization/coping but not stress exposures. METHODS Healthy Black (n=21; 20±2 years) and White (n=16; 25±7 years) women underwent testing for forearm reactive hyperemia, brachial artery flow-mediated dilation (FMD), and cerebrovascular reactivity. Psychosocial stress exposures (adverse childhood experiences; past week discrimination) and internalization/coping techniques (John Henryism Active Coping Scale; Giscombe Superwoman Schema Questionnaire) were assessed. RESULTS Reactive hyperemia and cerebrovascular reactivity were not different between groups (P>0.05), whereas FMD was lower in Black women (P=0.007). Neither adverse childhood experiences nor past week discrimination were associated with FMD in either group (P>0.05 for all). John Henryism Active Coping Scale scores were negatively associated with FMD in Black women (P=0.014) but positively associated with FMD in White women (P=0.042). Superwoman Schema-Succeed was negatively associated (P=0.044) and Superwoman Schema-Vulnerable tended to be negatively associated (P=0.057) with FMD in Black women. CONCLUSIONS These findings indicate that blunted FMD in Black women may be due more to stress internalization and maladaptive coping than stress exposures alone.
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Affiliation(s)
- Zachary T Martin
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
| | - Iman O Al-Daas
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
| | - Natalia Cardenas
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
| | - John O Kolade
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
| | - Emily R Merlau
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
| | - Joshua K Vu
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
| | - Kyrah K Brown
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX
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Krishnamurthy V, Sprick JD, Krishnamurthy LC, Barter JD, Turabi A, Hajjar IM, Nocera JR. The Utility of Cerebrovascular Reactivity MRI in Brain Rehabilitation: A Mechanistic Perspective. Front Physiol 2021; 12:642850. [PMID: 33815146 PMCID: PMC8009989 DOI: 10.3389/fphys.2021.642850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cerebrovascular control and its integration with other physiological systems play a key role in the effective maintenance of homeostasis in brain functioning. Maintenance, restoration, and promotion of such a balance are one of the paramount goals of brain rehabilitation and intervention programs. Cerebrovascular reactivity (CVR), an index of cerebrovascular reserve, plays an important role in chemo-regulation of cerebral blood flow. Improved vascular reactivity and cerebral blood flow are important factors in brain rehabilitation to facilitate desired cognitive and functional outcomes. It is widely accepted that CVR is impaired in aging, hypertension, and cerebrovascular diseases and possibly in neurodegenerative syndromes. However, a multitude of physiological factors influence CVR, and thus a comprehensive understanding of underlying mechanisms are needed. We are currently underinformed on which rehabilitation method will improve CVR, and how this information can inform on a patient's prognosis and diagnosis. Implementation of targeted rehabilitation regimes would be the first step to elucidate whether such regimes can modulate CVR and in the process may assist in improving our understanding for the underlying vascular pathophysiology. As such, the high spatial resolution along with whole brain coverage offered by MRI has opened the door to exciting recent developments in CVR MRI. Yet, several challenges currently preclude its potential as an effective diagnostic and prognostic tool in treatment planning and guidance. Understanding these knowledge gaps will ultimately facilitate a deeper understanding for cerebrovascular physiology and its role in brain function and rehabilitation. Based on the lessons learned from our group's past and ongoing neurorehabilitation studies, we present a systematic review of physiological mechanisms that lead to impaired CVR in aging and disease, and how CVR imaging and its further development in the context of brain rehabilitation can add value to the clinical settings.
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Affiliation(s)
- Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Justin D. Sprick
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Physics & Astronomy, Georgia State University, Atlanta, GA, United States
| | - Jolie D. Barter
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Aaminah Turabi
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Ihab M. Hajjar
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Joe R. Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
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Alali MH, Vianna LC, Lucas RAI, Junejo RT, Fisher JP. Impact of whole body passive heat stress and arterial shear rate modification on radial artery function in young men. J Appl Physiol (1985) 2020; 129:1373-1382. [PMID: 33031019 DOI: 10.1152/japplphysiol.00296.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We sought to determine how whole body heating acutely influences radial artery function, characterized using flow-mediated dilation (FMD) and low-flow-mediated constriction (L-FMC), and the mechanistic role of shear rate modification on radial artery functional characteristics during heating. Eleven young healthy men underwent whole body heating (water-perfused suit) sufficient to raise the core temperature by +1°C. Trials were repeated with (heat + WC) and without (heat) the application of a wrist cuff located distal to the radial artery examined, known to prevent increases in mean and anterograde shear rates but increase retrograde shear rate. Radial artery characteristics were assessed throughout each trial, with FMD and L-FMC assessed before and upon reaching the target core temperature. Heat markedly increased radial artery mean and anterograde shear rates, along with radial artery diameter and blood flow (P < 0.05). Heat + WC abolished the heat-induced increase in mean and anterograde shear rates (P > 0.05) but markedly increased retrograde shear rate (P < 0.05). Concomitantly, increases in radial artery diameter and blood flow were decreased (heat + WC vs. heat, P < 0.05). Heat attenuated FMD (8.6 ± 1.2% vs. 2.2 ± 1.4%, P < 0.05), whereas no change in FMD was observed in heat + WC (7.8 ± 1.2% vs. 10.8 ± 1.2%, P > 0.05). In contrast, L-FMC was not different in either trial (P > 0.05). In summary, acute whole body heating markedly elevates radial artery shear rate, diameter, and blood flow and diminishes FMD. However, marked radial artery vasodilation and diminished FMD are absent when these shear rate changes are prevented. Shear rate modifications underpin the radial artery response to acute whole body heat stress, but further endothelium-dependent vasodilation (FMD) is attenuated likely as the vasodilatory range limit is approached.NEW & NOTEWORTHY We observed that acute whole body heating elevates radial artery shear rate, diameter, and blood flow. This results in a diminished flow-meditated dilatation (FMD) but does not change low-flow-mediated constriction (L-FMC). Preventing shear rate changes during whole body heating reduces radial artery vasodilation and reverses FMD reductions but has no effect on L-FMC. These findings indicate that shear rate changes underpin conduit artery responses to acute whole body heat stress, but further endothelium-dependent flow-mediated vasodilation is attenuated as the vasodilatory range limit is approached.
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Affiliation(s)
- Mohammad H Alali
- School of Sport, Exercise & Rehabilitation Sciences, College of Life & Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Distrito Federal, Brazil
| | - Rebekah A I Lucas
- School of Sport, Exercise & Rehabilitation Sciences, College of Life & Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rehan T Junejo
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - James P Fisher
- Faculty of Medical & Health Sciences, Department of Physiology, University of Auckland, Auckland, New Zealand
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A greater burden of atrial fibrillation is associated with worse endothelial dysfunction in hypertension. J Hum Hypertens 2020; 35:667-677. [PMID: 32694585 DOI: 10.1038/s41371-020-0383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation (AF) and hypertension often co-exist and both are associated with endothelial dysfunction. We hypothesised that AF would further worsen endothelium-dependent flow-mediated dilatation (FMD) in hypertension patients compared to those without AF. In a cross-sectional comparison, we measured brachial artery diameter at rest and during reactive hyperaemia following 5 min of arterial occlusion in two patient groups: AF (and hypertension) (n = 61) and hypertension control groups (n = 33). The AF (and hypertension) subgroups: permanent AF (n = 30) and paroxysmal AF (n = 31) were also assessed. The permanent AF patients received heart rate and blood pressure (BP) control optimisation and were then followed up after eight weeks for repeat FMD testing. There was no significant difference in FMD between AF (and hypertension) group and hypertension control group (4.6%, 95% CI [2.6-5.9%] vs 2.6%, 95% CI [1.9-5.3%]; p = 0.25). There was a significant difference in FMD between permanent AF and paroxysmal AF groups (3.1%, 95% CI [2.3-4.8%] vs 5.9%, 95% CI [4.0-8.1%]; p = 0.02). Endothelium-dependent FMD response showed a non-significant improvement trend following eight weeks of heart rate and BP optimisation (3.1%, 95% CI [2.3-4.8%] (baseline) vs 5.2%, 95% CI [3.9-6.5%] (follow up), p = 0.09). Presence of AF generally does not incrementally worsen endothelial dysfunction in hypertension patients, although the duration and frequency of AF (paroxysmal AF to permanent AF) does lead to worsening endothelial function. Eight weeks of BP optimisation did not significantly improve endothelial dysfunction as measured by FMD.
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