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Watso JC, Fancher IS, Gomez DH, Hutchison ZJ, Gutiérrez OM, Robinson AT. The damaging duo: Obesity and excess dietary salt contribute to hypertension and cardiovascular disease. Obes Rev 2023; 24:e13589. [PMID: 37336641 PMCID: PMC10406397 DOI: 10.1111/obr.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
Hypertension is a primary risk factor for cardiovascular disease. Cardiovascular disease is the leading cause of death among adults worldwide. In this review, we focus on two of the most critical public health challenges that contribute to hypertension-obesity and excess dietary sodium from salt (i.e., sodium chloride). While the independent effects of these factors have been studied extensively, the interplay of obesity and excess salt overconsumption is not well understood. Here, we discuss both the independent and combined effects of excess obesity and dietary salt given their contributions to vascular dysfunction, autonomic cardiovascular dysregulation, kidney dysfunction, and insulin resistance. We discuss the role of ultra-processed foods-accounting for nearly 60% of energy intake in America-as a major contributor to both obesity and salt overconsumption. We highlight the influence of obesity on elevated blood pressure in the presence of a high-salt diet (i.e., salt sensitivity). Throughout the review, we highlight critical gaps in knowledge that should be filled to inform us of the prevention, management, treatment, and mitigation strategies for addressing these public health challenges.
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Affiliation(s)
- Joseph C. Watso
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Ibra S. Fancher
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Dulce H. Gomez
- School of Kinesiology, Auburn University, Auburn, Alabama, USA
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Orlando M. Gutiérrez
- Division of Nephrology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Farrell MC, Giza RJ, Shibao CA. Race and sex differences in cardiovascular autonomic regulation. Clin Auton Res 2020; 30:371-379. [PMID: 32894376 DOI: 10.1007/s10286-020-00723-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
Racial and ethnic differences in cardiovascular morbidity and mortality persist despite advances in risk factor identification and implementation of evidence-based treatment strategies. African American men and women are disproportionately affected by cardiovascular risk factors, particularly hypertension. In this context, previous studies have identified sex and racial differences in autonomic cardiovascular regulation which may contribute to the development of hypertension and its high morbidity burden among African Americans. In this review, we provide a comprehensive evaluation of the potential pathophysiological mechanisms of blood pressure control and their differences based on sex and race. These mechanisms include obesity-induced sympathetic activation, sympatho-vascular transduction, baroreflex sensitivity and adrenoreceptor vascular sensitivity, which have been the subjects of prior investigation in this field. Understanding the racial differences in the pathophysiology of hypertension and its co-morbid conditions would allow us to implement better treatment strategies tailored to African Americans, with the ultimate goal of reducing cardiovascular mortality in this population.
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Affiliation(s)
| | - Richard J Giza
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Cyndya A Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, 506 Robinson Research Building, Nashville, TN, 37232-6602, USA.
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3
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Drew RC, Charkoudian N, Park J. Neural control of cardiovascular function in black adults: implications for racial differences in autonomic regulation. Am J Physiol Regul Integr Comp Physiol 2019; 318:R234-R244. [PMID: 31823675 DOI: 10.1152/ajpregu.00091.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Black adults are at increased risk for developing hypertension and cardiovascular and chronic kidney disease and have greater associated morbidity/mortality than white adults who are otherwise demographically similar. Despite the key role of the autonomic nervous system in the regulation of cardiovascular function, the mechanistic contributions of sympathetic nerves to racial differences in cardiovascular dysfunction and disease remain poorly understood. In this review, we present an update and synthesis of current understanding regarding the roles of autonomic neural mechanisms in normal and pathophysiological cardiovascular control in black and white adults. At rest, many hemodynamic and autonomic variables, including blood pressure, cardiac output, and sympathetic nerve activity, are similar in healthy black and white adults. However, resting sympathetic vascular transduction and carotid baroreflex responses are altered in ways that tend to promote increased vasoconstriction and higher blood pressure, even in healthy, normotensive black adults. Acute sympathoexcitatory maneuvers, including exercise and cold pressor test, often result in augmented sympathetic and hemodynamic responses in healthy black adults. Clinically, although mechanistic evidence is scarce in this area, existing data support the idea that excessive sympathetic activation and/or transduction into peripheral vasoconstriction contribute importantly to the pathophysiology of hypertension and chronic kidney disease in black compared with white adults. Important areas for future work include more detailed study of sympathetic and hemodynamic reactivity to exercise and other stressors in male and female black adults and, particularly, sympathetic control of renal function, an important area of clinical concern in black patients.
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Affiliation(s)
- Rachel C Drew
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Atlanta Veterans Affairs Health Care System, Decatur, Georgia
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Grassi G, Biffi A, Seravalle G, Trevano FQ, Dell'Oro R, Corrao G, Mancia G. Sympathetic Neural Overdrive in the Obese and Overweight State. Hypertension 2019; 74:349-358. [PMID: 31203727 DOI: 10.1161/hypertensionaha.119.12885] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nerve traffic recordings (muscle sympathetic nerve traffic [MSNA]) have shown that sympathetic activation may occur in obesity. However, the small sample size of the available studies, presence of comorbidities, heterogeneity of the subjects examined represented major weaknesses not allowing to draw definite conclusions. This is the case for the overweight state. The present meta-analysis evaluated 1438 obese or overweight subjects recruited in 45 microneurographic studies. The analysis was primarily based on MSNA quantification in obesity and overweight, excluding as concomitant conditions hypertension, metabolic syndrome, and other comorbidities. Assessment was extended to the relationships of MSNA with other neuroadrenergic markers, such as plasma norepinephrine and heart rate, anthropometric variables, as body mass index, waist-to-hip ratio, presence/absence of obstructive sleep apnea, and metabolic profile. Compared with normoweights MSNA was significantly greater in overweight and more in obese individuals (37.0±4.1 versus 43.2±3.5 and 50.4±5.0 burts/100 heartbeats, P<0.01). This was the case even in the absence of obstructive sleep apnea. MSNA was significantly directly related to body mass index and waist-to-hip ratio ( r=0.41 and r=0.64, P<0.04 and <0.01, respectively), clinic blood pressure ( r=0.68, P<0.01), total cholesterol, LDL (low-density lipoprotein) cholesterol, and triglycerides ( r=0.91, r=0.94, and r=0.80, respectively, P<0.01) but unrelated to plasma insulin, glucose, and homeostatic model assessment for insulin resistance. No significant correlation was found between MSNA, heart rate, and norepinephrine. Thus, obesity and overweight are characterized by sympathetic overactivity which mirrors the severity of the clinical condition and reflects metabolic alterations, with the exclusion of glucose/insulin profile. Neither heart rate nor norepinephrine appear to represent faithful markers of the muscle sympathetic overdrive.
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Affiliation(s)
- Guido Grassi
- From the Clinica Medica, Department of Medicine and Surgery (G.G., F.Q.T., R.D.).,University of Milano-Bicocca (G.G.)
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology (A.B., G.C.).,Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (A.B., G.D.)
| | | | - Fosca Quarti Trevano
- From the Clinica Medica, Department of Medicine and Surgery (G.G., F.Q.T., R.D.)
| | - Raffaella Dell'Oro
- From the Clinica Medica, Department of Medicine and Surgery (G.G., F.Q.T., R.D.)
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology (A.B., G.C.).,Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (A.B., G.D.)
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5
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Fu Q. Sex differences in sympathetic activity in obesity and its related hypertension. Ann N Y Acad Sci 2019; 1454:31-41. [PMID: 31087350 DOI: 10.1111/nyas.14095] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 01/15/2023]
Abstract
The prevalence of obesity is rapidly increasing in the United States, particularly among women. Approximately 60-70% of hypertension in adults may be directly attributed to obesity. In addition, maternal obesity is a major risk factor for hypertensive disorders during pregnancy. The underlying mechanisms for the association between obesity and cardiovascular risk are multifactorial, but activation of the sympathetic nervous system is one significant contributing factor. This brief review summarizes the current knowledge on sex differences in sympathetic activity in obesity and its related hypertension, with a focus on studies in humans. Evidence suggests that abdominal visceral fat, rather than subcutaneous fat, is related to augmented sympathetic activity regardless of sex. Race/ethnicity may affect the relationship between obesity and sympathetic activity. Obesity-related hypertension has an important neurogenic component, which is characterized by sympathetic overactivity. However, sex may influence the association between hypertension and sympathetic overactivity in obese people. Finally, both body weight and sympathetic overactivity seem to be involved in the development of gestational hypertensive disorders in women. Chronic hyperinsulinemia due to insulin resistance, high plasma levels of leptin, and/or obstructive sleep apnea may be responsible for sympathetic overactivity in obesity-related hypertension.
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Affiliation(s)
- Qi Fu
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
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Costa J, Moreira A, Moreira P, Delgado L, Silva D. Effects of weight changes in the autonomic nervous system: A systematic review and meta-analysis. Clin Nutr 2018; 38:110-126. [PMID: 29395374 DOI: 10.1016/j.clnu.2018.01.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity has been linked to autonomic dysfunction, which is thought to be one of the main contributors for hypertension, cardiac remodelling and death. Exercise and diet-based weight loss are the mainstay therapy for obesity, but there is a paucity of data regarding the effect of weight changes in autonomic nervous system (ANS) activity. OBJECTIVE To describe the impact of weight changes in autonomic nervous system. METHODS A systematic literature search of four biomedical databases was performed evaluating effects of weight changes, thorough diet and/or exercise-based interventions, in the following ANS outcomes: heart rate variability, namely low frequency (LF)/high frequency (HF) ratio (LF/HF ratio), normalized units of LF (LFnu) and HF (HFnu), muscle sympathetic nerve activity (MSNA), noradrenaline spillover rate (NA-SR), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), baroreflex sensitivity and pupillometry. Quality appraisal was performed using the GRADE methodology and, where fitting, studies with comparable outcomes were pooled for meta-analysis. RESULTS Twenty-seven studies - 7 controlled clinical trials and 20 observational studies - were included. Weight gain was reported in 4 studies and weight loss in all the other studies. Interventions inducing weight changes included: hypocaloric or hypercaloric diets, exercise (strength, endurance or aerobic training) and hypocaloric diet coupled with exercise programs. Most studies which resulted in weight loss reported decreases in LF/HF ratio, LFnu, MSNA burst frequency and incidence, NA-SR, and an increase of baroreflex sensitivity, HF, HFnu and RMSSD, pointing to a parasympathetic nervous system activation. Meta-analysis regarding weight loss interventions showed a significant pooled effect size (95% CI) with a decreased of MSNA burst frequency -5.09 (-8.42, -1.75), MSNA incidence -6.66 (-12.40, -0.62), however this was not significant for SDNN 14.32 (-4.31, 32.96). Weight gain was associated with an increase in LF/HF, LFnu, MSNA burst frequency and incidence. The weight loss effects were potentiated by the association of hypocaloric diet with exercise. Nevertheless, weight changes effects in these outcomes were based in low or very low quality of evidence. CONCLUSIONS Diet and exercise based weight loss appears to increase parasympathetic and decrease sympathetic activity, the opposing effects being observed with weight gain. These findings are not uniformly reported in the literature, possibly due to differences in study design, methodology, characteristics of the participants and techniques used to estimate autonomic nervous activity.
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Affiliation(s)
- João Costa
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | - André Moreira
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, Universidade do Porto, Porto, Portugal
| | - Luís Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
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Fink GD. Exaggerated Sympathetic Neurovascular Transduction as a Mechanism of Neurogenic Hypertension: It Is Not All About Activity. Hypertension 2017; 71:64-65. [PMID: 29203626 DOI: 10.1161/hypertensionaha.117.10300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Gregory D Fink
- From the Department of Pharmacology and Toxicology, Michigan State University, East Lansing.
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Vranish JR, Holwerda SW, Young BE, Credeur DP, Patik JC, Barbosa TC, Keller DM, Fadel PJ. Exaggerated Vasoconstriction to Spontaneous Bursts of Muscle Sympathetic Nerve Activity in Healthy Young Black Men. Hypertension 2017; 71:192-198. [PMID: 29203629 DOI: 10.1161/hypertensionaha.117.10229] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/05/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022]
Abstract
Blacks have the highest prevalence of hypertension, putting them at greater risk of cardiovascular disease and death. Previous studies have reported that, relative to whites, healthy black men have augmented pressor responses to sympathoexcitatory stressors. Although important, these studies do not inform about the resting state and the influence of spontaneous changes in resting muscle sympathetic nerve activity (MSNA). Likewise, little is known about the transduction of MSNA into a vascular response at rest on a beat-to-beat basis. Accordingly, we tested the hypothesis that relative to whites, blacks would exhibit greater vasoconstriction and pressor responses following spontaneous bursts of MSNA. Mean arterial pressure, common femoral artery blood flow, and MSNA were continuously recorded during 20 minutes of supine rest in 35 young healthy men (17 blacks and 18 whites). Signal averaging was used to characterize changes in leg vascular conductance, total vascular conductance, and mean arterial pressure following spontaneous MSNA bursts. Blacks demonstrated significantly greater decreases in leg vascular conductance (blacks: -15.0±1.0%; whites: -11.5±1.2%; P=0.042) and total vascular conductance (blacks: -8.6±0.9%; whites: -5.1±0.4%; P=0.001) following MSNA bursts, which resulted in greater mean arterial pressure increases (blacks: +5.2±0.6 mm Hg; whites: +3.9±0.3 mm Hg; P=0.04). These exaggerated responses in blacks compared with whites were present whether MSNA bursts occurred in isolation (singles) or in combination (multiples) and were graded with increases in burst height. Collectively, these findings suggest that healthy young black men exhibit augmented sympathetic vascular transduction at rest and provide novel insight into potential mechanism(s) by which this population may develop hypertension later in life.
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Affiliation(s)
- Jennifer R Vranish
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Seth W Holwerda
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Benjamin E Young
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Daniel P Credeur
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Jordan C Patik
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Thales C Barbosa
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - David M Keller
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Paul J Fadel
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.).
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Marinos A, Gamboa A, Celedonio JE, Preheim BA, Okamoto LE, Ramirez CE, Arnold AC, Diedrich A, Biaggioni I, Shibao CA. Hypertension in Obese Black Women is Not Caused by Increased Sympathetic Vascular Tone. J Am Heart Assoc 2017; 6:JAHA.117.006971. [PMID: 29151035 PMCID: PMC5721777 DOI: 10.1161/jaha.117.006971] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Black women have one of the highest prevalence rates of hypertension and obesity in the United States. We previously reported that sympathetic activation induced by obesity is a significant contributor to hypertension in white patients. It is unknown whether sympathetic activity similarly contributes to hypertension in obese black women. Methods and Results We studied 42 obese women (16 white, body mass index 36±4 kg/m2, 44% with hypertension; 26 black, body mass index 35±4 kg/m2, 46% with hypertension). Antihypertensive medications were discontinued for 2 weeks before the day of the study. All patients underwent complete autonomic blockade with trimethaphan at a dosage of 4 mg/min. Resting sympathetic activity determined from muscle sympathetic nerve recordings was similar between obese black women with hypertension and those with normotension. In whites, sympathetic activity was elevated in obese patients with hypertension compared with normotension; the decrease in mean arterial blood pressure produced by trimethaphan was greater in obese white patients with hypertension compared with those with normotension (−26.8±9.7 mm Hg versus −14.8±7.9 mm Hg, P=0.02). In contrast, there was no difference in the depressor responses induced by trimethaphan between obese black women with hypertension and those with normotension (−15.5±10.5 mm Hg versus −12.3±10.2 mm Hg, P=0.45). Mean arterial blood pressure remained elevated in obese blacks with hypertension compared with those with normotension during trimethaphan infusion (83.7±15.0 mm Hg versus 71.7±9.8 mm Hg, P=0.02). Heart rate increased similarly with trimethaphan between white (P=0.11) and black (P=0.76) women with hypertension and normotension. Conclusions These findings suggest that sympathetic activity does not contribute to hypertension in obese black women and provide further evidence for racial differences in hypertension mechanisms.
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Peri-Okonny PA, Ayers C, Maalouf N, Das SR, de Lemos JA, Berry JD, Turer AT, Neeland IJ, Scherer PE, Vongpatanasin W. Adiponectin protects against incident hypertension independent of body fat distribution: observations from the Dallas Heart Study. Diabetes Metab Res Rev 2017; 33:10.1002/dmrr.2840. [PMID: 27455039 PMCID: PMC5477232 DOI: 10.1002/dmrr.2840] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Excess adipose tissue has been implicated in the pathogenesis of insulin resistance and atherosclerosis and is a key risk factor for blood pressure (BP) elevation. However, circulating levels of adiponectin, a protein produced by adipose tissue and widely implicated in the pathogenesis of insulin resistance and atherosclerosis, are inversely proportional to adiposity. The relationship between adiponectin and incident hypertension has not been determined in the general US population. METHODS Normotensive participants (n = 1233) enrolled in the Dallas Heart Study, a multiethnic, probability-based population sample of Dallas County adults were followed for median of 7 years. Retroperitoneal, intraperitoneal, visceral, and subcutaneous adipose tissue were measured at baseline by magnetic resonance imaging. Liver fat content was measured by 1 H-magnetic resonance spectroscopy. Relative risk regression was used to determine the association of adiponectin with incident hypertension after adjustment for age, race, sex, BMI, smoking, diabetes, baseline systolic BP, total cholesterol, and regional fat depot. RESULTS Of the 1233 study participants (median age 40 years, 40% black, and 56% women), 391 (32%) had developed hypertension over a median follow-up of 7 years. Adiponectin levels were associated with reduced risk of incident hypertension (RR 0.81, 95% CI [0.68-0.96]) in the fully adjusted model, which included liver fat. Similar results were observed after adjustment for subcutaneous or visceral fat depots when tested individually or simultaneously in the model. CONCLUSION Our study suggested a protective role of adiponectin against incident hypertension independent of body fat distribution.
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Affiliation(s)
| | - Colby Ayers
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX
| | - Naim Maalouf
- Endocrinology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sandeep R. Das
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - James A. de Lemos
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jarett D. Berry
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Aslan T. Turer
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian J. Neeland
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Philipp E. Scherer
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Wanpen Vongpatanasin
- Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
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Target organ complications and prognostic significance of alerting reaction: analysis from the Dallas Heart Study. J Hypertens 2015; 34:226-34. [PMID: 26485459 DOI: 10.1097/hjh.0000000000000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Noninvasive blood pressure (BP) measurement often triggers a transient rise in BP, known as an alerting reaction. However, the prevalence and prognostic significance of the alerting reaction has never been assessed in the general population. METHODS We evaluated the association between the alerting reaction and left ventricular mass by MRI and urinary albumin-to-creatinine ratio in the Dallas Heart Study, a large population sample of 3069 individuals. Participants were categorized into four groups based on levels of consecutive BP: first, normal first BP and average third to fifth (avg3-5) BP of less than 140/90 mmHg (control group); second, high first BP of at least 140/90 mmHg and normal (avg3-5) BP (alerting reaction group); third, normal first BP and high (avg3-5) BP; and fourth, high first to fifth BP. Then, associations between BP categories with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9.4 years were assessed. RESULTS The sample-weighted prevalence of isolated hypertension during the first BP measurement was 9.6%. Presence of an alerting reaction was independently associated with increased left ventricular mass, urinary albumin-to-creatinine ratio, cardiovascular events after adjustment for traditional cardiovascular risk factors, and baseline BP (adjusted hazard ratio 1.24, 95% confidence interval 1.07-1.43). CONCLUSION Our study indicated that the alerting reaction is independently associated with increased cardiovascular and renal complications.
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Franco RL, Privett SH, Bowen MK, Acevedo EO, Arrowood JA, Wickham EP, Evans RK. Sympathetic Activity Assessed during Exercise Recovery in Young Obese Females. J Pediatr 2015; 167:378-83.e1. [PMID: 26003997 PMCID: PMC4516681 DOI: 10.1016/j.jpeds.2015.04.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/16/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate differences in sympathetic activity, as assessed by an exercise recovery index (ERI; heart rate/oxygen consumption [VO2] plateau), between black and white obese female adolescents. An additional aim was to determine the association of ERI with insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]), cardiovascular fitness per fat-free mass (VO2 per fat-free mass), systolic blood pressure (SBP), and percent body fat (%FAT) in both black and white obese adolescents. STUDY DESIGN Sixty-one females volunteered to participate in this study. HOMA-IR, SBP, and %FAT were assessed during resting conditions in black (n = 49, 13.7 ± 1.6 years, 38.1 ± 6.1 kg/m(2)) and white (n = 12, 13.3 ± 2.2 years, 34.3 ± 4.9 kg/m(2)) obese adolescents. An ERI was calculated during a 5-minute passive recovery period immediately following a graded treadmill exercise test to exhaustion. RESULTS The ERI was significantly greater in black compared with white obese adolescent females (29.8 ± 6.4 vs 24.1 ± 3.1 bpm·mLO2(-1)·min(-1), P = .004). Using multiple linear regression modeling, there was a significant independent association between ERI and VO2 per fat-free mass (r = -0.310, P = .027) and %FAT (r = 0.326, P = .020) in black obese adolescents after controlling for HOMA-IR and SBP. CONCLUSIONS These results suggest that black obese adolescent females have greater sympathetic activity, as assessed by an ERI, than white obese adolescent females. These findings support the need for weight management efforts aimed at both reducing %FAT and improving fitness in obese adolescents, specifically black females. TRIAL REGISTRATION Registered with Clinicaltrials.gov: NCT00562293.
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Affiliation(s)
- R. Lee Franco
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - Stacey H. Privett
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - Mary K. Bowen
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - Edmund O. Acevedo
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - James A. Arrowood
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, 1001 East Broad Street, Suite 405, Richmond, VA, USA 23298-0036
| | - Edmond P. Wickham
- Departments of Internal Medicine and Pediatrics, Division of Endocrinology and Metabolism, School of Medicine, Virginia Commonwealth University, 10001 East Broad Street, Suite 405, Richmond, VA, USA 23298-0036
| | - Ronald K. Evans
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
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Abstract
Metabolic syndrome is associated with adverse health outcomes and is a growing problem worldwide. Although efforts to harmonise the definition of metabolic syndrome have helped to better understand the prevalence and the adverse outcomes associated with the disorder on a global scale, the mechanisms underpinning the metabolic changes that define it are incompletely understood. Accumulating evidence from laboratory and human studies suggests that activation of the sympathetic nervous system has an important role in metabolic syndrome. Indeed, treatment strategies commonly recommended for patients with metabolic syndrome, such as diet and exercise to induce weight loss, are associated with sympathetic inhibition. Pharmacological and device-based approaches to target activation of the sympathetic nervous system directly are available and have provided evidence to support the important part played by sympathetic regulation, particularly for blood pressure and glucose control. Preliminary evidence is encouraging, but whether therapeutically targeting sympathetic overactivity could help to prevent metabolic syndrome and attenuate its adverse outcomes remains to be determined.
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Affiliation(s)
- Markus Schlaich
- Neurovascular Hypertension and Kidney Disease and Human Neurotransmitters Laboratories, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Nora Straznicky
- Neurovascular Hypertension and Kidney Disease and Human Neurotransmitters Laboratories, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Elisabeth Lambert
- Neurovascular Hypertension and Kidney Disease and Human Neurotransmitters Laboratories, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Gavin Lambert
- Neurovascular Hypertension and Kidney Disease and Human Neurotransmitters Laboratories, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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14
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Dipla K, Nassis GP, Vrabas IS. Blood Pressure Control at Rest and during Exercise in Obese Children and Adults. J Obes 2012; 2012:147385. [PMID: 22666555 PMCID: PMC3361254 DOI: 10.1155/2012/147385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/19/2012] [Accepted: 03/01/2012] [Indexed: 11/17/2022] Open
Abstract
The hemodynamic responses to exercise have been studied to a great extent over the past decades, and an exaggerated blood pressure response during an acute exercise bout has been considered as an indicator of cardiovascular risk. Obesity is a major factor influencing the blood pressure response to exercise since evidence indicates that the arterial pressure response to exercise is exacerbated in obese compared with lean adults. Signs of augmented responses (such as an exaggerated blood pressure response) to physical exertion appear early in life (from the prepubertal years) in obese individuals. Understanding the mechanisms that drive the altered hemodynamic responses during exercise in obese individuals and prevent the progression to hypertension is vitally important. This paper focuses on the evidence linking obesity with alterations of the autonomic nervous system and discusses the potential mechanisms and consequences of the altered sympathetic nervous system behavior in obese individuals at rest and during exercise. Furthermore, this paper presents the alterations in the reflex regulatory mechanisms ("exercise pressor reflex" and baroreflex) in obese children and adults and addresses the effects of training on obesity-related disturbances.
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Affiliation(s)
- Konstantina Dipla
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Agios Ioannis, 62110 Serres, Greece
- *Konstantina Dipla:
| | - George P. Nassis
- Department of Sport Medicine and Biology of Exercise, Faculty of Physical Education and Sport Science, University of Athens, 17237 Daphne, Greece
| | - Ioannis S. Vrabas
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Agios Ioannis, 62110 Serres, Greece
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