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Lin M, Zhang Z, Gao X, Bian Y, Wu RS, Park G, Lou Z, Zhang Z, Xu X, Chen X, Kang A, Yang X, Yue W, Yin L, Wang C, Qi B, Zhou S, Hu H, Huang H, Li M, Gu Y, Mu J, Yang A, Yaghi A, Chen Y, Lei Y, Lu C, Wang R, Wang J, Xiang S, Kistler EB, Vasconcelos N, Xu S. A fully integrated wearable ultrasound system to monitor deep tissues in moving subjects. Nat Biotechnol 2024; 42:448-457. [PMID: 37217752 DOI: 10.1038/s41587-023-01800-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Recent advances in wearable ultrasound technologies have demonstrated the potential for hands-free data acquisition, but technical barriers remain as these probes require wire connections, can lose track of moving targets and create data-interpretation challenges. Here we report a fully integrated autonomous wearable ultrasonic-system-on-patch (USoP). A miniaturized flexible control circuit is designed to interface with an ultrasound transducer array for signal pre-conditioning and wireless data communication. Machine learning is used to track moving tissue targets and assist the data interpretation. We demonstrate that the USoP allows continuous tracking of physiological signals from tissues as deep as 164 mm. On mobile subjects, the USoP can continuously monitor physiological signals, including central blood pressure, heart rate and cardiac output, for as long as 12 h. This result enables continuous autonomous surveillance of deep tissue signals toward the internet-of-medical-things.
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Affiliation(s)
- Muyang Lin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ziyang Zhang
- Department of Computer Science Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xiaoxiang Gao
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yizhou Bian
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ray S Wu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Geonho Park
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Zhiyuan Lou
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Zhuorui Zhang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Xiangchen Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiangjun Chen
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Andrea Kang
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Yang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Wentong Yue
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Lu Yin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Chonghe Wang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Baiyan Qi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Sai Zhou
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Hongjie Hu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hao Huang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Mohan Li
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Yue Gu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Jing Mu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Albert Yang
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Amer Yaghi
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yimu Chen
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yusheng Lei
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Chengchangfeng Lu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Ruotao Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | | | - Erik B Kistler
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Department of Anesthesiology and Critical Care, University of California San Diego, La Jolla, CA, USA
| | - Nuno Vasconcelos
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Sheng Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA.
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA.
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2
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Bane A, Wilson L, Jumper J, Spindler L, Wyatt P, Willoughby D. Effects of Blood Flow Restriction Resistance Training on Autonomic and Endothelial Function in Persons with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:761-775. [PMID: 38701159 PMCID: PMC11191514 DOI: 10.3233/jpd-230259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/05/2024]
Abstract
Background Autonomic dysfunction precedes endothelial dysfunction in Parkinson's disease (PD) and causes blood pressure and circulation abnormalities that are highly disruptive to one's quality of life. While exercise interventions have proven helpful for motor symptoms of PD, improving associated non-motor symptoms is limited. Low-intensity resistance training with blood flow restriction (LIRT-BFR) improves autonomic dysfunction in non-PD patients and high-intensity resistance training (HIRT) is recommended for motor symptom improvements for people with PD (PwPD). Objective To determine the effects of LIRT-BFR and HIRT on homocysteine and autonomic and endothelial function in PwPD and to determine the hemodynamic loads during LIRT-BFR and HIRT in PwPD using a novel exercise protocol. Methods Thirty-eight PwPD were assigned LIRT-BFR, HIRT or to a control (CNTRL) group. The LIRT-BFR and HIRT groups exercised three days per week for four weeks. The LIRT-BFR protocol used 60% limb occlusion pressure (LOP) and performed three sets of 20 repetitions at 20% of the one-repetition maximum (1RM). The HIRT group performed three sets of eight repetitions at 80% 1RM. The CNTRL group was asked to continue their normal daily routines. Results LIRT-BFR significantly improved orthostatic hypotension (p = 0.026), homocysteine levels (p < 0.001), peripheral circulation (p = 0.003), supine blood pressure (p = 0.028) and heart rate variability (p = 0.041); LIRT-BFR improved homocysteine levels (p < 0.018), peripheral circulation (p = 0.005), supine blood pressure (p = 0.007) and heart rate variability (p = 0.047) more than HIRT; and hemodynamic loads for LIRT-BFR and HIRT were similar. Conclusions LIRT-BFR may be more effective than HIRT for autonomic and endothelial function improvements in PwPD and hemodynamic loads may be lessened in LIRT-BFR protocols using single-joint exercises with intermittent blood flow restriction. Further research is needed to determine if non-motor symptoms improve over time and if results are sustainable.
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Affiliation(s)
- Annie Bane
- Department of Kinesiology and Nutrition, Abilene Christian University, Abilene, TX, USA
| | - Lorraine Wilson
- Department of Kinesiology and Nutrition, Abilene Christian University, Abilene, TX, USA
| | - Jill Jumper
- Department of Physical Therapy, Hardin-Simmons University, Abilene, TX, USA
| | - Lindsay Spindler
- Department of Kinesiology, Health and Recreation, Hardin-Simmons University, Abilene, TX, USA
| | - Pricilla Wyatt
- Texas Tech University Health Science Center, Abilene, TX, USA
| | - Darryn Willoughby
- Physicians Assistant Program and the Exercise and Sport Science Department, University of Mary Hardin-Baylor, Belton, TX, USA
- School of Medicine, Baylor College of Medicine, Temple, TX, USA
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3
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Grotle AK, Langlo JV, Holsbrekken E, Stone AJ, Tanaka H, Fadel PJ. Age-related alterations in the cardiovascular responses to acute exercise in males and females: role of the exercise pressor reflex. Front Physiol 2023; 14:1287392. [PMID: 38028783 PMCID: PMC10652405 DOI: 10.3389/fphys.2023.1287392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Autonomic adjustments of the cardiovascular system are critical for initiating and sustaining exercise by facilitating the redistribution of blood flow and oxygen delivery to meet the metabolic demands of the active skeletal muscle. Afferent feedback from active skeletal muscles evokes reflex increases in sympathetic nerve activity and blood pressure (BP) (i.e., exercise pressor reflex) and contributes importantly to these primary neurovascular adjustments to exercise. When altered, this reflex contributes significantly to the exaggerated sympathetic and BP response to exercise observed in many cardiovascular-related diseases, highlighting the importance of examining the reflex and its underlying mechanism(s). A leading risk factor for the pathogenesis of cardiovascular disease in both males and females is aging. Although regular exercise is an effective strategy for mitigating the health burden of aging, older adults face a greater risk of experiencing an exaggerated cardiovascular response to exercise. However, the role of aging in mediating the exercise pressor reflex remains highly controversial, as conflicting findings have been reported. This review aims to provide a brief overview of the current understanding of the influence of aging on cardiovascular responses to exercise, focusing on the role of the exercise pressor reflex and proposing future directions for research. We reason that this review will serve as a resource for health professionals and researchers to stimulate a renewed interest in this critical area.
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Affiliation(s)
- A. K. Grotle
- Department of Sports, Food and Natural Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - J. V. Langlo
- Department of Sports, Food and Natural Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - E. Holsbrekken
- Department of Sports, Food and Natural Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - A. J. Stone
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - H. Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - P. J. Fadel
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
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Seo Y, Kwon S, Sunarya U, Park S, Park K, Jung D, Cho Y, Park C. Blood pressure estimation and its recalibration assessment using wrist cuff blood pressure monitor. Biomed Eng Lett 2023; 13:221-233. [PMID: 37124108 PMCID: PMC10130301 DOI: 10.1007/s13534-023-00271-1] [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: 10/20/2022] [Revised: 01/02/2023] [Accepted: 02/16/2023] [Indexed: 05/02/2023] Open
Abstract
The rapid evolution of wearable technology in healthcare sectors has created the opportunity for people to measure their blood pressure (BP) using a smartwatch at any time during their daily activities. Several commercially-available wearable devices have recently been equipped with a BP monitoring feature. However, concerns about recalibration remain. Pulse transit time (PTT)-based estimation is required for initial calibration, followed by periodic recalibration. Recalibration using arm-cuff BP monitors is not practical during everyday activities. In this study, we investigated recalibration using PTT-based BP monitoring aided by a deep neural network (DNN) and validated the performance achieved with more practical wrist-cuff BP monitors. The PTT-based prediction produced a mean absolute error (MAE) of 4.746 ± 1.529 mmHg for systolic blood pressure (SBP) and 3.448 ± 0.608 mmHg for diastolic blood pressure (DBP) when tested with an arm-cuff monitor employing recalibration. Recalibration clearly improved the performance of both DNN and conventional linear regression approaches. We established that the periodic recalibration performed by a wrist-worn BP monitor could be as accurate as that obtained with an arm-worn monitor, confirming the suitability of wrist-worn devices for everyday use. This is the first study to establish the potential of wrist-cuff BP monitors as a means to calibrate BP monitoring devices that can reliably substitute for arm-cuff BP monitors. With the use of wrist-cuff BP monitoring devices, continuous BP estimation, as well as frequent calibrations to ensure accurate BP monitoring, are now feasible.
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Affiliation(s)
- Youjung Seo
- Department of Computer Engineering, Kwangwoon University, Seoul, 01897 Korea
| | - Saehim Kwon
- Department of Artificial Intelligence, Kwangwoon University, Seoul, 01897 Korea
| | - Unang Sunarya
- Department of Computer Engineering, Kwangwoon University, Seoul, 01897 Korea
- School of Applied Science, Telkom University, Bandung, 40257 Indonesia
| | - Sungmin Park
- Department of Convergence IT Engineering and the Department of Electrical Engineering, Pohang University of Science and Technology, Pohang, 37673 Korea
| | - Kwangsuk Park
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, 03080 Korea
| | - Dawoon Jung
- Center for Artificial Intelligence, Korea Institute of Science and Technology, Seoul, 13916 Korea
| | - Youngho Cho
- Department of Electrical and Communication Engineering, University of Daelim, Anyang, 13916 Korea
| | - Cheolsoo Park
- Department of Computer Engineering, Kwangwoon University, Seoul, 01897 Korea
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5
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Yang CH, Teng LY, Lai MW, Weng KP, Tsai SW, Lin KL. Long-Term Results of Serial Exercise Testing and Echocardiography Examinations in Patients with Pulmonary Stenosis. J Cardiovasc Dev Dis 2023; 10:jcdd10010031. [PMID: 36661926 PMCID: PMC9865162 DOI: 10.3390/jcdd10010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Pulmonary stenosis (PS) affects cardiopulmonary function and exercise performance. Cardiopulmonary exercise testing (CPET) together with transthoracic echocardiography (TTE) can measure exercise performance, PS progression, and treatment effects. We assessed exercise capacity in PS patients using these methods. We enrolled 28 PS patients aged 6-35 years who received surgery, balloon pulmonary valvuloplasty, and follow-up care. The control population was selected by a 1:1 matching on age, sex, and body mass index. Baseline and follow-up peak pulmonary artery pulse wave velocity (PAV) were compared using TTE. Initial CPET revealed no significant differences in anaerobic metabolic equivalent (MET), peak oxygen consumption (VO2), and heart rate recovery between the two groups, nor were significant differences in pulmonary function identified. Within the PS group, there were no significant differences in MET, peak VO2, and heart rate recovery between the baseline and final CPET. Similarly, no significant differences were observed between the baseline and final PAV. The exercise capacity of patients with properly managed PS was comparable to that of healthy individuals. However, during the follow-up, declining trends in pulmonary function, aerobic metabolism, and peak exercise load capacity were observed among adolescents with PS. This study provides long-term data suggesting that PS patients should be encouraged to perform physical activity. Regular reevaluation should also be encouraged to limit performance deterioration.
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Affiliation(s)
- Chia-Hsin Yang
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Taichung 427213, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404328, Taiwan
| | - Li-Yun Teng
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Taichung 427213, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ming-Wei Lai
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Taichung 427213, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ken-Pen Weng
- Congenital Structural Heart Disease Center, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Taichung 427213, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ko-Long Lin
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veteran General Hospital, Kaohsiung 813414, Taiwan
- Correspondence: ; Tel.: +88-673-422-121 (ext. 4211)
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Cardiometabolic Biomarkers and Habitual Caffeine Consumption Associate with the Adverse Ambulatory Blood Pressure Response to Strenuous Physical Exertion among Firefighters. Nutrients 2022; 14:nu14194025. [PMID: 36235676 PMCID: PMC9572770 DOI: 10.3390/nu14194025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Caffeine has beneficial effects on firefighter job performance reducing fatigue and improving psychomotor vigilance. However, excessive caffeine intake may raise blood pressure (BP) following a bout of acute exercise among adults with elevated BP. The influence of caffeine intake on the ambulatory BP (ABP) response to vigorous physical exertion among firefighters has not been studied. In this sub-study we conducted secondary statistical analyses from a larger clinical trial (NCT04514354) that included examining the influence of habitual caffeine intake, and cardiometabolic biomarkers shown to influence BP, on the ABP response following a bout of sudden vigorous exertion over 19 h among firefighters. Previously, we found high amounts of calcium and sodium intake raised BP following a bout of acute exercise among adults with elevated BP. Thus, other secondary aims were to examine the influence of habitual calcium and sodium intake, and cardiometabolic biomarkers have shown to influence BP, on the ABP response following sudden vigorous exertion over 19 h among firefighters. Firefighters (n = 15) completed a Food-Frequency Questionnaire assessing habitual dietary intake over the past year. They randomly completed a maximal graded exercise stress test (GEST) and non-exercise CONTROL on separate non-workdays leaving the laboratory wearing an ABP monitor for 19 h. Prior to and immediately after the GEST, fasting venous blood was collected to measure lipid-lipoproteins, c-reactive protein, and blood glucose. Height and weight were taken to calculate body mass index. Repeated measures ANCOVA tested if the ABP response differed after GEST vs. CONTROL. Linear mixed models examined the relationships among caffeine, calcium, sodium, cardiometabolic biomarkers, and the ABP response following GEST vs. CONTROL. Firefighters were middle-aged (40.2 ± 9.5 year), overweight (29.0 ± 3.9 kg/m2) men with elevated BP (124.1 ± 10.3/79.6 ± 11.5 mmHg) who consumed 542.0 ± 348.9 mg of caffeine/day, about ~50% more than the dietary reference intake. Unexpectedly, systolic ABP was higher by 18.0 ± 6.7 mmHg and diastolic ABP by 9.1 ± 5.4 mmHg (ps < 0.01) over 19 h following GEST vs. CONTROL. We found 24% of the variance in the adverse ABP response to maximal physical exertion was explained by caffeine intake, and when combined with c-reactive protein, non-high-density lipoprotein-cholesterol, body mass index, blood glucose, and resting heart rate, up to 74% of the variability in the ABP response was explained. Additionally, we found calcium (ps < 0.001) and sodium (p < 0.0001) intake each explained up to 24% of the ABP response. Further investigation is needed in a larger, more diverse sample of firefighters to better establish how caffeine contributes to the adverse BP response to strenuous physical exertion.
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7
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Jiang D, Jiang Y, Wang K, Wang Z, Pei Y, Wu J, He C, Mo X, Wang H. Binary ethosomes-based transdermal patches assisted by metal microneedles significantly improve the bioavailability of carvedilol. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Han S, Contreras MI, Bazrafkan A, Rafi M, Dara SM, Orujyan A, Panossian A, Crouzet C, Lopour B, Choi B, Wilson RH, Akbari Y. Cortical Anoxic Spreading Depolarization During Cardiac Arrest is Associated with Remote Effects on Peripheral Blood Pressure and Postresuscitation Neurological Outcome. Neurocrit Care 2022; 37:139-154. [PMID: 35729464 PMCID: PMC9259534 DOI: 10.1007/s12028-022-01530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/29/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spreading depolarizations (SDs) are self-propagating waves of neuronal and glial depolarizations often seen in neurological conditions in both humans and animal models. Because SD is thought to worsen neurological injury, the role of SD in a variety of cerebral insults has garnered significant investigation. Anoxic SD is a type of SD that occurs because of anoxia or asphyxia. Although asphyxia leading to a severe drop in blood pressure may affect cerebral hemodynamics and is widely known to cause anoxic SD, the effect of anoxic SD on peripheral blood pressure in the extremities has not been investigated. This relationship is especially important to understand for conditions such as circulatory shock and cardiac arrest that directly affect both peripheral and cerebral perfusion in addition to producing anoxic SD in the brain. METHODS In this study, we used a rat model of asphyxial cardiac arrest to investigate the role of anoxic SD on cerebral hemodynamics and metabolism, peripheral blood pressure, and the relationship between these variables in 8- to 12-week-old male rats. We incorporated a multimodal monitoring platform measuring cortical direct current simultaneously with optical imaging. RESULTS We found that during anoxic SD, there is decoupling of peripheral blood pressure from cerebral blood flow and metabolism. We also observed that anoxic SD may modify cerebrovascular resistance. Furthermore, shorter time difference between anoxic SDs measured at different locations in the same rat was associated with better neurological outcome on the basis of the recovery of electrocorticography activity (bursting) immediately post resuscitation and the neurological deficit scale score 24 h post resuscitation. CONCLUSIONS To our knowledge, this is the first study to quantify the relationship between peripheral blood pressure, cerebral hemodynamics and metabolism, and neurological outcome in anoxic SD. These results indicate that the characteristics of SD may not be limited to cerebral hemodynamics and metabolism but rather may also encompass changes in peripheral blood flow, possibly through a brain-heart connection, providing new insights into the role of anoxic SD in global ischemia and recovery.
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Affiliation(s)
- Sangwoo Han
- Department of Neurology, University of California, Irvine, Irvine, CA, USA.,Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, USA
| | | | - Afsheen Bazrafkan
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
| | - Masih Rafi
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
| | - Shirin M Dara
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
| | - Ani Orujyan
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
| | - Anais Panossian
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
| | - Christian Crouzet
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.,Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA
| | - Beth Lopour
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Bernard Choi
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.,Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA.,Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Robert H Wilson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA.,Department of Surgery, University of California, Irvine, Irvine, CA, USA.,Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Yama Akbari
- Department of Neurology, University of California, Irvine, Irvine, CA, USA. .,Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, USA. .,Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA.
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Xu L, Cui J, Li M, Wu Q, Liu M, Xu M, Shi G, Yin J, Yang J. Association Between Serum Asprosin and Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus in the Community: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:1877-1884. [PMID: 35757196 PMCID: PMC9215350 DOI: 10.2147/dmso.s361808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the association between serum asprosin and diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) in the community. METHODS In this cross-sectional study, we retrospectively collected the clinical data of T2DM patients from a community health service center in southeastern Shanxi Province between November 2019 and July 2021. Logistic regression analysis was used to calculate the odds ratio (OR) and the 95% confidence interval (95% CI) of asprosin levels on the risk of DN. RESULTS Among 498 T2DM patients included in this study, 221 had microalbuminuria, 105 had massive albuminuria, and 172 did not have any signs of nephropathy. Serum asprosin level was positively correlated with diastolic blood pressure, body mass index, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine, ACR and albumin-to-creatinine ratio (all P < 0.05) and negatively correlated with low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose, HbA1c and estimated glomerular filtration rate (all P < 0.05). After adjusting for covariates, increased asprosin was associated with diabetic nephropathy (all OR = 2.560, 95% CI: 1.1592-4.116; P < 0.001). CONCLUSION The risk of DN significantly increases with serum asprosin levels, especially among female patients.
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Affiliation(s)
- Linxin Xu
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Junfang Cui
- Department of Geratology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Mina Li
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Qianqian Wu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Ming Liu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Minggang Xu
- Department of Endocrinology, Changzhi Second People’s Hospital, Changzhi, 046000, People’s Republic of China
| | - Guoliang Shi
- Department of Endocrinology, Changzhi Second People’s Hospital, Changzhi, 046000, People’s Republic of China
| | - Jianhong Yin
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Jing Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
- Correspondence: Jing Yang; Jianhong Yin, Tel +86-351-4639756, Email ;
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10
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Hasegawa D, Hori A, Okamura Y, Baba R, Suijo K, Mizuno M, Sugawara J, Kitatsuji K, Ogata H, Toda K, Hotta N. Aging exaggerates blood pressure response to ischemic rhythmic handgrip exercise in humans. Physiol Rep 2021; 9:e15125. [PMID: 34817113 PMCID: PMC8611780 DOI: 10.14814/phy2.15125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022] Open
Abstract
Ischemic skeletal muscle conditions are known to augment exercise-induced increases in blood pressure (BP). Aging is also a factor that enhances the pressor response to exercise. However, the effects of aging on the BP response to ischemic exercise remain unclear. We, therefore, tested the hypothesis that aging enhances the BP response to rhythmic handgrip (RHG) exercise during postexercise muscle ischemia (PEMI). We divided the normotensive participants without cardiovascular diseases into three age groups: young (n = 26; age, 18-28 years), middle-aged (n = 23; age, 35-59 years), and older adults (n = 23; age, 60-80 years). The participants performed RHG exercise with minimal effort for 1 min after rest with and without PEMI, which was induced by inflating a cuff on the upper arm just before the isometric handgrip exercise ended; the intensity was 30% of maximal voluntary contraction force. Under PEMI, the increase in diastolic BP (DBP) from rest to RHG exercise in the older adult group (Δ13 ± 2 mmHg) was significantly higher than that in the young (Δ5 ± 2 mmHg) and middle-aged groups (Δ6 ± 1 mmHg), despite there being no significant difference between the groups in the DBP response from rest to RHG exercise without PEMI. Importantly, based on multiple regression analysis, age remained a significant independent determinant of both the SBP and DBP responses to RHG exercise during PEMI (p < 0.01). These findings indicate that aging enhances the pressor response to ischemic rhythmic exercise.
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Affiliation(s)
- Daisuke Hasegawa
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- Nagoya Heisei College of Nursing and Medical CareNagoyaJapan
| | - Amane Hori
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- Japan Society for the Promotion of ScienceTokyoJapan
| | - Yukiko Okamura
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Reizo Baba
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Kenichi Suijo
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Masaki Mizuno
- Department of Applied Clinical ResearchUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jun Sugawara
- Human Informatics and Interaction Research InstituteNational Institute of Advanced Industrial Science and TechnologyTsukubaJapan
| | - Koji Kitatsuji
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Hisayoshi Ogata
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Kaoru Toda
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Norio Hotta
- Graduate School of Life and Health SciencesChubu UniversityKasugaiJapan
- College of Life and Health SciencesChubu UniversityKasugaiJapan
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11
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The impact of repeated, local heating-induced increases in blood flow on lower limb endothelial function in young, healthy females. Eur J Appl Physiol 2021; 121:3017-3030. [PMID: 34251539 DOI: 10.1007/s00421-021-04749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the present study was to examine the effect of repeated, single leg heating on lower limb endothelial function. METHODS Macrovascular function was assessed with superficial femoral artery (SFA) reactive hyperemia flow-mediated dilation (RH-FMD) and sustained stimulus FMD (SS-FMD). Calf microvascular function was assessed as the peak and area under the curve of SFA reactive hyperemia (RH). Participants (n = 13 females, 23 ± 2 yrs) had one leg randomized to the single leg heating intervention (EXP; other leg: control (CON)). The EXP leg underwent 8 weeks of single leg heating via immersion in 42.5 ℃ water for five 35-min sessions/week. At weeks 0, 2, 4, 6, and 8, SFA RH-FMD, SS-FMD (shear stress increased via plantar flexion exercise), and SFA RH flow were measured. RESULTS None of the variables changed with repeated, single leg heating (interaction week*limb RH-FMD: p = 0.076; SS-FMD: p = 0.958; RH flow p = 0.955). Covariation for the shear stress stimulus did not alter the FMD results. CONCLUSION Eight weeks of single leg heating did not change SFA endothelial or calf microvascular function. These results are in contrast with previous findings that limb heating improves upper limb endothelial function.
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12
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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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13
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Vartela V, Armenis I, Leivadarou D, Toutouzas K, Makrilakis K, Athanassopoulos GD, Karatasakis G, Kolovou G, Mavrogeni S, Perrea D. Reduced global longitudinal strain at rest and inadequate blood pressure response during exercise treadmill testing in male heterozygous familial hypercholesterolemia patients. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2021; 9:100083. [PMID: 34095810 PMCID: PMC8167294 DOI: 10.1016/j.ijchy.2021.100083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023]
Abstract
Background Heterozygous familial hypercholesterolemia (heFH) is a genetic disorder leading to premature coronary artery disease (CAD). We hypothesized that the subclinical pathophysiologic consequences of hypercholesterolemia may be detected before the occurrence of clinically overt CAD by stress testing and myocardial strain imaging. Patients-methods We evaluated the treadmill tests (ETTs) of 46 heFH men without known arterial hypertension/diabetes mellitus/vasculopathy like CAD and of 39 healthy men matched for age, baseline systolic/diastolic blood pressure (BP) and heart rate (HR), using Bruce protocol. Global longitudinal strain (GLS) of the left ventricle (LV) additionally to ejection fraction was obtained. Results heFH men reached a significantly higher peak systolic and diastolic BP compared to controls (p = 0.002 and p < 0.001, respectively). Mean rate pressure product was significantly higher in heFH patients (p = 0.038). Both duration of the ETT and workload in metabolic equivalents was lower in the heFH group (p < 0.001 and p < 0.001, respectively). Baseline to peak rise of systolic and diastolic BP in heFH men was higher (p = 0.008 and p < 0.001 for systolic and diastolic BP, respectively). Furthermore, heFH men had higher rise of HR from baseline to peak, compared to controls; (p = 0.047). GLS in heHF men was slightly decreased (p = 0.014), although the ejection fraction was similar in both groups. Conclusion heFH men have a higher rise in systolic/diastolic BP during ETT, which may reflect early, preclinical hypertension. Furthermore, slight impairment of LV GLS is present, despite the absence of apparent myocardial dysfunction in conventional 2D echocardiography.
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Key Words
- Arterial blood pressure
- BP, blood pressure
- CAD, coronary artery disease
- Coronary artery disease
- DBP, diastolic blood pressure
- EDV, end-diastolic volume
- ESV, end-systolic volume
- ETT, Exercise treadmill test
- Exercise treadmill test
- FH, Familial hypercholesterolemia
- GLS, Global longitudinal strain
- Global longitudinal strain
- HDL, high density lipoprotein
- HR, heart rate
- Heterozygous familial hypercholesterolemia
- LDL, low-density lipoprotein
- LV, left ventricle
- LVEF, LV ejection fraction
- METs, metabolic equivalents
- RPP, rate pressure product
- SBP, systolic blood pressure
- TC, total cholesterol
- TG, triglyceride
- heFH, heterozygous familial hypercholesterolemia
- hoFH, homozygous familial hypercholesterolemia
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Affiliation(s)
- Vasiliki Vartela
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - Iakovos Armenis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | | | - Konstantinos Toutouzas
- National and Kapodistrian University of Athens, Medical School, Greece.,Hippokration Hospital, First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Greece
| | - Konstantinos Makrilakis
- Internal Medicine, National and Kapodistrian University of Athens Medical School, Greece.,Hellenic Diabetes Association, Athens, Greece.,Laikon Hospital, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - George Karatasakis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | | | - Sophia Mavrogeni
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - Despina Perrea
- National and Kapodistrian University of Athens, Division of Experimental Surgery, Greece
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14
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Factors Related to Blood Pressure Response after Community-Based Exercise Program in the Elderly Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063149. [PMID: 33803874 PMCID: PMC8003188 DOI: 10.3390/ijerph18063149] [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: 02/11/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Exercise has been recommended for blood pressure (BP) control, but not every individual can improve BP and reduce the risk of cardiovascular disease effectively by exercise. This study aimed to evaluate the BP response after 12-week exercise intervention and then identify the potential factors of responders on BP (R-BP) control. This was a retrospective cohort study from a project of Taipei City Government. Subjects completed the original program were included for further analysis. Sociodemographic factors, health-related behaviors, and cardiovascular risks were extracted as potential factors. The results were categorized into R-BP control, i.e., BP under optimal level (systolic BP (SBP) < 140 mmHg; and diastolic BP (DBP) < 90 mmHg) or a significant BP reduction (SBP ↓10 mmHg or DBP ↓5 mmHg) after intervention, or non-responder on BP control, i.e., subjects who failed to achieve the targets. There were 81.62% R-BP subjects. R-BP showed lower SBP and lower risk of hypertension at baseline. Active lifestyle could quadruple the number of R-BP. Higher educational level or more prescription medications were likely to be R-BP in subjects with diagnosed hypertension. Active lifestyle combined with exercise could benefit R-BP in the elderly population. Health-related factors also need to be considered for BP control.
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15
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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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16
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Muller CR, Courelli V, Lucas A, Williams AT, Li JB, Dos Santos F, Cuddington CT, Moses SR, Palmer AF, Kistler EB, Cabrales P. Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin. Sci Rep 2021; 11:2509. [PMID: 33510204 PMCID: PMC7843604 DOI: 10.1038/s41598-021-81717-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Traumatic brain injury (TBI) is often accompanied by hemorrhage, and treatment of hemorrhagic shock (HS) after TBI is particularly challenging because the two therapeutic treatment strategies for TBI and HS often conflict. Ischemia/reperfusion injury from HS resuscitation can be exaggerated by TBI-induced loss of autoregulation. In HS resuscitation, the goal is to restore lost blood volume, while in the treatment of TBI the priority is focused on maintenance of adequate cerebral perfusion pressure and avoidance of secondary bleeding. In this study, we investigate the responses to resuscitation from severe HS after TBI in rats, using fresh blood, polymerized human hemoglobin (PolyhHb), and lactated Ringer's (LR). Rats were subjected to TBI by pneumatic controlled cortical impact. Shortly after TBI, HS was induced by blood withdrawal to reduce mean arterial pressure (MAP) to 35-40 mmHg for 90 min before resuscitation. Resuscitation fluids were delivered to restore MAP to ~ 65 mmHg and animals were monitored for 120 min. Increased systolic blood pressure variability (SBPV) confirmed TBI-induced loss of autoregulation. MAP after resuscitation was significantly higher in the blood and PolyhHb groups compared to the LR group. Furthermore, blood and PolyhHb restored diastolic pressure, while this remained depressed for the LR group, indicating a loss of vascular tone. Lactate increased in all groups during HS, and only returned to baseline level in the blood reperfused group. The PolyhHb group possessed lower SBPV compared to LR and blood groups. Finally, sympathetic nervous system (SNS) modulation was higher for the LR group and lower for the PolyhHb group compared to the blood group after reperfusion. In conclusion, our results suggest that PolyhHb could be an alternative to blood for resuscitation from HS after TBI when blood is not available, assuming additional testing demonstrate similar favorable results. PolyhHb restored hemodynamics and oxygen delivery, without the logistical constraints of refrigerated blood.
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Affiliation(s)
- Cynthia R Muller
- Department of Bioengineering, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA, 92093-0412, USA
| | - Vasiliki Courelli
- Department of Bioengineering, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA, 92093-0412, USA
| | - Alfredo Lucas
- Department of Bioengineering, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA, 92093-0412, USA
| | - Alexander T Williams
- Department of Bioengineering, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA, 92093-0412, USA
| | - Joyce B Li
- Department of Bioengineering, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA, 92093-0412, USA
| | - Fernando Dos Santos
- Department of Anesthesiology and Critical Care, University of California San Diego, San Diego, CA, USA
| | - Clayton T Cuddington
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA
| | - Savannah R Moses
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA
| | - Andre F Palmer
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA
| | - Erik B Kistler
- Department of Anesthesiology and Critical Care, University of California San Diego, San Diego, CA, USA
| | - Pedro Cabrales
- Department of Bioengineering, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA, 92093-0412, USA.
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17
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Yamada S, Nitta G, Takano Y, Yoshimura S, Aoki K, Dohi Y. Effects of physical therapy on blood pressure in daily clinical practice-a pilot study. J Phys Ther Sci 2020; 32:433-438. [PMID: 32753782 PMCID: PMC7344282 DOI: 10.1589/jpts.32.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/03/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Most exercise therapy procedures induce hemodynamic changes and could be a cardiovascular risk. This pilot study investigated factors that induce an exaggerated increase in blood pressure during exercise therapy. [Participants and Methods] We measured the blood pressure and pulse rate before and after exercise therapy for ambulation on days 1, 2, and 7 of the exercise therapy in patients (n=23; age, 69 ± 11 years) who were hospitalized for a stroke or an orthopedic surgery. [Results] Each participant's blood pressure and pulse rate were significantly increased after the exercise therapy. Regression analysis demonstrated that the increase in systolic blood pressure was independently predicted by body weight and pulse rate before the exercise therapy. In the logistic regression analysis, age and body weight were independent predictors of the exaggerated increase in systolic blood pressure (fourth quartile). [Conclusion] A significant increase in blood pressure was induced by exercise therapy. There was a correlation between systolic blood pressure increase and pulse rate before the exercise therapy. Old age or increased body weight predicts exaggerated increase in blood pressure during exercise therapy.
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Affiliation(s)
- Shota Yamada
- Physical Medicine and Rehabilitation, Nagoya City West
Medical Center, Japan
| | - Gen Nitta
- Department of Rehabilitation, Fujieda Heisei Memorial
Hospital, Japan
| | - Yuki Takano
- Department of Rehabilitation, Kashiwazaki General Hospital
and Medical Center, Japan
| | | | - Kazuji Aoki
- Faculty of Rehabilitation Sciences, Nagoya Gakuin
University: 3-1-17 Taiho, Atsuta-ku, Nagoya 456-0062, Japan
| | - Yasuaki Dohi
- Faculty of Rehabilitation Sciences, Nagoya Gakuin
University: 3-1-17 Taiho, Atsuta-ku, Nagoya 456-0062, Japan
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18
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Hotta N, Hori A, Okamura Y, Baba R, Watanabe H, Sugawara J, Vongpatanasin W, Wang J, Kim HK, Ishizawa R, Iwamoto GA, Mitchell JH, Smith SA, Mizuno M. Insulin resistance is associated with an exaggerated blood pressure response to ischemic rhythmic handgrip exercise in nondiabetic older adults. J Appl Physiol (1985) 2020; 129:144-151. [PMID: 32584663 DOI: 10.1152/japplphysiol.00247.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Patients with type 2 diabetes display an exaggerated pressor response to exercise. However, evidence supporting the association between the magnitude of the pressor response to exercise and insulin resistance-related factors including hemoglobin A1c (HbA1c) or homeostatic model assessment of insulin resistance (HOMA-IR) in nondiabetic subjects has remained sparse and inconclusive. Thus we investigated the relationship between cardiovascular responses to exercise and insulin resistance-related factors in nondiabetic healthy men (n = 23) and women (n = 22) above 60 yr old. We measured heart rate (HR) and blood pressure (BP) responses during: isometric handgrip (IHG) exercise of 30% maximal voluntary contraction, a period of skeletal muscle ischemia (SMI) induced by tourniqueting the arm after IHG, and rhythmic dynamic handgrip (DHG) exercise during SMI. Greater diastolic BP (DBP) responses to DHG with SMI was associated with male sex (r = 0.44, P = 0.02) and higher HbA1c (r = 0.33, P = 0.03), heart-ankle pulse wave velocity (haPWV) (r = 0.45, P < 0.01), and resting systolic BP (SBP) (r = 0.36, P = 0.02). HbA1c persisted as a significant determinant explaining the variance in the DBP response to DHG with SMI in multivariate models despite adjustment for sex, haPWV, and resting SBP. It was also determined that the DBP response to DHG with SMI in a group in which HOMA-IR was abnormal (Δ33 ± 3 mmHg) was significantly higher than that of groups in which HOMA-IR was at intermediate (Δ20 ± 4 mmHg) and normal (Δ23 ± 2 mmHg) levels. These data suggest that even in nondiabetic older adults, insulin resistance is related to an exaggerated pressor response to exercise especially when performed under ischemic conditions.NEW & NOTEWORTHY The diastolic blood pressure response to rhythmic dynamic handgrip exercise under ischemic conditions was demonstrated to be correlated with insulin resistance-related factors in nondiabetic older adults. This finding provides important insight to the prescription of exercise in this particular patient population as the blood pressure response to exercise, especially under ischemic conditions, could be exaggerated to nonsafe levels.
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Affiliation(s)
- Norio Hotta
- College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Amane Hori
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Yukiko Okamura
- College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Reizo Baba
- College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Hidehiro Watanabe
- Department of Rehabilitation, Tokai Memorial Hospital, Kasugai, Japan
| | - Jun Sugawara
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jijia Wang
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Han-Kyul Kim
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rie Ishizawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gary A Iwamoto
- Department of Cell Biology, 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 Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Masaki Mizuno
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
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19
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Li Y, Liu F, Su C, Yu B, Liu D, Chen HJ, Lin DA, Yang C, Zhou L, Wu Q, Xia W, Xie X, Tao J. Biodegradable Therapeutic Microneedle Patch for Rapid Antihypertensive Treatment. ACS APPLIED MATERIALS & INTERFACES 2019; 11:30575-30584. [PMID: 31382742 DOI: 10.1021/acsami.9b09697] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A hypertensive emergency causes severe cardiovascular diseases accompanied by acute target organ damage, requiring rapid and smooth blood pressure (BP) reduction. Current medicines for treating hypertensive emergencies, such as sodium nitroprusside (SNP), require careful dose control to avoid side effects (e.g., cyanide poisoning). The clinical administration of SNP using intravenous injection or drip further restrict its usage for first aid or self-aid in emergencies. Here, we developed an antihypertensive microneedle (aH-MN) technique to transdermally deliver SNP in combination with sodium thiosulfate (ST) as a cyanide antidote in a painless way. Dissolvable microneedles loaded with SNP and ST were fabricated via the centrifugation casting method, where the SNPs were stably packaged in microneedles and would be immediately released into the systemic circulation via subcutaneous capillaries when aH-MNs penetrated the skin. The antihypertensive effects were demonstrated on spontaneously hypertensive rat models. Rapid and potent BP reduction was achieved via aH-MN treatment, fulfilling clinical BP-control requirements for hypertensive emergencies. The side effects including skin irritation and target organ damage of aH-MN therapies were evaluated; the combinative delivery of ST effectively suppressed these side effects induced by the consecutive intake of SNP. This study introduces an efficient and patient-friendly antihypertensive therapy with a favorable side-effect profile, particularly a controllable and self-administrable approach to treat hypertensive emergencies.
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Affiliation(s)
- Yan Li
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
- Department of Cardiovascular Medicine , The First Affiliated Hospital of Jinan University , 510630 Guangzhou , China
| | - Fanmao Liu
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Chen Su
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
| | - Bingbo Yu
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
| | - Di Liu
- Pritzker School of Medicine , University of Chicago , Chicago , Illinois 60637 , United States
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Di-An Lin
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Chengduan Yang
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Lingfei Zhou
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Qianni Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center , Sun Yat-sen University , 510060 Guangzhou , China
| | - Wenhao Xia
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
| | - Xi Xie
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Jun Tao
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
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20
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Chen Y, Yang J, Su J, Qin Y, Shen C, Li Y, Lu S, Pan E, Gao Y, Miao D, Zhang N, Zhou J, Wu M. Physical activity, sedentary time and their associations with clustered metabolic risk among people with type 2 diabetes in Jiangsu province: a cross-sectional study. BMJ Open 2019; 9:e027906. [PMID: 31444181 PMCID: PMC6707692 DOI: 10.1136/bmjopen-2018-027906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Investigating the association between total physical activity, physical activity in different domains and sedentary time with clustered metabolic risk in patients with type 2 diabetes from Jiangsu province, China. DESIGN Interview-based cross-sectional study conducted between December 2013 and January 2014. SETTING 44 selected townships across two cities, Changshu and Huai'an, in Jiangsu province. PARTICIPANTS 20 340 participants selected using stratified cluster-randomised sampling and an interviewer-managed questionnaire. METHODS We constructed clustered metabolic risk by summing sex-specific standardised values of waist circumference, fasting triacylglycerol, fasting plasma glucose, systolic blood pressure and the inverse of blood high-density lipoprotein cholesterol (HDL-cholesterol). Self-reported total physical activity included occupation, commuting and leisure-time physical activity. The un-standardised regression coefficient [B] and its 95% CI were calculated using multivariate linear regression analyses. RESULTS This study included 17 750 type 2 diabetes patients (aged 21-94 years, 60.3% female). The total (B=-0.080; 95% CI: -0.114 to -0.046), occupational (B=-0.066; 95% CI: -0.101 to- 0.031) and leisure-time physical activity (B=-0.041; 95% CI: -0.075 to -0.007), and sedentary time (B=0.117; 95% CI: 0.083 to 0.151) were associated with clustered metabolic risk. Total physical activity, occupational physical activity and sedentary time were associated with waist circumference, triacylglycerol and HDL-cholesterol, but not with systolic blood pressure. Commuting physical activity and sedentary time were significantly associated with triacylglycerol (B=-0.012; 95% CI: -0.019 to -0.005) and fasting plasma glucose (B=0.008; 95% CI: 0.003 to 0.01), respectively. Leisure-time physical activity was only significantly associated with systolic blood pressure (B=-0.239; 95% CI: -0.542 to- 0.045). CONCLUSIONS Total, occupational and leisure-time physical activity were inversely associated with clustered metabolic risk, whereas sedentary time increased metabolic risk. Commuting physical activity was inversely associated with triacylglycerol. These findings suggest that increased physical activity in different domains and decreased sedentary time may have protective effects against metabolic risk in type 2 diabetes patients.
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Affiliation(s)
- Yijia Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jie Yang
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Yu Qin
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ying Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Shurong Lu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an Center for Disease Control and Prevention, Huai'an, China
| | - Yan Gao
- Institute of Suzhou Biobank, Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Dandan Miao
- Department of Chronic Disease Prevention and Control, Huai'an Center for Disease Control and Prevention, Huai'an, China
| | - Ning Zhang
- Changshu Center for Disease Control and Prevention, Changshu, China
| | - Jinyi Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Ming Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
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21
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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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22
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Currie KD, Floras JS, La Gerche A, Goodman JM. Exercise Blood Pressure Guidelines: Time to Re-evaluate What is Normal and Exaggerated? Sports Med 2018; 48:1763-1771. [PMID: 29574665 DOI: 10.1007/s40279-018-0900-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Blood pressure responses to graded exercise testing can provide important diagnostic and prognostic information. While published guidelines outline what constitutes a "normal" and "abnormal" (i.e., exaggerated) blood pressure response to exercise testing, the widespread use of exaggerated blood pressure responses as a clinical tool is limited due to sparse and inconsistent data. A review of the original sources from these guidelines reveals an overall lack of empirical evidence to support both the normal blood pressure responses and their upper limits. In this current opinion, we critically evaluate the current exercise blood pressure guidelines including (1) the normal blood pressure responses to graded exercise testing; (2) the upper limits of this normal response; (3) the blood pressure criteria for test termination; and (4) the thresholds for exaggerated blood pressure responses. We provide evidence that exercise blood pressure responses vary according to subject characteristics, and subsequently a re-evaluation of what constitutes normal and abnormal responses is necessary to strengthen the clinical utility of this assessment.
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Affiliation(s)
- Katharine D Currie
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - John S Floras
- University Health Network and Mount Sinai Hospital Division of Cardiology, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.,Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Andre La Gerche
- Sports Cardiology and Cardiac Magnetic Resonance Imaging Lab, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada. .,University Health Network and Mount Sinai Hospital Division of Cardiology, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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23
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Piché ME, Laberge AS, Brassard P, Arsenault BJ, Bertrand OF, Després JP, Costerousse O, Poirier P. Rosiglitazone lowers resting and blood pressure response to exercise in men with type 2 diabetes: A 1-year randomized study. Diabetes Obes Metab 2018; 20:1740-1750. [PMID: 29573098 DOI: 10.1111/dom.13293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 11/27/2022]
Abstract
AIMS We aimed to determine the effect of 1-year treatment with the insulin sensitizer peroxisome proliferator-activated receptor (PPAR)-γ agonist rosiglitazone on exercise capacity and blood pressure (BP) response to exercise in men with coronary artery disease (CAD) and type 2 diabetes (T2D). MATERIALS AND METHODS A total of 116 men (age, 64 ± 7 years; body mass index, 30.0 ± 4.4 kg/m2 ) with CAD and T2D were randomized to receive rosiglitazone or placebo for 1 year. Exercise capacity (VO2peak ) and BP response to exercise were assessed with a maximal treadmill test, prior to the intervention and at 1-year follow-up. Exercise-induced hypertension (EIH) was defined as maximal systolic BP ≥ 220 mm Hg and/or diastolic BP ≥ 100 mm Hg. RESULTS PPAR-γ agonist-treated patients showed improvements in fasting glucose, HbA1c and insulin sensitivity (Homeostasis model assessment of insulin resistance [HOMA-IR]) (all P < .05). Resting BPs, maximal exercise diastolic BP and resting rate-pressure product (RPP) were all reduced in the PPAR-γ agonist group (P < .05). Maximal exercise duration was unchanged. T2D patients who displayed the greatest improvement in insulin sensitivity (HOMA-IR) under PPAR-γ agonist treatment experienced a greater reduction in exercise BP and RPP (P < .05). The proportion of men with EIH decreased in the PPAR-γ agonist group during follow-up (39.00% ± 0.06% vs 21.00% ± 0.05%). In the subgroup with EIH that was treated with a PPAR-γ agonist, resting and exercise diastolic BP, as well as resting RPP, were all reduced at 1-year follow-up (P < .05). CONCLUSIONS The insulin sensitizer rosiglitazone has a beneficial effect on resting and BP response to exercise in men with CAD and T2D, especially in those with an exaggerated BP response to exercise.
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Affiliation(s)
- Marie-Eve Piché
- Faculty of Medicine, Laval University, Quebec, Canada
- Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Patrice Brassard
- Faculty of Medicine, Laval University, Quebec, Canada
- Quebec Heart and Lung Institute, Quebec, Canada
| | - Benoit J Arsenault
- Faculty of Medicine, Laval University, Quebec, Canada
- Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Jean-Pierre Després
- Faculty of Medicine, Laval University, Quebec, Canada
- Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Paul Poirier
- Quebec Heart and Lung Institute, Quebec, Canada
- Faculty of Pharmacy, Laval University, Quebec, Canada
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24
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Martinelli B, Pires Di Lorenzo VA, Quitério RJ, Ambrozin ARP, Arca EA, Jamami M. Cardiorespiratory repercussions according to the abdominal circumference measurement of men with obstructive respiratory disorder submitted to respiratory physiotherapy. Physiother Theory Pract 2018; 34:835-845. [DOI: 10.1080/09593985.2018.1430195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bruno Martinelli
- Department of Postgraduate Program in Physical Therapy, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | - Valéria Amorim Pires Di Lorenzo
- Department of Postgraduate Program in Physical Therapy, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | - Robison José Quitério
- Department of Physical Therapy, São Paulo State University - UNESP, Marília, São Paulo, Brazil
| | | | - Eduardo Aguilar Arca
- Department of Postgraduate Program in Physical Therapy, University of Sagrado Coração – USC, Bauru, São Paulo, Brazil
| | - Maurício Jamami
- Department of Postgraduate Program in Physical Therapy, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
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25
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Wang A, Yang L, Wen W, Zhang S, Hao D, Khalid SG, Zheng D. Quantification of radial arterial pulse characteristics change during exercise and recovery. J Physiol Sci 2016; 68:113-120. [PMID: 28028653 PMCID: PMC5799316 DOI: 10.1007/s12576-016-0515-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/13/2016] [Indexed: 12/02/2022]
Abstract
It is physiologically important to understand the arterial pulse waveform characteristics change during exercise and recovery. However, there is a lack of a comprehensive investigation. This study aimed to provide scientific evidence on the arterial pulse characteristics change during exercise and recovery. Sixty-five healthy subjects were studied. The exercise loads were gradually increased from 0 to 125 W for female subjects and to 150 W for male subjects. Radial pulses were digitally recorded during exercise and 4-min recovery. Four parameters were extracted from the raw arterial pulse waveform, including the pulse amplitude, width, pulse peak and dicrotic notch time. Five parameters were extracted from the normalized radial pulse waveform, including the pulse peak and dicrotic notch position, pulse Area, Area1 and Area2 separated by notch point. With increasing loads during exercise, the raw pulse amplitude increased significantly with decreased pulse period, reduced peak and notch time. From the normalized pulses, the pulse Area, pulse Area1 and Area2 decreased, respectively, from 38 ± 4, 61 ± 5 and 23 ± 5 at rest to 34 ± 4, 52 ± 6 and 13 ± 5 at 150-W exercise load. During recovery, an opposite trend was observed. This study quantitatively demonstrated significant changes of radial pulse characteristics during different exercise loads and recovery phases.
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Affiliation(s)
- Anran Wang
- College of Life Science and Bio-engineering, Beijing University of Technology, 100 Pingluoyuan Chaoyang District, Beijing, 100124, China
| | - Lin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, 100 Pingluoyuan Chaoyang District, Beijing, 100124, China.
| | - Weimin Wen
- College of Life Science and Bio-engineering, Beijing University of Technology, 100 Pingluoyuan Chaoyang District, Beijing, 100124, China
| | - Song Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, 100 Pingluoyuan Chaoyang District, Beijing, 100124, China
| | - Dongmei Hao
- College of Life Science and Bio-engineering, Beijing University of Technology, 100 Pingluoyuan Chaoyang District, Beijing, 100124, China
| | - Syed G Khalid
- Health and Wellbeing Academy, Faculty of Medical Science, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK
| | - Dingchang Zheng
- Health and Wellbeing Academy, Faculty of Medical Science, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK
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26
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Caselli S, Vaquer Segui A, Quattrini F, Di Gacinto B, Milan A, Assorgi R, Verdile L, Spataro A, Pelliccia A. Upper normal values of blood pressure response to exercise in Olympic athletes. Am Heart J 2016; 177:120-8. [PMID: 27297857 DOI: 10.1016/j.ahj.2016.04.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/25/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Exercise test is widespread performed in athletes to assess cardiovascular adaptations during effort; however, scarce information exists relative to the behavior of blood pressure during exercise in athletes. We sought to define the normal values and upper limits of blood pressure response to exercise in a large population of elite, healthy athletes. METHODS A total of 1,876 healthy, normotensive elite athletes (aged 25 ± 6 years, 64% male) underwent a comprehensive clinical evaluation including maximal bicycle exercise test. RESULTS At maximum exercise, the systolic blood pressure increased significantly (Δ = +69 ± 18 mm Hg; P< .001), whereas diastolic blood pressure showed minimal change (Δ = +1 ± 7 mm Hg; P= .001). The upper reference values were 220 mm Hg in male and 200 mm Hg in female athletes for systolic blood pressure, and 85 mm Hg in male and 80 mm Hg in female for diastolic blood pressure. A subgroup of 142 athletes (7.5%) showed high blood pressure response to exercise, that is, increase in systolic and/or diastolic blood pressure above the 95th percentile. Multivariate logistic regression analysis showed that endurance and mixed sport disciplines, body mass index, and baseline systolic blood pressure were the strongest determinants for high blood pressure response to exercise. CONCLUSION The gender-specific reference values for systolic and diastolic blood pressure at maximum exercise in athletes were defined. A small subset (7.5%) of athletes showed higher blood pressure response, in the absence of target organ disease or metabolic abnormalities, and associated with superior physical performance and larger cardiac remodeling.
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27
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Jiménez-Trujillo I, González-Pascual M, Jiménez-García R, Hernández-Barrera V, de Miguel-Yanes JM, Méndez-Bailón M, de Miguel-Diez J, Salinero-Fort MÁ, Perez-Farinos N, Carrasco-Garrido P, López-de-Andrés A. Type 2 Diabetes Mellitus and Thoracic Aortic Aneurysm and Dissection: An Observational Population-Based Study in Spain From 2001 to 2012. Medicine (Baltimore) 2016; 95:e3618. [PMID: 27149499 PMCID: PMC4863816 DOI: 10.1097/md.0000000000003618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
To describe trends in the rates of discharge due to thoracic aortic aneurysm and dissection (TAAD) among patients with and without type 2 diabetes in Spain (2001-2012).We used national hospital discharge data to select all of the patients who were discharged from the hospital after TAAD. We focused our analysis on patients with TAAD in the primary diagnosis field. Discharges were grouped by diabetes status (diabetic or nondiabetic). Incidence was calculated overall and stratified by diabetes status. We divided the study period into 4 periods of 3 years each. We analyzed diagnostic and surgical procedures, length of stay, and in-hospital mortality.We identified 48,746 patients who were discharged with TAAD. The rates of discharge due to TAAD increased significantly in both diabetic patients (12.65 cases per 100,000 in 2001/2003 to 23.92 cases per 100,000 in 2010/2012) and nondiabetic patients (17.39 to 21.75, respectively). The incidence was higher among nondiabetic patients than diabetic patients in 3 of the 4 time periods.The percentage of patients who underwent thoracic endovascular aortic repair increased in both groups, whereas the percentage of patients who underwent open repair decreased. The frequency of hospitalization increased at a higher rate among diabetic patients (incidence rate ratio 1.14, 95% confidence interval [CI] 1.07-1.20) than among nondiabetic patients (incidence rate ratio 1.08, 95% CI 1.07-1.11). The in-hospital mortality was lower in diabetic patients than in nondiabetic patients (odds ratio 0.83, 95% CI 0.69-0.99).The incidence rates were higher in nondiabetic patients. Hospitalizations seemed to increase at a higher rate among diabetic patients. Diabetic patients had a significantly lower mortality, possibly because of earlier diagnoses, and improved and more readily available treatments.
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Affiliation(s)
- Isabel Jiménez-Trujillo
- From the Preventive Medicine and Public Health Teaching and Research Unit (IJ-T, MG-P, RJ-G, VH-B, PC-G, AL-D-A), Health Sciences Faculty, Rey Juan Carlos University, Alcorcon; Medicine Department (JMM-Y, MM-B), Hospital Gregorio Marañon; Pneumology Department (JDM-D), Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid; Dirección Técnica de Docencia e Investigación(MÁS-F), Gerencia Atención Primaria, Madrid; and Health Security Agency (NP-F), Ministry of Health. Madrid, Comunidad de Madrid, Spain
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28
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Rontoyanni VG, Werner K, Sanders TAB, Hall WL. Differential acute effects of carbohydrate- and protein-rich drinks compared with water on cardiac output during rest and exercise in healthy young men. Appl Physiol Nutr Metab 2015; 40:803-10. [PMID: 26244599 DOI: 10.1139/apnm-2014-0358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The acute effects of drinks rich in protein (PRO) versus carbohydrate (CHO) on cardiovascular hemodynamics and reactivity are uncertain. A randomized crossover design was used to compare 400-mL isoenergetic (1.1 MJ) drinks containing whey protein (PRO; 44 g) or carbohydrate (CHO; 57 g) versus 400 mL of water in 14 healthy men. The primary and secondary outcomes were changes in cardiac output, blood pressure, systemic vascular resistance (SVR) and digital volume pulse measured prior to and 30 min following consumption at rest, during 12 min of multi-stage bicycle ergometry, and 15 min postexercise. The mean change (95% confidence interval (CI)) in resting cardiac output at 30 min was greater for CHO than for PRO or water: 0.7 (0.4 to 1.0), 0.1 (-0.2 to 0.40), and 0.0 (-0.3 to 0.3) L/min (P < 0.001), respectively; the higher cardiac output following CHO was accompanied by an increase in stroke volume and a lower SVR. The mean increments (95% CI) in cardiac output during exercise were CHO 4.7 (4.4 to 5.0), PRO 4.9 (4.6 to 5.2), and water 4.6 (4.3 to 4.9) L/min with the difference between PRO versus water being significant (P < 0.025). There were no other statistically significant differences. In summary, a CHO-rich drink increased cardiac output and lowered SVR in the resting state compared with a PRO-rich drink or water but the effect size of changes in these variables did not differ during or after exercise between CHO and PRO. Neither protein nor carbohydrate affected blood pressure reactivity to exercise.
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Affiliation(s)
- Victoria G Rontoyanni
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Kristin Werner
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Thomas A B Sanders
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Wendy L Hall
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
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29
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Ohta Y, Kawano Y, Minami J, Iwashima Y, Hayashi S, Yoshihara F, Nakamura S. Effects of daily walking on office, home and 24-h blood pressure in hypertensive patients. Clin Exp Hypertens 2015; 37:433-7. [PMID: 25815710 DOI: 10.3109/10641963.2015.1013115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aerobic exercise has been recommended in the management of hypertension. However, few studies have examined the effect of walking on ambulatory blood pressure (BP), and no studies have employed home BP monitoring. We investigated the effects of daily walking on office, home, and 24-h ambulatory BP in hypertensive patients. Sixty-five treated or untreated patients with essential hypertension (39 women and 26 men, 60 ± 9 years) were examined in a randomized cross-over design. The patients were asked to take a daily walk of 30-60 min to achieve 10 000 steps/d for 4 weeks, and to maintain usual activities for another 4 weeks. The number of steps taken and home BP were recorded everyday. Measurement of office and ambulatory BP, and sampling of blood and urine were performed at the end of each period. The average number of steps were 5349 ± 2267/d and 10 049 ± 3403/d in the control and walking period, respectively. Body weight and urinary sodium excretion did not change. Office, home, and 24-h BP in the walking period were lower compared to the control period by 2.6 ± 9.4/1.3 ± 4.9 mmHg (p < 0.05), 1.6 ± 6.8/1.5 ± 3.7 mmHg (p < 0.01), and 2.4 ± 7.6/1.8 ± 5.3 mmHg (p < 0.01), respectively. Average 24-h heart rate and serum triglyceride also decreased significantly. The changes in 24-h BP with walking significantly correlated with the average 24-h BP in the control period. In conclusion, daily walking lowered office, home, and 24-h BP, and improved 24-h heart rate and lipid metabolism in hypertensive patients. However, the small changes in BP may limit the value of walking as a non-pharmacologic therapy for hypertension.
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Affiliation(s)
- Yuko Ohta
- Division of Internal Medicine, Japan Seafarers Relief Association, Moji Ekisaikai Hospital , Kitakyushu, Fukuoka , Japan
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30
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Najafi F, Nalini M, Nikbakht MR. Changes in risk factors and exercise capacity after cardiac rehabilitation and its effect on hospital readmission. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e4899. [PMID: 25031860 PMCID: PMC4082520 DOI: 10.5812/ircmj.4899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 01/28/2013] [Accepted: 02/15/2014] [Indexed: 11/16/2022]
Abstract
Background: Despite the positive outcomes reported with cardiac rehabilitation (CR), its impacts have been reported to be different from a region or country to another, which may be due to the different contents of rehabilitation programs. Objectives: To investigate the effect of CR on cardiovascular risk factors. Patients and Methods: This is a retrospective cohort study on the data from Imam Ali Cardiac Rehabilitation Center in Kermanshah province, Iran from 2001 to 2008. We used paired t-test to evaluate the effect of CR on cardiovascular risk factors. Logistic regression or t-test (unequal variance) were used to assess the factors influencing re-admission (due to cardiac problems). The relationship between different variables and death was studied using univariate cox proportional hazard. P values < 0.05 were considered significant for all analyses. Results: Out of 504 patients who completed rehabilitation, a total of 499 were analyzed. These 499 patients consisted of 383 men and 116 women. All anthropometric measurements, blood lipids (except HDL cholesterol), systolic and diastolic blood pressure, depression, anxiety and exercise capacity improved after rehabilitation (P < 0.05 for all cases). The improvement was observed in both sexes. A total of 39 patients were re-admitted to hospital after rehabilitation. Being female (OR = 2.40; 95%CI: 1.22-4.68) and history of diabetes (OR = 2.04; 95%CI: 1.04-4.02) increased the risk of re-admission significantly. Patients who were readmitted had higher anthropometric measurements at the beginning and the end of the program. Moreover, the initial exercise capacity of readmitted patients was lower than those who were not readmitted. After a maximal follow-up period of 6.3 years (median = 2.99 years), only eight patients expired (survival rate: 97.5%; 95%CI: 94.7-98.8). None of the variables in our study was significantly related to the survival rate. Conclusions: The comprehensive CR program in Imam Ali Center efficiently reduces cardiovascular risk factors and improves exercise capacity.
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Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding Authors: Mehdi Nalini, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel:+98-9183853465, Fax: +98-8318392834, E-mail: ; Farid Najafi, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel: +98-9183853465, Fax: +98-8318392834, E-mail:
| | - Mehdi Nalini
- Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding Authors: Mehdi Nalini, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel:+98-9183853465, Fax: +98-8318392834, E-mail: ; Farid Najafi, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel: +98-9183853465, Fax: +98-8318392834, E-mail:
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Salazar Vázquez BY, Salazar Vázquez MA, Chávez-Negrete A, Escobedo G, Cabrales P, Subramaniam S, Intaglietta M, Pérez-Tamayo R. Influence of serological factors and BMI on the blood pressure/hematocrit association in healthy young men and women. Vasc Health Risk Manag 2014; 10:271-7. [PMID: 24851053 PMCID: PMC4018417 DOI: 10.2147/vhrm.s60130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The association between mean arterial blood pressure (MAP) and hematocrit (Hct) as a surrogate for blood viscosity was investigated in a young (average 20.0±2.3 years), healthy population of 174 men and 442 women. Health status was assessed by clinical examination and serological evaluation. Individuals with severe anemia or hemoconcentration, prior traumas or major surgical intervention, smokers, and pregnant or lactating women were excluded from the study. The MAP/Hct association was positive and significant (P=0.04) for women and negative, albeit not significantly so, for men. The MAP/Hct association was also evaluated in subgroups of the same population with a progressive step-by-step exclusion of: individuals with cholesterol >200 mg/dL; triglycerides >200 mg/dL; body mass index >25 kg/m(2); and glucose >100 mg/dL. This consecutively reduced the strength of the positive MAP/Hct association in women, which became negative - although not significantly so - when all anomalously high factors were excluded. The same trend was found in men. Our study indicates that previously reported positive trends in the relationship between the MAP and Hct in the population are not present in a young, healthy population of men or women that excludes individuals with the confounding factors of above normal serological values and BMI.
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Affiliation(s)
- Beatriz Y Salazar Vázquez
- Faculty of Medicine, Universidad Juárez del Estado de Durango, Victoria de Durango, Dgo, Mexico ; Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México Dr Eduardo Liceaga, México City, Mexico ; Department of Bioengineering, University of California, San Diego, CA, USA
| | - Miguel A Salazar Vázquez
- Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México Dr Eduardo Liceaga, México City, Mexico ; Department of Pediatrics, Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Durango, Dgo, Mexico
| | | | - Galileo Escobedo
- Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México Dr Eduardo Liceaga, México City, Mexico
| | - Pedro Cabrales
- Department of Bioengineering, University of California, San Diego, CA, USA
| | | | - Marcos Intaglietta
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Ruy Pérez-Tamayo
- Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México Dr Eduardo Liceaga, México City, Mexico
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Abstract
Irrespective of apparent 'normal' resting blood pressure (BP), some individuals may experience an excessive elevation in BP with exercise (i.e. systolic BP ≥210 mm Hg in men or ≥190 mm Hg in women or diastolic BP ≥110 mm Hg in men or women), a condition termed exercise hypertension or a 'hypertensive response to exercise' (HRE). An HRE is a relatively common condition that is identified during standard exercise stress testing; however, due to a lack of information with respect to the clinical ramifications of an HRE, little value is usually placed on such a finding. In this review, we discuss both the clinical importance and underlying physiological contributors of exercise hypertension. Indeed, an HRE is associated with an increased propensity for target organ damage and also predicts the future development of hypertension, cardiovascular events and mortality, independent of resting BP. Moreover, recent work has highlighted that some of the elevated cardiovascular risks associated with an HRE may be related to high-normal resting BP (pre-hypertension) or ambulatory 'masked' hypertension and that an HRE may be an early warning signal of abnormal BP control that is otherwise undetected with clinic BP. Whilst an HRE may be amenable to treatment via pharmacological and lifestyle interventions, the exact physiological mechanism of an HRE remains elusive, but it is likely a manifestation of multiple factors including large artery stiffness, increased peripheral resistance, neural circulatory control and metabolic irregularity. Future research focus may be directed towards determining threshold values to denote the increased risk associated with an HRE and further resolution of the underlying physiological factors involved in the pathogenesis of an HRE.
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Affiliation(s)
- Martin G Schultz
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tas., Australia
| | - James E Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tas., Australia
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Idoue A, Hirata C, Utsumi M, Miyai N, Iwahara A, Hattori S, Uematsu Y, Shiba M, Buyo M, Arita M. Relationship between blood pressure response during step exercise test and atherosclerotic markers. Clin Exp Hypertens 2014; 37:19-25. [DOI: 10.3109/10641963.2014.897716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ayaka Idoue
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Chiaki Hirata
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Miyoko Utsumi
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Miyai
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Akihiko Iwahara
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Sonomi Hattori
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Yuji Uematsu
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Mitsuru Shiba
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Momoko Buyo
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
| | - Mikio Arita
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama, Japan
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Schultz MG, Otahal P, Cleland VJ, Blizzard L, Marwick TH, Sharman JE. Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. Am J Hypertens 2013; 26:357-66. [PMID: 23382486 DOI: 10.1093/ajh/hps053] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The prognostic relevance of a hypertensive response to exercise (HRE) is ill-defined in individuals undergoing exercise stress testing. The study described here was intended to provide a systematic review and meta-analysis of published literature to determine the value of exercise-related blood pressure (BP) (independent of office BP) for predicting cardiovascular (CV) events and mortality. METHODS Online databases were searched for published longitudinal studies reporting exercise-related BP and CV events and mortality rates. RESULTS We identified for review 12 longitudinal studies with a total of 46,314 individuals without significant coronary artery disease, with total CV event and mortality rates recorded over a mean follow-up of 15.2±4.0 years. After adjustment for age, office BP, and CV risk factors, an HRE at moderate exercise intensity carried a 36% greater rate of CV events and mortality (95% CI, 1.02-1.83, P = 0.039) than that of subjects without an HRE. Additionally, each 10mm Hg increase in systolic BP during exercise at moderate intensity was accompanied by a 4% increase in CV events and mortality, independent of office BP, age, or CV risk factors (95% CI, 1.01-1.07, P = 0.02). Systolic BP at maximal workload was not significantly associated with the outcome of an increased rate of CV, whether analyzed as a categorical (HR=1.49, 95% CI, 0.90-2.46, P = 0.12) or a continuous (HR=1.01, 95% CI, 0.98-1.04, P = 0.53) variable. CONCLUSIONS An HRE at moderate exercise intensity during exercise stress testing is an independent risk factor for CV events and mortality. This highlights the need to determine underlying pathophysiological mechanisms of exercise-induced hypertension.
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Affiliation(s)
- Martin G Schultz
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
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Gaudreault V, Després JP, Rhéaume C, Alméras N, Bergeron J, Tremblay A, Poirier P. Exercise-Induced Hypertension in Men with Metabolic Syndrome: Anthropometric, Metabolic, and Hemodynamic Features. Metab Syndr Relat Disord 2013. [DOI: 10.1089/met.2012.0071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Valérie Gaudreault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Caroline Rhéaume
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Natalie Alméras
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Jean Bergeron
- Centre de recherche du Centre Hospitalier Universitaire de Québec, pavillon CHUL, Québec, Canada
| | - Angelo Tremblay
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
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Siegel D. Exercise-Induced Hypertension: Not Quite Ready for Prime Time. Metab Syndr Relat Disord 2013; 11:1-3. [DOI: 10.1089/met.2013.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David Siegel
- Medical Service, Department of Veterans Affairs, Northern California Health Care System, Mather, California
- Department of Medicine, School of Medicine, University of California, Davis, Sacramento, California
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37
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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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38
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Weston KS, Sacre JW, Jellis CL, Coombes JS. Contribution of autonomic dysfunction to abnormal exercise blood pressure in type 2 diabetes mellitus. J Sci Med Sport 2013; 16:8-12. [DOI: 10.1016/j.jsams.2012.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/01/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
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Farahani AV, Mansournia MA, Asheri H, Fotouhi A, Yunesian M, Jamali M, Ziaee V. The effects of a 10-week water aerobic exercise on the resting blood pressure in patients with essential hypertension. Asian J Sports Med 2012; 1:159-67. [PMID: 22375204 PMCID: PMC3289176 DOI: 10.5812/asjsm.34854] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 07/23/2010] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To investigate the effects of a 10-week water aerobic exercise on the resting blood pressure in patients with stage 1 or 2 hypertension referring to Tehran University Clinics. METHODS Forty men with stage 1 or 2 essential hypertension were assigned to two groups of intervention [n = 12; aged 48.33±10.74 years (mean±SD)] and control [n = 28; aged 46.96±11.58 years (mean±SD)]. Subjects in the intervention group participated in a supervised 10-week water aerobic training program of 55 min sessions, 3 days per week on alternate days, while those in the control group were not involved in any regular training program during this period. Blood pressure of the participants was recorded and compared at the beginning and at the end of the study (48 hours after the last training session). RESULTS Exercise lowered systolic blood pressure and mean arterial pressure by 11.71 (95% confidence interval: 5.07 to 18.35) and 5.90 (95% confidence interval: 1.17 to 10.63) mm Hg respectively. The lowering effect of exercise on diastolic blood pressure was neither statistically significant nor clinically important (0.55 mm Hg; P. value = 0.8). There was no significant effect of age, baseline body mass index and stage of hypertension on the exercise-induced changes in blood pressure. CONCLUSION A 10-week course of water aerobic exercise markedly reduced the systolic and mean arterial blood pressure of patients with essential hypertension and is especially recommended for the obese and the elderly who have orthopedic problems or bronchospasm.
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Affiliation(s)
- Ali Vasheghani Farahani
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Cardiology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad-Ali Mansournia
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Address: Sports Medicine Research Center, No 7, Al-e-Ahmad Highway, P.O. Box 14395-578, Tehran, IR Iran E-mail:
| | - Hossein Asheri
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Akbar Fotouhi
- School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Masud Yunesian
- School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Jamali
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Vahid Ziaee
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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40
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Sacre JW, Holland DJ, Jenkins C, Sharman JE. Augmentation index immediately after maximal exercise in patients with type 2 diabetes mellitus. Med Sci Sports Exerc 2012; 44:75-83. [PMID: 21685818 DOI: 10.1249/mss.0b013e318228588c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Patients with type 2 diabetes mellitus (T2DM) have exaggerated brachial and central (ascending aortic) blood pressure (BP) during exercise, which is associated with adverse outcomes. Central systolic loading, represented by the augmentation index (AIx), may contribute to exaggerated exercise central BP. This study sought to compare the central AIx response to peak exercise in T2DM and control patients and to identify mechanisms of altered exercise central AIx. METHODS Central BP and AIx were quantified by radial tonometry at rest and immediately after peak treadmill exercise in 106 patients with T2DM and 106 nondiabetic controls, pair-matched by age, gender, peak exercise brachial BP, and postexercise HR corresponding to tonometry acquisition. Cardiac volumes (by echocardiography) were assessed in a subgroup (22 T2DM and 22 controls) to derive rest and postexercise arterial-ventricular coupling parameters, including cardiac index (stroke volume index × HR), peripheral vascular resistance index (cardiac index / mean BP), and effective arterial elastance index (end-systolic pressure / stroke volume index). Reserve parameters (exercise--rest) were also defined. RESULTS Patients with T2DM had lower postexercise central AIx (-1% ± 13% vs 3% ± 14%, P = 0.038) and greater central AIx reserve (-24% ± 13% vs -20% ± 11%, P = 0.002) compared with controls, despite raised postexercise peripheral vascular resistance index (P = 0.013) and effective arterial elastance index (P = 0.011); these parameters independently predicted higher central AIx at rest (P < 0.01) but not after exercise. Moreover, T2DM was independently associated with lower postexercise central AIx (β = -0.21, P = 0.006). Cardiac index reserve, which was blunted in T2DM (P = 0.004), represented the only independent correlate of central AIx reserve (r = 0.39, P = 0.01). CONCLUSIONS Patients with T2DM have significantly (and paradoxically) lower postexercise central AIx and greater central AIx reserve, which may be explained by an impaired cardiac functional reserve.
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Affiliation(s)
- Julian W Sacre
- School of Medicine, The University of Queensland, Brisbane, Australia
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A comparison of the changes in cardiac output and systemic vascular resistance during exercise following high-fat meals containing DHA or EPA. Br J Nutr 2012; 108:492-9. [PMID: 22348439 DOI: 10.1017/s0007114511005721] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Long-chain n-3 PUFA can lower blood pressure (BP) but their acute effects on cardiac output, BP and systemic vascular resistance (SVR) in response to dynamic exercise are uncertain. We compared the effects of high-fat meals rich in EPA (20 : 5n-3), DHA (22 : 6n-3) or oleic acid (control) on cardiac output, BP and SVR in response to exercise stress testing. High-fat meals (50 g fat) containing high-oleic sunflower oil enriched with 4·7 g of either EPA or DHA v. control (high-oleic sunflower oil only) were fed to twenty-two healthy males using a randomised cross-over design. Resting measurements of cardiac output, heart rate and BP were made before and hourly over 5 h following the meal. A standardised 12 min exercise test was then conducted with further measurements made during and post-exercise. Blood samples were collected at fasting, 5 h postprandially and immediately post-exercise for the analysis of lipid, glucose and 8-isoprostane-F2α (8-iso-PGF2α). Plasma concentrations of EPA and DHA increased by 0·22 mmol/l 5 h following the EPA and DHA meals, respectively, compared with the control (P < 0·001). Resting cardiac output and 8-iso-PGF2α increased similarly following all meals and there were no significant differences in cardiac output during exercise between the meals. SVR was lower at 5 h and during exercise following the DHA but not EPA meal, compared with the control meal, by 4·9 % (95 % CI 1·3, 8·4; P < 0·01). Meals containing DHA appear to differ from EPA with regard to their effects on cardiovascular haemodynamics during exercise.
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Schultz MG, Hordern MD, Leano R, Coombes JS, Marwick TH, Sharman JE. Lifestyle change diminishes a hypertensive response to exercise in type 2 diabetes. Med Sci Sports Exerc 2011; 43:764-9. [PMID: 20881877 DOI: 10.1249/mss.0b013e3181fcf034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE A hypertensive response to exercise (HRE) is common in patients with type 2 diabetes and is associated with increased left ventricular (LV) mass and mortality. This study aimed to determine whether lifestyle modification would improve exercise blood pressure (BP) and reduce LV mass in patients with type 2 diabetes. METHODS One hundred and eighty-five patients with type 2 diabetes were randomized to 1 yr of lifestyle intervention (n=97, mean ± SD age=54.7 ± 11.3 yr, 51% men) or usual care (control; n=88, age=53.8 ± 8.1 yr, 61% men). Brachial BP was measured at rest and during a graded maximal exercise test at baseline and 1 yr. Patients also underwent two-dimensional echocardiography to determine LV dimensions. A subgroup of 61 patients had resting and exercise central BP estimated from radial tonometry. An HRE was defined as a maximal exercise systolic BP of ≥210 mm Hg for men and ≥190 mm Hg for women. RESULTS At study entry, there were 101 patients (55%) with an HRE (n=51 controls). Compared with controls, lifestyle intervention significantly reduced the propensity to develop an HRE in those participants who did not have HRE at baseline (29.8% vs 59.5%, P=0.006). However, absolute values of exercise and resting (brachial and central) BP and LV mass were not significantly changed (all P values >0.05). There were significant (all P values <0.05) improvements in V˙O2max, body mass index, plasma glucose, insulin resistance, and HDL cholesterol after lifestyle intervention compared with control. CONCLUSIONS Lifestyle intervention significantly attenuates the development of an HRE but does not reduce cardiac size after 1 yr in patients with type 2 diabetes.
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Gopinath B, Baur LA, Hardy LL, Kifley A, Rose KA, Wong TY, Mitchell P. Relationship between a range of sedentary behaviours and blood pressure during early adolescence. J Hum Hypertens 2011; 26:350-6. [PMID: 21614023 DOI: 10.1038/jhh.2011.40] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Very few studies have explored links between physical activity, sedentary behaviours and blood pressure (BP) in early adolescence. We aimed to assess the association between a range of sedentary activities (screen time, television (TV) viewing, computer usage, video game usage and time spent in homework or reading) and BP in schoolchildren. Eligible year-7 students (2353/3144, mean age 12.7 years) from a random cluster sample of 21 Sydney schools were examined during 2003-2005. Parents and children completed detailed questionnaires of activity. BP was measured using a standard protocol and high BP was defined using published guidelines. Height and weight were measured, and body mass index (BMI) calculated. After adjusting for age, sex, ethnicity, parental education, height, BMI and time spent in physical activity, each hour per day spent in screen time, watching TV and playing video games was associated with a significant increase in diastolic BP of 0.44 (P=0.0001), 0.99 (P<0.0001) and 0.64 mm Hg (P=0.04), respectively. In contrast, each hour per day spent reading was associated with a decrease of 0.91 (P=0.01) and 0.69 mm Hg (P=0.02) in systolic and diastolic BP, respectively. Our results indicate that addressing different types of sedentary activities could be a potentially important strategy to reduce the prevalence of elevated BP in children.
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Affiliation(s)
- B Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, New South Wales, Australia
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Gopinath B, Hardy LL, Teber E, Mitchell P. Association between physical activity and blood pressure in prepubertal children. Hypertens Res 2011; 34:851-5. [PMID: 21525949 DOI: 10.1038/hr.2011.46] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Elevated blood pressure (BP) during childhood and adolescence increases the risk of hypertension in later life. Although physical activity is known to positively moderate BP, data regarding this relationship are limited in prepubertal children. We aimed to assess the association between a range of physical activities (including indoor and outdoor activity) and BP in a large community-based sample of prepubertal schoolchildren. Eligible year-1 schoolchildren (n=1765; mean age 6.7 ± 0.4 years) from a random cluster sample of 34 schools in Sydney, Australia, were examined. Parents completed detailed questionnaires about their child's activity. Height and weight were measured, and body mass index (BMI) was calculated. BP was measured using a standard protocol, and elevated BP was defined using published guidelines. Physical activity was classified as low, medium or high (that is, as tertiles). After adjusting for age, sex, ethnicity, height, BMI, parental qualifications and family history of hypertension and/or cardiovascular disease, children in the highest tertile of outdoor and indoor activities had significantly lower diastolic BP (∼1.5 mm Hg; P(trend)=0.01) and systolic BP (∼1.3 mm Hg; P(trend)=0.03), respectively, compared with those in the lowest tertile (reference). Linearly, time spent in indoor activities (each hour per day) was associated with ∼2.4 mm Hg decrease in diastolic BP (P=0.001). Physical activity was independently associated with lower BP in this sample of prepubertal children. The findings emphasize the importance of ensuring regular physical activity programs in primary schools to potentially reduce the risk of elevated BP in childhood and in later life.
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Affiliation(s)
- Bamini Gopinath
- 1] Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
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Schultz MG, Hare JL, Marwick TH, Stowasser M, Sharman JE. Masked hypertension is “unmasked” by low-intensity exercise blood pressure. Blood Press 2011; 20:284-9. [DOI: 10.3109/08037051.2011.566251] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hull JH, Ansley L, Bolton CE, Sharman JE, Knight RK, Cockcroft JR, Shale DJ, Garrod R. The effect of exercise on large artery haemodynamics in cystic fibrosis. J Cyst Fibros 2011; 10:121-7. [PMID: 21220217 DOI: 10.1016/j.jcf.2010.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/13/2010] [Accepted: 12/02/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adult patients with cystic fibrosis (CF) have resting abnormal large artery haemodynamics. Here, we obtain further insight in patients with CF by evaluating haemodynamic response to physiological stress. METHODS Thirty-six stable CF patients mean (SD) age 28.9 (9.0)years and 25 controls matched for age, gender and body mass index were studied. Central haemodynamic parameters; including augmentation index (AIx) and wasted left ventricular pressure energy (∆E(W)) were determined pre, during and post light intensity cycle ergometry. RESULTS During exercise, despite a similar heart rate and blood pressure, patients had comparatively greater ∆E(W) (P=0.03) and trend towards greater AIx (P=0.07) than controls. Exercise ∆E(W) was greatest in patients with CF related diabetes (n=11). In all subjects, exercise ∆E(W) was related to age (r=0.54, P<0.001) and FEV(1)% predicted (r=-0.32, P=0.01). CONCLUSIONS Adults with CF have an abnormal haemodynamic response to exercise. This finding has deleterious implications for myocardial performance.
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Affiliation(s)
- James H Hull
- Faculty of Health and Social Care Sciences, Kingston University and St George's, London, UK.
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Cockburn JA, Brett SE, Guilcher A, Ferro A, Ritter JM, Chowienczyk PJ. Differential effects of beta-adrenoreceptor antagonists on central and peripheral blood pressure at rest and during exercise. Br J Clin Pharmacol 2010; 69:329-35. [PMID: 20406217 DOI: 10.1111/j.1365-2125.2009.03577.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Differential effects of beta-adrenoreceptor antagonists (beta-ARB) on central and peripheral blood pressure may relate to change in heart rate and/or vasodilator tone and thus be exaggerated during exercise. AIMS To examine acute effects of selective and nonselective beta-ARB on central and peripheral blood pressure, cardiac output and peripheral vascular resistance during exercise. METHODS Healthy volunteers (n= 20, 18 men, 19-54 years) received propranolol 80 mg, bisoprolol 20 mg, and placebo 1 h before bicycle ergometry (50, 75 and 100 W each for 3 min) in a randomized, cross-over study. Cardiac output was determined by pulmonary uptake of soluble and inert gas tracers (InnoCor, Innovision). Central systolic blood pressure (SBP) was determined from the late systolic shoulder of the digital artery pressure waveform (Finometer, Finopres). RESULTS At rest, both beta-ARB reduced brachial but not central SBP (compared with placebo). During exercise, beta-ARB reduced brachial SBP (reductions of 19.9 +/- 4.3 mmHg and 23.2 +/- 2.7 mmHg for propranolol and bisoprolol, respectively, at 100 W, each P < 0.0001) but not central SBP. The difference between peripheral and central SBP was reduced, relative to that during placebo, by 21.5 mmHg (95% confidence interval 8.8, 34.1) and 26.4 mmHg (18.1, 34.8) for propranolol and bisoprolol, respectively, at 100 W (each P < 0.01). There was no significant effect of beta-ARB on diastolic blood pressure or peripheral vascular resistance. CONCLUSIONS Despite reducing brachial blood pressure, acute beta-adrenoreceptor blockade in man at rest and during exercise does not reduce central blood pressure.
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Affiliation(s)
- James A Cockburn
- King's College London School of Medicine, Department of Clinical Pharmacology, St Thomas' Hospital, London, UK
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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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Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S. Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulation 2010; 121:2109-16. [PMID: 20439788 DOI: 10.1161/circulationaha.109.895292] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with exaggerated exercise blood pressure (BP) tend to develop future hypertension. It is controversial whether they have higher risk of death from cardiovascular disease (CVD). METHODS AND RESULTS A total of 6578 asymptomatic Lipid Research Clinics Prevalence Study participants (45% women; mean age, 46 years; 74% with untreated baseline BP <140/90 mm Hg [nonhypertensive]) performing submaximal Bruce treadmill tests were followed for 20 years (385 CVD deaths occurred). Systolic and diastolic BP at rest, Bruce stage 2, and maximal BP during exercise were significantly associated with CVD death. When we compared multivariate hazard ratios and 95% confidence intervals per 10/5-mm Hg BP increments, the association was strongest for rest BP (systolic, 1.21 [1.14 to 1.27]; diastolic, 1.20 [1.14 to 1.26]), then Bruce stage 2 BP (systolic, 1.09 [1.04 to 1.14]; diastolic, 1.09 [1.05 to 1.13]), then maximal exercise BP (systolic, 1.06 [1.01 to 1.10]; diastolic, 1.04 [1.01 to 1.08]). Overall, exercise BP was not significant after adjustment for rest BP. However, hypertension status modified the risk associated with exercise BP (P(interaction)=0.03). Among nonhypertensives, whether they had normal BP (<120/80 mm Hg) or prehypertension, Bruce stage 2 BP >180/90 versus < or =180/90 mm Hg carried increased risk independent of rest BP and risk factors (adjusted hazard ratio for systolic, 1.96 [1.40 to 2.74], P<0.001; diastolic, 1.48 [1.06 to 2.06], P=0.02) and added predictive value (net reclassification improvement, systolic, 12.0% [-0.1% to 24.2%]; diastolic, 9.9% [-0.3% to 20.0%]; relative integrated discrimination improvement, 14.3% and 12.0%, respectively). CONCLUSIONS In asymptomatic individuals, elevated exercise BP carried higher risk of CVD death but became nonsignificant after accounting for rest BP. However, Bruce stage 2 BP >180/90 mm Hg identified nonhypertensive individuals at higher risk of CVD death.
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Affiliation(s)
- Sandra A Weiss
- Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215, USA
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Vanhecke TE, Franklin BA, Zalesin KC, Sangal RB, deJong AT, Agrawal V, McCullough PA. Cardiorespiratory Fitness and Obstructive Sleep Apnea Syndrome in Morbidly Obese Patients. Chest 2008; 134:539-545. [DOI: 10.1378/chest.08-0567] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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