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Bunsawat K, Nelson MD, Hearon CM, Wray DW. Exercise intolerance in heart failure with preserved ejection fraction: Causes, consequences and the journey towards a cure. Exp Physiol 2024; 109:502-512. [PMID: 38063130 PMCID: PMC10984794 DOI: 10.1113/ep090674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/22/2023] [Indexed: 04/04/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for over 50% of all heart failure cases nationwide and continues to rise in its prevalence. The complex, multi-organ involvement of the HFpEF clinical syndrome requires clinicians and investigators to adopt an integrative approach that considers the contribution of both cardiac and non-cardiac function to HFpEF pathophysiology. Thus, this symposium review outlines the key points from presentations covering the contributions of disease-related changes in cardiac function, arterial stiffness, peripheral vascular function, and oxygen delivery and utilization to exercise tolerance in patients with HFpEF. While many aspects of HFpEF pathophysiology remain poorly understood, there is accumulating evidence for a decline in vascular health in this patient group that may be remediable through pharmacological and lifestyle interventions and could improve outcomes and clinical status in this ever-growing patient population.
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Affiliation(s)
- Kanokwan Bunsawat
- Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical CenterSalt Lake CityUtahUSA
- Department of Internal Medicine, Division of GeriatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Michael D. Nelson
- Department of KinesiologyUniversity of Texas at ArlingtonArlingtonTexasUSA
| | - Christopher M. Hearon
- Department of Applied Clinical ResearchThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - D. Walter Wray
- Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical CenterSalt Lake CityUtahUSA
- Department of Internal Medicine, Division of GeriatricsUniversity of UtahSalt Lake CityUtahUSA
- Department of Nutrition and Integrative PhysiologyUniversity of UtahSalt Lake CityUtahUSA
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Dillon KN, Kang Y, Maharaj A, Martinez MA, Fischer SM, Figueroa A. L-Citrulline supplementation attenuates aortic pressure and pressure waves during metaboreflex activation in postmenopausal women. Br J Nutr 2024; 131:474-481. [PMID: 37664994 DOI: 10.1017/s000711452300199x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Postmenopausal women have augmented pressure wave responses to low-intensity isometric handgrip exercise (IHG) due to an overactive metaboreflex (postexercise muscle ischaemia, PEMI), contributing to increased aortic systolic blood pressure (SBP). Menopause-associated endothelial dysfunction via arginine (ARG) and nitric oxide deficiency may contribute to exaggerated exercise SBP responses. L-Citrulline supplementation (CIT) is an ARG precursor that decreases SBP, pulse pressure (PP) and pressure wave responses to cold exposure in older adults. We investigated the effects of CIT on aortic SBP, PP, and pressure of forward (Pf) and backward (Pb) waves during IHG and PEMI in twenty-two postmenopausal women. Participants were randomised to CIT (10 g/d) or placebo (PL) for 4 weeks. Aortic haemodynamics were assessed via applanation tonometry at rest, 2 min of IHG at 30 % of maximal strength, and 3 min of PEMI. Responses were analysed as change (Δ) from rest to IHG and PEMI at 0 and 4 weeks. CIT attenuated ΔSBP (−9 ± 2 v. −1 ± 1 mmHg, P = 0·006), ΔPP (−5 ± 2 v. 0 ± 1 mmHg, P = 0·03), ΔPf (−6 ± 2 v. −1 ± 1 mmHg, P = 0·01) and ΔPb (−3 ± 1 v. 0 ± 1 mmHg, P = 0·02) responses to PEMI v. PL. The ΔPP during PEMI was correlated with ΔPf (r = 0·743, P < 0·001) and ΔPb (r = 0·724, P < 0·001). Citrulline supplementation attenuates the increase in aortic pulsatile load induced by muscle metaboreflex activation via reductions in forward and backward pressure wave amplitudes in postmenopausal women.
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Affiliation(s)
- Katherine N Dillon
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Yejin Kang
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Arun Maharaj
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mauricio A Martinez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Stephen M Fischer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Arturo Figueroa
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
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Stock JM, Shenouda N, Chouramanis NV, Patik JC, Martens CR, Farquhar WB, Chirinos JA, Edwards DG. Effect of acute handgrip and aerobic exercise on wasted pressure effort and arterial wave reflections in healthy aging. Am J Physiol Heart Circ Physiol 2023; 325:H617-H628. [PMID: 37477688 PMCID: PMC10642996 DOI: 10.1152/ajpheart.00133.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023]
Abstract
Aging increases arterial stiffness and wave reflections that augment left ventricular wasted pressure effort (WPE). A single bout of exercise may be effective at acutely reducing WPE via reductions in arterial wave reflections. In young adults (YA) acute aerobic exercise decreases, whereas handgrip increases, wave reflections. Whether acute exercise mitigates or exacerbates WPE and arterial wave reflection in healthy aging warrants further examination. The purpose of this study was to determine if there are age-related differences in WPE and wave reflection during acute handgrip and aerobic exercise. When compared with baseline, WPE increased substantially in older adults (OA) during handgrip (5,219 ± 2,396 vs. 7,019 ± 2,888 mmHg·ms, P < 0.001). When compared with baseline, there was a robust reduction in WPE in OA during moderate-intensity aerobic exercise (5,428 ± 2,084 vs. 3,290 ± 1,537 mmHg·ms, P < 0.001), despite absolute WPE remaining higher in OA compared with YA during moderate-intensity aerobic exercise (OA 3,290 ± 1,537 vs. YA 1,188 ± 962 mmHg·ms, P < 0.001). There was no change in wave reflection timing indexed to ejection duration in OA during handgrip (40 ± 6 vs. 38 ± 4%, P = 0.41) or moderate-intensity aerobic exercise (40 ± 5 vs. 42 ± 8%, P = 0.99). Conversely, there was an earlier return of wave reflection in YA during handgrip (60 ± 11 vs. 52 ± 6%, P < 0.001) and moderate-intensity aerobic exercise (59 ± 7 vs. 51 ± 9%, P < 0.001). Changes in stroke volume were not different between groups during handgrip (P = 0.08) or aerobic exercise (P = 0.47). The greater increase in WPE during handgrip and decrease in WPE during aerobic exercise suggest that aortic hemodynamic responses to acute exercise are exaggerated with healthy aging without affecting stroke volume.NEW & NOTEWORTHY We demonstrated that acute aerobic exercise attenuated, whereas handgrip augmented, left ventricular hemodynamic load from wave reflections more in healthy older (OA) compared with young adults (YA) without altering stroke volume. These findings suggest an exaggerated aortic hemodynamic response to acute exercise perturbations with aging. They also highlight the importance of considering exercise modality when examining aortic hemodynamic responses to acute exercise in older adults.
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Affiliation(s)
- Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Ninette Shenouda
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Nicholas V Chouramanis
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Jordan C Patik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Christopher R Martens
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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Piccioli F, Li Y, Valiani A, Caleffi V, Chowienczyk P, Alastruey J. Cardiac contractility is a key factor in determining pulse pressure and its peripheral amplification. Front Cardiovasc Med 2023; 10:1197842. [PMID: 37424904 PMCID: PMC10326904 DOI: 10.3389/fcvm.2023.1197842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background Arterial stiffening and peripheral wave reflections have been considered the major determinants of raised pulse pressure (PP) and isolated systolic hypertension, but the importance of cardiac contractility and ventricular ejection dynamics is also recognised. Methods We examined the contributions of arterial compliance and ventricular contractility to variations in aortic flow and increased central (cPP) and peripheral (pPP) pulse pressure, and PP amplification (PPa) in normotensive subjects during pharmacological modulation of physiology, in hypertensive subjects, and in silico using a cardiovascular model accounting for ventricular-aortic coupling. Reflections at the aortic root and from downstream vessels were quantified using emission and reflection coefficients, respectively. Results cPP was strongly associated with contractility and compliance, whereas pPP and PPa were strongly associated with contractility. Increased contractility by inotropic stimulation increased peak aortic flow (323.9 ± 52.8 vs. 389.1 ± 65.1 ml/s), and the rate of increase (3193.6 ± 793.0 vs. 4848.3 ± 450.4 ml/s2) in aortic flow, leading to larger cPP (36.1 ± 8.8 vs. 59.0 ± 10.8 mmHg), pPP (56.9 ± 13.1 vs. 93.0 ± 17.0 mmHg) and PPa (20.8 ± 4.8 vs. 34.0 ± 7.3 mmHg). Increased compliance by vasodilation decreased cPP (62.2 ± 20.2 vs. 45.2 ± 17.8 mmHg) without altering d P / d t , pPP or PPa. The emission coefficient changed with increasing cPP, but the reflection coefficient did not. These results agreed with in silico data obtained by independently changing contractility/compliance over the range observed in vivo. Conclusions Ventricular contractility plays a key role in raising and amplifying PP, by altering aortic flow wave morphology.
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Affiliation(s)
| | - Ye Li
- King’s College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas’ Hospital, London, United Kingdom
| | | | - Valerio Caleffi
- Department of Engineering, University of Ferrara, Ferrara, Italy
| | - Phil Chowienczyk
- King’s College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas’ Hospital, London, United Kingdom
| | - Jordi Alastruey
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St. Thomas’ Hospital, London, United Kingdom
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Jeong JH, Lee B, Hong J, Yang TH, Park YH. Reproduction of human blood pressure waveform using physiology-based cardiovascular simulator. Sci Rep 2023; 13:7856. [PMID: 37188872 DOI: 10.1038/s41598-023-35055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
This study presents a cardiovascular simulator that mimics the human cardiovascular system's physiological structure and properties to reproduce the human blood pressure waveform. Systolic, diastolic blood pressures, and its waveform are key indicators of cardiovascular health. The blood pressure waveform is closely related to the pulse wave velocity and the overlap of the forward and reflected pressure waves. The presented cardiovascular simulator includes an artificial aorta made of biomimetic silicone. The artificial aorta has the same shape and stiffness as the human standard and is encased with a compliance chamber. The compliance chamber prevents distortion of the blood pressure waveform from strain-softening by applying extravascular pressure. The blood pressure waveform reproduced by the simulator has a pressure range of 80-120 mmHg, a pulse wave velocity of 6.58 m/s, and an augmentation index of 13.3%. These values are in the middle of the human standard range, and the reproduced blood pressure waveform is similar to that of humans. The errors from the human standard values are less than 1 mmHg for blood pressure, 0.05 m/s for pulse wave velocity, and 3% for augmentation index. The changes in blood pressure waveform according to cardiovascular parameters, including heart rate, stroke volume, and peripheral resistance, were evaluated. The same pressure ranges and trends as in humans were observed for systolic and diastolic blood pressures according to cardiovascular parameters.
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Affiliation(s)
- Jae-Hak Jeong
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Bomi Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Junki Hong
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Tae-Heon Yang
- Department of Electronic Engineering, Korea National University of Transportation, Chungju-si, Republic of Korea
| | - Yong-Hwa Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea.
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Kang Y, Maharaj A, Dillon KN, Fischer SM, Figueroa A. Menopause influences aortic pulse pressure and pressure wave responses to metaboreflex activation in women. Menopause 2022; 29:1423-1429. [PMID: 36194846 DOI: 10.1097/gme.0000000000002078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Postmenopausal women (post-MW) have greater risk of heart failure due to aortic pulsatile overload on the left ventricle associated with increased backward wave pressure (Pb). Post-MW have exaggerated peripheral blood pressure (BP) response to exercise mediated by metaboreflex (postexercise muscle ischemia [PEMI]) overactivation. Increased forward wave pressure (Pf) and Pb are determinants of aortic pulse pressure (PP) during isometric handgrip exercis (IHG) in young adults. We hypothesized that aortic PP and pressure wave responses to PEMI are augmented in nonhypertensive post-MW compared with premenopausal women (pre-MW). METHODS Aortic BP, Pf, Pb, and reflection magnitude were assessed at rest and during IHG and PEMI by applanation tonometry in 15 pre-MW and 16 post-MW. RESULTS Aortic systolic BP during PEMI similarly increased in both groups. The increase in diastolic BP was lower in post-MW (post-MW Δ6 ± 2 vs pre-MW Δ11 ± 2 mm Hg, P < 0.05). Aortic PP (post-MW Δ8 ± 2 vs pre-MW Δ3 ± 2), Pf (post-MW Δ6 ± 1 vs pre-MW Δ0 ± 1), and Pb (post-MW Δ5 ± 1 vs pre-MW Δ2 ± 1) augmented during PEMI in post-MW ( P < 0.05 for all), but not in pre-MW. Reflection magnitude increased during PEMI only in pre-MW (pre-MW Δ7 ± 2 vs post-MW Δ-1 ± 2, P < 0.05) due to concurrent increases in Pf and Pb in post-MW. CONCLUSIONS Even in nonhypertensive postmenopausal women, increases in Pf and Pb and decrease in aortic DBP are important factors that contribute to the augmented aortic PP response to PEMI.
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Affiliation(s)
- Yejin Kang
- From the Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX
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Obayashi M, Kobayashi S, Nanno T, Hamada Y, Yano M. Relation between Oscillometric Measurement of Central Hemodynamics and Left Ventricular Hypertrophy in Hypertensive Patients. Pulse (Basel) 2022; 9:116-124. [PMID: 35083178 DOI: 10.1159/000520006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction The augmentation index (AIx) or central systolic blood pressure (SBP), measured by radial applanation tonometry, has been reported to be independently associated with left ventricular hypertrophy (LVH) in Japanese hypertensive patients. Cuff-based oscillometric measurement of the AIx using Mobil-O-Graph® showed a low or moderate agreement with the AIx measurement with other devices. Methods The AIx measured using the Mobil-O-Graph was validated against the tonometric measurements of the radial AIx measured using HEM-9000AI in 110 normotensive healthy individuals (age, 21-76 years; 50 men). We investigated the relationship between the central hemodynamics assessed using the Mobil-O-Graph and LVH in 100 hypertensive patients (age, 54-75 years; 48 men), presenting a wall thickness of ≥11 mm and ≥10 mm in men and women, respectively. Results Although the Mobil-O-Graph-measured central AIx showed no negative values, it correlated moderately with the HEM-9000AI-measured radial AIx (r = 0.602, p < 0.001) in the normotensive individuals. The hypertensive patients did not show a significant difference in the central SBP between the sexes, but the central AIx was lower in men than in women. The independent determinants influencing left ventricle (LV) mass index (LVMI) (R2 = 0.362; adjusted R2 = 0.329, p < 0.001) were heart rate (β = -0.568 ± 0.149, p < 0.001), central SBP (β = 0.290 ± 0.100, p = 0.005), and aortic root diameter (β = 1.355 ± 0.344, p = 0.001). Age (β = -0.025 ± 0.124, p = 0.841) and the central AIx (β = 0.120 ± 0.131, p = 0.361) were not independently associated with the LVMI. The area under the receiver operator characteristic curve to evaluate the diagnostic performance of the central AIx for the presence of LVH (LVMI >118 g/m2 in men or >108 g/m2 in women) was statistically significant in men (0.875, p < 0.001) but not in women (0.622, p = 0.132). In men, a central AIx of 28.06% had a sensitivity of 83.3% and specificity of 80.0% for detecting LVH. Conclusions AIx measurement in men provided useful prognostic information for the presence of LVH. Pulse-wave analysis assessed using the Mobil-O-Graph may be a valuable tool for detecting LVH in hypertensive patients.
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Affiliation(s)
- Masakazu Obayashi
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Shigeki Kobayashi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takuma Nanno
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Yoriomi Hamada
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Ministro G, Castaño JB, Barboza CA, Moura EG, Ferreira-Melo SE, Mostarda CT, Fattori A, Moreno-Junior H, Rodrigues B. ACUTE TRANSCRANIAL DIRECT CURRENT STIMULATION (tDCS) IMPROVES VENTILATORY VARIABILITY AND AUTONOMIC MODULATION IN RESISTANT HYPERTENSIVE PATIENTS. Respir Physiol Neurobiol 2021; 297:103830. [PMID: 34915178 DOI: 10.1016/j.resp.2021.103830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
Here, we assessed the impact of one session of transcranial direct current stimulation (tDCS) or SHAM (20 min, each) on ventilatory responses to cardiopulmonary exercise test, central and peripheral blood pressure (BP), and autonomic modulation in resistant hypertensive (RHT) patients. RHT subjects (n = 13) were randomly submitted to SHAM and tDCS crossing sessions (1 week of "washout"). Patients and a technician who set the tDCS/Sham room up were both blind. After brain stimulation, patients were submitted to a cardiopulmonary exercise test to evaluate ventilatory and cardiovascular response to exercise. Hemodynamic (Finometer®, Beatscope), and autonomic variables were measured at baseline (before tDCS/Sham) and after incremental exercise. RESULTS: Our study shows that tDCS condition improved heart rate recovery, VO2 peak, and vagal modulation (after cardiopulmonary exercise test); attenuated the ventilatory variability response, central and peripheral blood pressure well as sympathetic modulation (after cardiopulmonary exercise test) in comparison with SHAM. These data suggest that acute tDCS sessions prevented oscillatory ventilation behavior during the cardiopulmonary exercise test and mitigated the increase of systolic blood pressure in RHT patients. After the exercise test, tDCS promotes better vagal reentry and improved autonomic modulation, possibly reducing central blood pressure and aortic augmentation index compared to SHAM. Brazilian Registry of Clinical Trials (ReBEC): https://ensaiosclinicos.gov.br/rg/RBR-8n7c9p.
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Affiliation(s)
- Gabriela Ministro
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Javier B Castaño
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Catarina A Barboza
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Eliezer G Moura
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Silvia E Ferreira-Melo
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - André Fattori
- Department of Clinical Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Heitor Moreno-Junior
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Bruno Rodrigues
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil; Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Pradhan A, Scaringi J, Gerard P, Arena R, Myers J, Kaminsky LA, Kung E. Systematic Review and Regression Modeling of the Effects of Age, Body Size, and Exercise on Cardiovascular Parameters in Healthy Adults. Cardiovasc Eng Technol 2021; 13:343-361. [PMID: 34668143 DOI: 10.1007/s13239-021-00582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Blood pressure, cardiac output, and ventricular volumes correlate to various subject features such as age, body size, and exercise intensity. The purpose of this study is to quantify this correlation through regression modeling. METHODS We conducted a systematic review to compile reference data of healthy subjects for several cardiovascular parameters and subject features. Regression algorithms used these aggregate data to formulate predictive models for the outputs-systolic and diastolic blood pressure, ventricular volumes, cardiac output, and heart rate-against the features-age, height, weight, and exercise intensity. A simulation-based procedure generated data of virtual subjects to test whether these regression models built using aggregate data can perform well for subject-level predictions and to provide an estimate for the expected error. The blood pressure and heart rate models were also validated using real-world subject-level data. RESULTS The direction of trends between model outputs and the input subject features in our study agree with those in current literature. CONCLUSION Although other studies observe exponential predictor-output relations, the linear regression algorithms performed the best for the data in this study. The use of subject-level data and more predictors may provide regression models with higher fidelity. SIGNIFICANCE Models developed in this study can be useful to clinicians for personalized patient assessment and to researchers for tuning computational models.
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Affiliation(s)
- Aseem Pradhan
- Department of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | - John Scaringi
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Patrick Gerard
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being and Clinical Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Ethan Kung
- Department of Mechanical Engineering, Clemson University, Clemson, SC, USA.
- Department of Bioengineering, Clemson University, Clemson, SC, USA.
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Schultz MG, La Gerche A, Sharman JE. Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing. Exerc Sport Sci Rev 2021; 50:25-30. [PMID: 34669623 DOI: 10.1249/jes.0000000000000276] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We propose that for correct clinical interpretation of exaggerated exercise blood pressure (EEBP), both cardiorespiratory fitness and exercise workload must be considered. A key recommendation towards achieving the correct clinical interpretation of EEBP is that exercise BP should be measured during submaximal exercise with a fixed external workload.
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Affiliation(s)
- Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia Baker Institute, Melbourne, Australia
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11
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Stock JM, Chirinos JA, Edwards DG. Lower-body dynamic exercise reduces wave reflection in healthy young adults. Exp Physiol 2021; 106:1720-1730. [PMID: 33999464 DOI: 10.1113/ep089581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/14/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? There is a paradoxical reduction in augmentation index during lower-body dynamic (LBD) exercise in the face of an increase in central pressure. To determine causality, the amplitudes of forward and backward pressure waves were assessed separately using wave separation analysis. What is the main finding and its importance? Reflection magnitude decreased during LBD exercise in healthy young adults and was attributable to an increased forward pressure wave amplitude and decreased backward pressure wave amplitude. This vasoactive response might limit the adverse effects of wave reflection during LBD exercise, optimizing ventricular-arterial interactions. ABSTRACT Acute lower-body dynamic (LBD) exercise decreases surrogate measures of wave reflection, such as the augmentation index. However, the augmentation index is influenced by the combined effects of wave reflection timing, magnitude and other confounding factors external to wave reflection, which make it difficult to discern the origin of changes in surrogate measures. The relative contributions of forward (Pf) and backward (Pb) pressure wave amplitudes to central pressure can be determined by wave separation analysis. Reflection magnitude (RM = Pb/Pf) and the timing of apparent wave reflection return can also be determined. We tested the hypothesis that acute LBD exercise decreases RM and reflected wave transit time (RWTT). Applanation tonometry was used to record radial artery pressure waveforms in 25 adults (24 ± 4 years of age) at baseline and during light-, moderate- and vigorous-intensity exercise. Wave separation analysis was conducted offline using a personalized physiological flow wave to determine Pf, Pb, RM and RWTT. The RM decreased during all intensities of exercise compared with baseline (all P < 0.001; baseline, 43 ± 5%; light, 33 ± 6%; moderate, 23 ± 7%; vigorous, 17 ± 5%). The reduction in RM was attributable to the combined effect of increased Pf and decreased Pb during exercise. The RWTT decreased during all intensities of exercise compared with baseline (all P < 0.04; baseline, 156 ± 17 ms; light, 144 ± 15 ms; moderate, 129 ± 16 ms; vigorous, 121 ± 17 ms). Lastly, in a stepwise multilinear regression, Pf, but not Pb and RWTT, contributed to increased central pulse pressure during LBD exercise. These data show that wave reflection decreased and that central pulse pressure is most influenced by Pf during LBD exercise.
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Affiliation(s)
- Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
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12
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Tsai TY, Cheng HM, Chuang SY, Chia YC, Soenarta AA, Minh HV, Siddique S, Turana Y, Tay JC, Kario K, Chen CH. Isolated systolic hypertension in Asia. J Clin Hypertens (Greenwich) 2020; 23:467-474. [PMID: 33249701 PMCID: PMC8029528 DOI: 10.1111/jch.14111] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 11/04/2020] [Indexed: 01/09/2023]
Abstract
Isolated systolic hypertension (ISH) is the most common type of essential hypertension in the elderly and young adults. With rapid industrialization and population aging, the prevalence of ISH in Asia will rise substantially. Asian populations have distinct epidemiological features, risk factors and are especially vulnerable to ISH. There is a pressing need for Asian countries to formulate their unique strategies for control of ISH. In this review, we focus on the (1) epidemiology and pathophysiology, (2) risk factors and impact on outcomes, and (3) treatment goal and strategy for ISH in Asia.
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Affiliation(s)
- Tsung-Ying Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya Kuala, Lumpur, Malaysia
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Harapan Kita, University of Indonesia-National Cardiovascular Center, Jakarta, Indonesia
| | - Huynh Van Minh
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | | | - Yuda Turana
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Chen-Huan Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
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13
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Stock JM, Chouramanis NV, Chirinos JA, Edwards DG. Dynamic and isometric handgrip exercise increases wave reflection in healthy young adults. J Appl Physiol (1985) 2020; 129:709-717. [PMID: 32853105 PMCID: PMC7654685 DOI: 10.1152/japplphysiol.00281.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023] Open
Abstract
Early return and increased magnitude of wave reflection augments pulsatile load, wastes left ventricular effort, and is associated with cardiovascular events. Acute handgrip (HG) exercise increases surrogate measures of wave reflection such as augmentation index. However, augmentation index does not allow distinguishing between timing versus magnitude of wave reflection and is affected by factors other than wave reflection per se. Wave separation analysis decomposes central pressure into relative contributions of forward (Pf) and backward (Pb) pressure wave amplitudes to calculate reflection magnitude (RM = Pb/Pf) and determine the timing of apparent wave reflection return. We tested the hypothesis that acute dynamic and isometric HG exercise increases RM and decreases reflected wave transit time (RWTT). Applanation tonometry was used to record radial artery pressure waveforms in 30 adults (25 ± 4 yr) at baseline and during dynamic and isometric HG exercise. Wave separation analysis was performed offline using a physiological flow wave to derive Pf, Pb, RM, and RWTT. We found that RM increased during dynamic and isometric HG exercise compared with baseline (P = 0.04 and P < 0.01, respectively; baseline 40 ± 5, dynamic 43 ± 6, isometric 43 ± 7%). Meanwhile, RWTT decreased during dynamic and isometric HG exercise compared with baseline (P = 0.03 and P < 0.001, respectively; baseline 164 ± 23, dynamic 155 ± 23, isometric 148 ± 20 ms). Moreover, the changes in RM and RWTT were not different between dynamic and isometric HG exercise. The present data suggest that wave reflection timing (RWTT) and magnitude (RM) are important factors that contribute to increased central blood pressure during HG exercise.NEW & NOTEWORTHY This study demonstrated that wave reflection magnitude is increased while reflected wave transit time is decreased during handgrip exercise in healthy young adults. The larger backward pressure waves and earlier return of these pressure waves were not different between dynamic and isometric handgrip exercise. These acute changes in wave reflection during handgrip exercise transiently augment pulsatile load.
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Affiliation(s)
- Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Nicholas V Chouramanis
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
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14
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Tagawa K, Nakata Y, Yokota A, Sato T, Maeda S. Music attenuates a widened central pulse pressure caused by resistance exercise: A randomized, single-blinded, sham-controlled, crossover study. Eur J Sport Sci 2020; 21:1225-1233. [PMID: 32859143 DOI: 10.1080/17461391.2020.1817153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Increasing central blood pressure is an independent predictor of cardiovascular disease and is an acute effect of high-intensity resistance exercise. It has been shown that classical music suppresses increased peripheral pressure during exercise. We hypothesized that classical music would suppress increased central pressure induced by high-intensity resistance exercise. To confirm this hypothesis, we examined the effect of classical music on central pressure following high-intensity resistance exercise in 18 young men. A randomized, single-blinded, sham-controlled, crossover trial was conducted under parallel experimental conditions on four separate days. The order of experiments was randomized between sham control (seated rest), music (20-min classical music track compilation), resistance exercise (5 sets of 10 repetitions at 75% of 1 repetition maximum), and resistance exercise with music conditions. Aortic pressure was measured in all subjects. No significant interaction between time, music, and resistance exercise was observed for aortic systolic pressure and diastolic pressure. In contrast, aortic pulse pressure showed a significant interaction; that is, aortic pulse pressure significantly widened after resistance exercise, whereas music significantly attenuated this widening. No significant change was observed in aortic pulse pressure in sham control and music conditions. The present findings suggest that music attenuates resistance exercise-induced increase in central pressure.
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Affiliation(s)
- Kaname Tagawa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.,Graduate School of Education, Miyagi University of Education, Sendai, Japan
| | - Yoshio Nakata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Atsumu Yokota
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tomohito Sato
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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15
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Cooke AB, Dasgupta K, Spronck B, Sharman JE, Daskalopoulou SS. Adults With Type 2 Diabetes Mellitus Exhibit a Greater Exercise-Induced Increase in Arterial Stiffness and Vessel Hemodynamics. Hypertension 2020; 75:1565-1573. [DOI: 10.1161/hypertensionaha.120.14778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Individuals with type 2 diabetes mellitus (T2DM) have a greater blood pressure (BP) response to acute maximal exercise compared to those without T2DM; however, whether they exhibit a different arterial stiffness response to maximal exercise has yet to be explored. Adults with (n=66) and without T2DM (n=61) underwent an arterial stress test: at rest and immediately postexercise, carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness, brachial BP, heart rate, and other hemodynamic measurements were assessed. Linear regression models were used to evaluate between-group differences at rest, and the response to exercise (postexercise value), adjusting for covariates including BP and heart rate when relevant, and the corresponding baseline value of each parameter. All participants (mean±SD: age 59.3±10.6 years; body mass index 31.2±3.9 kg/m
2
) had hypertension (mean BP 130±14/80±9 mm Hg). At rest, participants with T2DM had significantly higher carotid-femoral pulse wave velocity (10.3±2.7 versus 9.1±1.9 m/s), heart rate (69±11 versus 66±10 beats/min), and lower diastolic BP (79±9 versus 83±9 mm Hg), but systolic BP (129±15 versus 131±13 mm Hg) was similar. In response to exercise, participants with T2DM showed greater increases in carotid-femoral pulse wave velocity (1.6 [95% CI, 0.4–2.9 m/s]) and systolic BP (9 [95% CI, 1–17 mm Hg]) than participants without T2DM. A greater proportion of participants with T2DM had a hypertensive response to exercise compared to participants without T2DM (n=23, 35% versus n=11, 18%;
P
=0.033). By incorporating exercise as a vascular stressor, we provide evidence of a greater increase in arterial stiffness in individuals with T2DM, independently of resting arterial stiffness, and the BP postexercise.
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Affiliation(s)
- Alexandra B. Cooke
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (A.B.C., K.D.), McGill University, Montreal, QC, Canada
| | - Kaberi Dasgupta
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (A.B.C., K.D.), McGill University, Montreal, QC, Canada
| | - Bart Spronck
- Department of Biomedical Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT (B.S.)
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, the Netherlands (B.S.)
| | - James E. Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia (J.E.S.)
| | - Stella S. Daskalopoulou
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
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16
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Sarma S, Howden E, Carrick-Ranson G, Lawley J, Hearon C, Samels M, Everding B, Livingston S, Adams-Huet B, Palmer MD, Levine BD. Elevated exercise blood pressure in middle-aged women is associated with altered left ventricular and vascular stiffness. J Appl Physiol (1985) 2020; 128:1123-1129. [PMID: 32240019 DOI: 10.1152/japplphysiol.00458.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Women are at higher risk for developing heart failure with preserved ejection fraction (HFpEF). We examined the utility of peak exercise blood pressure (BP) in identifying preclinical features of HFpEF, namely vascular and cardiac stiffness in middle-aged women. We studied 47 healthy, nonobese middle-aged women (53 ± 5 yr). Oxygen uptake (V̇o2) and BP were assessed at rest and maximal treadmill exercise. Resting cardiac function and stiffness were assessed by echocardiography and invasive measurement (right heart catheterization) of left ventricular (LV) filling pressure under varying preloads. LV stiffness was calculated by curve fit of the diastolic portion of the pressure-volume curve. Aortic pulse-wave velocity was measured by arterial tonometry. Body fat was measured using dual-energy X-ray absorptiometry. Subjects in the highest exercise BP tertile had peak systolic BP of 201 ± 11 compared with 142 ± 19 mmHg in the lowest tertile (P < 0.001). Higher exercise BP was associated with increased age, percentage body fat, smaller LV size, slower LV relaxation, and increased LV and vascular stiffness. After adjustment, LV and arterial stiffness remained significantly associated with peak exercise BP. There was a trend toward increased body fat and slowed LV relaxation (both P < 0.07). In otherwise healthy middle-aged women, elevated exercise BP was independently associated with increased vascular stiffness and a smaller, stiffer LV, functional and structural risk factors characteristic for stages A and B HFpEF.NEW & NOTEWORTHY Women are at increased risk for heart failure with preserved ejection fraction (HFpEF) largely due to higher prevalence of arterial and cardiac stiffening. We were able to identify several subclinical markers of early (stages A and B) HFpEF pathophysiology largely on the basis of exercise blood pressure (BP) response in otherwise healthy middle-aged women. Exercise BP response may be an inexpensive screening tool to identify women at highest risk for developing future HFpEF.
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Affiliation(s)
- Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas, Dallas, Texas
| | - Erin Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Justin Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Christopher Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Braden Everding
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Sheryl Livingston
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Beverley Adams-Huet
- Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas, Dallas, Texas
| | - M Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas, Dallas, Texas
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17
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Figueroa A, Maharaj A, Johnson SA, Fischer SM, Arjmandi BH, Jaime SJ. Exaggerated Aortic Pulse Pressure and Wave Amplitude During Muscle Metaboreflex Activation in Type 2 Diabetes Patients. Am J Hypertens 2020; 33:70-76. [PMID: 31877218 DOI: 10.1093/ajh/hpz135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/25/2019] [Accepted: 08/09/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peripheral mean arterial pressure (MAP) responses to muscle metaboreflex activation using postexercise muscle ischemia (PEMI) in type 2 diabetes patients (T2D) are contradictory. Given that aortic pulse pressure (PP) and wave reflections are better indicators of cardiac load than peripheral MAP, we evaluated aortic blood pressure (BP) and wave amplitude during PEMI. METHODS Aortic BP and pressure wave amplitudes were measured at rest and during PEMI following isometric handgrip at 30% maximum voluntary contraction (MVC) in 16 T2D and 15 controls. Resting aortic stiffness (carotid-femoral pulse wave velocity, cfPWV) and fasting blood glucose (FBG) were measured. RESULTS Increases in aortic MAP (Δ26 ± 2 mmHg vs. Δ17 ± 2 mmHg), PP (Δ15 ± 2 mmHg vs. Δ10 ± 1 mmHg), augmentation index (AIx) (Δ8.2 ± 1.0% vs. Δ4.5 ± 1.3%), augmented pressure (AP) (Δ11 ± 1 mmHg vs. Δ5 ± 1 mmHg), forward (Pf) (Δ9 ± 1 mmHg vs. Δ5 ± 1 mmHg), and backward pressure waves (Pb) (Δ10 ± 1 mmHg vs. Δ5 ± 1 mmHg) responses to PEMI were greater in T2D than controls (P < 0.05). Aortic PP, but not MAP, response to PEMI was correlated to Pf (r = 0.63, P < 0.001) and Pb (r = 0.82, P < 0.001) responses and cfPWV (r = 0.37, P < 0.05). CONCLUSIONS Aortic BP and pressure wave responses to muscle metaboreflex activation are exaggerated in T2D. Aortic PP during PEMI was related to increased wave reflection, forward wave amplitude, and aortic stiffness in T2D patients.
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Affiliation(s)
- Arturo Figueroa
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Arun Maharaj
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Sarah A Johnson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - Stephen M Fischer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Bahram H Arjmandi
- Department of Nutrition, Food, and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
| | - Salvador J Jaime
- Department of Exercise and Sport Science, University of Wisconsin–La Crosse, La Crosse, Wisconsin, USA
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18
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Tsao CW, Washington F, Musani SK, Cooper LL, Tripathi A, Hamburg NM, Benjamin EJ, Vasan RS, Mitchell GF, Fox ER. Clinical Correlates of Aortic Stiffness and Wave Amplitude in Black Men and Women in the Community. J Am Heart Assoc 2019; 7:e008431. [PMID: 30608191 PMCID: PMC6404204 DOI: 10.1161/jaha.117.008431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Black individuals have greater risk for cardiovascular disease (CVD) than whites. Identifying CVD risk factors associated with abnormal aortic hemodynamics in blacks may optimize CVD prevention and treatment strategies. Methods and Results Jackson Heart Study participants underwent applanation tonometry (2011–2016) with assessment of carotid‐femoral pulse wave velocity (CFPWV) and forward wave amplitude (FWA). CVD risk factors were assessed during examination 3 (2009–2012). We examined the association of risk factors with binary and continuous CFPWV and FWA in multivariable stepwise models. We evaluated for effect modification by sex to determine differential associations of risk factors with aortic hemodynamics in men and women. We examined 1322 individuals (mean age 66±11 years, 66% women). Age was strongly associated with elevated CFPWV (odds ratio, 4.76; 95% confidence interval, 3.84–5.89 [P<0.0001]) and FWA (odds ratio, 2.30; 95% CI, 1.98–2.69 [P<0.0001]). Men had greater odds of elevated CFPWV compared with women (odds ratio, 1.54; 95% confidence interval, 1.11–2.13 [P=0.009]). Heart rate, mean arterial pressure, and use of antihypertensive medications were associated with elevated CFPWV and FWA (all P≤0.02). Additionally, total/high‐density lipoprotein cholesterol and fasting glucose were associated with elevated CFPWV (both P≤0.002) and use of diabetes mellitus medications was associated with elevated FWA (P≤0.0001). We observed a steeper association of age and mean arterial pressure with unfavorable aortic hemodynamics in women than men. Conclusions In blacks in the community, differential CVD risk factors are associated with aortic stiffness and FWA. Future work may determine the impact of risk factor modification on abnormal central aortic hemodynamics and CVD outcomes.
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Affiliation(s)
- Connie W Tsao
- 1 Division of Cardiovascular Department of Medicine Beth Israel Deaconess Medical Center Boston MA
| | - Floyd Washington
- 2 Division of Cardiovascular Disease University of Mississippi Medical Center and the Jackson Heart Study Jackson MS
| | - Solomon K Musani
- 2 Division of Cardiovascular Disease University of Mississippi Medical Center and the Jackson Heart Study Jackson MS
| | | | - Avnish Tripathi
- 4 Division of Cardiovascular Medicine University of Louisville Medical Center Louisville Kentucky
| | - Naomi M Hamburg
- 5 Department of Medicine Sections of Cardiology and Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA
| | - Emelia J Benjamin
- 5 Department of Medicine Sections of Cardiology and Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA
| | - Ramachandran S Vasan
- 5 Department of Medicine Sections of Cardiology and Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA
| | | | - Ervin R Fox
- 2 Division of Cardiovascular Disease University of Mississippi Medical Center and the Jackson Heart Study Jackson MS
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19
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Sex differences in excess and reservoir arterial blood pressures as markers of phenotype. J Hypertens 2019; 37:2159-2167. [DOI: 10.1097/hjh.0000000000002135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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20
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Myocardial preload alters central pressure augmentation through changes in the forward wave. J Hypertens 2019; 36:544-551. [PMID: 29016531 DOI: 10.1097/hjh.0000000000001583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Augmentation index (AIx) is often used to quantify the contribution of wave reflection to central pulse pressure. Recent studies have challenged this view by showing how contractility-induced changes in the forward pressure wave can markedly impact AIx. We hypothesized that changes in preload will also affect AIx through changes in the forward wave and studied this in two experiments. METHODS Noninvasively obtained aortic pressure was used to study central haemodynamics and wave morphology. In the first experiment, we examined the effects of head-up tilt with and without unilateral thigh cuff in 12 young healthy volunteers (mean age 26 years, 50% men). In the second experiment, we examined the effects of active standing in 31 middle-aged patients (mean age 57 years, 65% men) before and after phlebotomy. RESULTS Head-up tilt or active standing significantly decreased AIx [-17.7 ± 10.4 percentage point (pp) in the young population, -4.7 ± 12.3 pp in the middle-aged population, both P < 0.05]. The fall in AIx was associated with increases in HR, diastolic pressure and systemic vascular resistance and a decrease in stroke volume (all P < 0.05). Inflation of a unilateral thigh cuff reduced the decrease in AIx by 10.7 pp, whereas 500 ml of blood loss augmented the fall in AIx by 5.9 pp (both P < 0.05). The changes in AIx were related to a preload-induced change in forward pressure wave shape (earlier peaking and steeper downstroke). CONCLUSION Next to inotropic and chronotropic effects, preload emerges as another myocardial factor that obscures the relation between wave reflection and AIx.
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21
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Pomella N, Wilhelm EN, Kolyva C, González-Alonso J, Rakobowchuk M, Khir AW. Noninvasive assessment of the common carotid artery hemodynamics with increasing exercise work rate using wave intensity analysis. Am J Physiol Heart Circ Physiol 2018; 315:H233-H241. [PMID: 29569959 PMCID: PMC6139620 DOI: 10.1152/ajpheart.00667.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Noninvasively determined local wave speed (c) and wave intensity (WI) parameters provide insights into arterial stiffness and cardiac-vascular interactions in response to physiological perturbations. However, the effects of incremental exercise and subsequent recovery on c and WI have not been fully established. We examined the changes in c and WI parameters in the common carotid artery (CCA) during exercise and recovery in eight young, healthy male athletes. Ultrasound measurements of CCA diameter and blood flow velocity were acquired at rest, during five stages of incremental exercise (up to 70% maximum work rate), and throughout 1 h of recovery, and noninvasive WI analysis [diameter-velocity (DU) approach] was performed. During exercise, c increased (+136%), showing increased stiffness with work rate. All peak and area of forward compression, backward compression, and forward expansion waves increased during exercise (+452%, +700%, and +900%, respectively). However, WI reflection indexes and CCA resistance did not significantly change from rest to exercise. Furthermore, wave speed and the magnitude of all waves returned to baseline within 5 min of recovery, suggesting that the effects of exercise in the investigated parameters of young, healthy individuals were transient. In conclusion, incremental exercise was associated with an increase in local CCA stiffness and increases in all wave parameters, indicative of enhanced ventricular contractility and improved late-systolic blood flow deceleration. NEW & NOTEWORTHY We examined hemodynamics of the common carotid artery using noninvasive application of wave intensity analysis during exercise and recovery. The hemodynamic adjustments to exercise were associated with increases in local common carotid artery stiffness and all waves’ parameters, with the latter indicating enhanced ventricular contractility and improved late systolic blood flow deceleration.
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Affiliation(s)
- N Pomella
- Institute of Environment, Health and Societies, Biomedical Engineering Research Theme, Brunel University London , Middlesex , United Kingdom
| | - E N Wilhelm
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Middlesex , United Kingdom
| | - C Kolyva
- Institute of Environment, Health and Societies, Biomedical Engineering Research Theme, Brunel University London , Middlesex , United Kingdom
| | - J González-Alonso
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Middlesex , United Kingdom
| | - M Rakobowchuk
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Middlesex , United Kingdom
| | - A W Khir
- Institute of Environment, Health and Societies, Biomedical Engineering Research Theme, Brunel University London , Middlesex , United Kingdom
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22
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Su J, Manisty C, Parker KH, Simonsen U, Nielsen-Kudsk JE, Mellemkjaer S, Connolly S, Lim PB, Whinnett ZI, Malik IS, Watson G, Davies JE, Gibbs S, Hughes AD, Howard L. Wave Intensity Analysis Provides Novel Insights Into Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.006679. [PMID: 29089339 PMCID: PMC5721764 DOI: 10.1161/jaha.117.006679] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background In contrast to systemic hypertension, the significance of arterial waves in pulmonary hypertension (PH) is not well understood. We hypothesized that arterial wave energy and wave reflection are augmented in PH and that wave behavior differs between patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and Results Right heart catheterization was performed using a pressure and Doppler flow sensor–tipped catheter to obtain simultaneous pressure and flow velocity measurements in the pulmonary artery. Wave intensity analysis was subsequently applied to the acquired data. Ten control participants, 11 patients with PAH, and 10 patients with CTEPH were studied. Wave speed and wave power were significantly greater in PH patients compared with controls, indicating increased arterial stiffness and right ventricular work, respectively. The ratio of wave power to mean right ventricular power was lower in PAH patients than CTEPH patients and controls. Wave reflection index in PH patients (PAH: ≈25%; CTEPH: ≈30%) was significantly greater compared with controls (≈4%), indicating downstream vascular impedance mismatch. Although wave speed was significantly correlated to disease severity, wave reflection indexes of patients with mildly and severely elevated pulmonary pressures were similar. Conclusions Wave reflection in the pulmonary artery increased in PH and was unrelated to severity, suggesting that vascular impedance mismatch occurs early in the development of pulmonary vascular disease. The lower wave power fraction in PAH compared with CTEPH indicates differences in the intrinsic and/or extrinsic ventricular load between the 2 diseases.
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Affiliation(s)
- Junjing Su
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark .,National Heart and Lung Institute Imperial College London, London, United Kingdom
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | | | - Soren Mellemkjaer
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Susan Connolly
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - P Boon Lim
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Zachary I Whinnett
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Iqbal S Malik
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Geoffrey Watson
- National Heart and Lung Institute Imperial College London, London, United Kingdom
| | - Justin E Davies
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Simon Gibbs
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alun D Hughes
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Luke Howard
- National Heart and Lung Institute Imperial College London, London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
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Vennin S, Li Y, Willemet M, Fok H, Gu H, Charlton P, Alastruey J, Chowienczyk P. Identifying Hemodynamic Determinants of Pulse Pressure: A Combined Numerical and Physiological Approach. Hypertension 2017; 70:1176-1182. [PMID: 29084874 DOI: 10.1161/hypertensionaha.117.09706] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/28/2017] [Accepted: 10/04/2017] [Indexed: 01/21/2023]
Abstract
We examined the ability of a simple reduced model comprising a proximal characteristic impedance linked to a Windkessel element to accurately predict central pulse pressure (PP) from aortic blood flow, verified that parameters of the model corresponded to physical properties, and applied the model to examine PP dependence on cardiac and vascular properties. PP obtained from the reduced model was compared with theoretical values obtained in silico and measured values in vivo. Theoretical values were obtained using a distributed multisegment model in a population of virtual (computed) subjects in which cardiovascular properties were varied over the pathophysiological range. In vivo measurements were in normotensive subjects during modulation of physiology with vasoactive drugs and in hypertensive subjects. Central PP derived from the reduced model agreed with theoretical values (mean difference±SD, -0.09±1.96 mm Hg) and with measured values (mean differences -1.95±3.74 and -1.18±3.67 mm Hg for normotensive and hypertensive subjects, respectively). Parameters extracted from the reduced model agreed closely with theoretical and measured physical properties. Central PP was seen to be determined mainly by total arterial compliance (inversely associated with central arterial stiffness) and ventricular dynamics: the blood volume ejected by the ventricle into the aorta up to time of peak pressure and blood flow into the aorta (corresponding to the rate of ventricular ejection) up to this time point. Increased flow and volume accounted for 20.1 mm Hg (52%) of the 39.0 mm Hg difference in PP between the upper and lower tertiles of the hypertensive subjects.
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Affiliation(s)
- Samuel Vennin
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom
| | - Ye Li
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom
| | - Marie Willemet
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom
| | - Henry Fok
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom
| | - Haotian Gu
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom
| | - Peter Charlton
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom
| | - Jordi Alastruey
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom
| | - Phil Chowienczyk
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology (S.V., Y.L., H.F., H.G., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.V., Y.L., M.W., P.C., J.A.), King's College London, St Thomas' Hospital, London, United Kingdom.
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Kingsley JD, Tai YL, Vaughan JA, Mayo X. High-Intensity Interval Cycling Exercise on Wave Reflection and Pulse Wave Velocity. J Strength Cond Res 2017; 31:1313-1320. [PMID: 27548787 DOI: 10.1519/jsc.0000000000001598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Kingsley, JD, Tai, YL, Vaughan, J, and Mayo, X. High-intensity interval cycling exercise on wave reflection and pulse wave velocity. J Strength Cond Res 31(5): 1313-1320, 2017-The purpose of this study was to assess the effects of high-intensity exercise on wave reflection and aortic stiffness. Nine young, healthy men (mean ± SD: age: 22 ± 2 years) participated in the study. The high-intensity interval cycling exercise consisted of 3 sets of Wingate Anaerobic Tests (WATs) with 7.5% of bodyweight as resistance and 2 minutes of rest between each set. Measurements were taken at rest and 1 minute after completion of the WATs. Brachial and aortic blood pressures, as well as wave reflection characteristics, were measured through pulse wave analysis. Aortic stiffness was assessed through carotid-femoral pulse wave velocity (cfPWV). A repeated-measures analysis of variance was used to investigate the effects of the WATs on blood pressure and vascular function across time. There was no change in brachial or aortic systolic pressure from rest to recovery. There was a significant (p ≤ 0.05) decrease in brachial diastolic pressure (rest: 73 ± 6 mm Hg; recovery: 67 ± 9 mm Hg) and aortic diastolic pressure (rest: 75 ± 6 mm Hg; recovery: 70 ± 9 mm Hg) from rest to recovery. In addition, there was no significant change in the augmentation index (rest: 111.4 ± 6.5%; recovery: 109.8 ± 5.8%, p = 0.65) from rest to recovery. However, there was a significant (p ≤ 0.05) increase in the augmentation index normalized at 75 b·min (rest: 3.29 ± 9.82; recovery 21.21 ± 10.87) during recovery compared with rest. There was no change in cfPWV (rest: 5.3 ± 0.8 m·s; recovery: 5.7 ± 0.5m·s; p = 0.09) in response to the WAT. These data demonstrate that high-intensity interval cycling exercise with short rest periods has a nonsignificant effect on vascular function.
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Affiliation(s)
- J Derek Kingsley
- Cardiovascular Dynamics Laboratory, Exercise Physiology, Kent State University, Kent, Ohio
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Li Y, Gu H, Fok H, Alastruey J, Chowienczyk P. Forward and Backward Pressure Waveform Morphology in Hypertension. Hypertension 2017; 69:375-381. [PMID: 27920128 PMCID: PMC5222553 DOI: 10.1161/hypertensionaha.116.08089] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/22/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023]
Abstract
We tested the hypothesis that increased pulse wave reflection and altered backward waveform morphology contribute to increased pulse pressure in subjects with higher pulse pressure compared with lower pulse pressure and to actions of vasoactive drugs to increase pulse pressure. We examined the relationship of backward to forward wave morphology in 158 subjects who were evaluated for hypertension (including some normotensive subjects) divided into 3 groups by central pulse pressure: group 1, 33±6.5 mm Hg; group 2, 45±4.1 mm Hg; and group 3, 64±12.9 mm Hg (means±SD) and in healthy normotensive subjects during administration of inotropic and vasomotor drugs. Aortic pressure and flow in the aortic root were estimated by carotid tonometry and Doppler sonography, respectively. Morphology of the backward wave relative to the forward wave was similar in subjects in the lowest and highest tertiles of pulse pressure. Similar results were seen with the inotropic, vasopressor and vasodilator drugs, dobutamine, norepinephrine, and phentolamine, with the backward wave maintaining a constant ratio to the forward wave. However, nitroglycerin, a drug with a specific action to dilate muscular conduit arteries, reduced the amplitude of the backward wave relative to the forward wave from 0.26±0.018 at baseline to 0.19±0.019 during nitroglycerin 30 μg/min IV (P<0.01). These results are best explained by an approximately constant amount of reflection of the forward wave from the peripheral vasculature. The amount of reflection can be modified by dilation of peripheral muscular conduit arteries but contributes little to increased pulse pressure in hypertension.
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Affiliation(s)
- Ye Li
- From the British Heart Foundation Centre (Y.L., H.G., H.F., P.C.) and Division of Imaging Sciences and Biomedical Engineering (J.A.), King's College London, United Kingdom
| | - Haotian Gu
- From the British Heart Foundation Centre (Y.L., H.G., H.F., P.C.) and Division of Imaging Sciences and Biomedical Engineering (J.A.), King's College London, United Kingdom
| | - Henry Fok
- From the British Heart Foundation Centre (Y.L., H.G., H.F., P.C.) and Division of Imaging Sciences and Biomedical Engineering (J.A.), King's College London, United Kingdom
| | - Jordi Alastruey
- From the British Heart Foundation Centre (Y.L., H.G., H.F., P.C.) and Division of Imaging Sciences and Biomedical Engineering (J.A.), King's College London, United Kingdom
| | - Philip Chowienczyk
- From the British Heart Foundation Centre (Y.L., H.G., H.F., P.C.) and Division of Imaging Sciences and Biomedical Engineering (J.A.), King's College London, United Kingdom.
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26
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Schultz MG. The clinical importance of exercise blood pressure. Artery Res 2017. [DOI: 10.1016/j.artres.2017.11.004] [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] Open
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27
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Mynard JP, Smolich JJ. Wave potential: A unified model of arterial waves, reservoir phenomena and their interaction☆. Artery Res 2017. [DOI: 10.1016/j.artres.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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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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29
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Tai YL, Gerhart H, Mayo X, Kingsley JD. Acute resistance exercise using free weights on aortic wave reflection characteristics. Clin Physiol Funct Imaging 2016; 38:145-150. [DOI: 10.1111/cpf.12396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/16/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Yu Lun Tai
- Cardiovascular Dynamics Laboratory, Exercise Physiology; Kent State University; Kent OH USA
| | - Hayden Gerhart
- Cardiovascular Dynamics Laboratory, Exercise Physiology; Kent State University; Kent OH USA
| | - Xián Mayo
- Cardiovascular Dynamics Laboratory, Exercise Physiology; Kent State University; Kent OH USA
| | - J. Derek Kingsley
- Cardiovascular Dynamics Laboratory, Exercise Physiology; Kent State University; Kent OH USA
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Lefferts WK, Hughes WE, Heffernan KS. Effect of acute nitrate ingestion on central hemodynamic load in hypoxia. Nitric Oxide 2016; 52:49-55. [DOI: 10.1016/j.niox.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/03/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
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Schultz MG, Hughes AD, Davies JE, Sharman JE. Associations and clinical relevance of aortic-brachial artery stiffness mismatch, aortic reservoir function, and central pressure augmentation. Am J Physiol Heart Circ Physiol 2015; 309:H1225-33. [PMID: 26276816 DOI: 10.1152/ajpheart.00317.2015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/12/2015] [Indexed: 01/09/2023]
Abstract
Central augmentation pressure (AP) and index (AIx) predict cardiovascular events and mortality, but underlying physiological mechanisms remain disputed. While traditionally believed to relate to wave reflections arising from proximal arterial impedance (and stiffness) mismatching, recent evidence suggests aortic reservoir function may be a more dominant contributor to AP and AIx. Our aim was therefore to determine relationships among aortic-brachial stiffness mismatching, AP, AIx, aortic reservoir function, and end-organ disease. Aortic (aPWV) and brachial (bPWV) pulse wave velocity were measured in 359 individuals (aged 61 ± 9, 49% male). Central AP, AIx, and aortic reservoir indexes were derived from radial tonometry. Participants were stratified by positive (bPWV > aPWV), negligible (bPWV ≈ aPWV), or negative stiffness mismatch (bPWV < aPWV). Left-ventricular mass index (LVMI) was measured by two-dimensional-echocardiography. Central AP and AIx were higher with negative stiffness mismatch vs. negligible or positive stiffness mismatch (11 ± 6 vs. 10 ± 6 vs. 8 ± 6 mmHg, P < 0.001 and 24 ± 10 vs. 24 ± 11 vs. 21 ± 13%, P = 0.042). Stiffness mismatch (bPWV-aPWV) was negatively associated with AP (r = -0.18, P = 0.001) but not AIx (r = -0.06, P = 0.27). Aortic reservoir pressure strongly correlated to AP (r = 0.81, P < 0.001) and AIx (r = 0.62, P < 0.001) independent of age, sex, heart rate, mean arterial pressure, and height (standardized β = 0.61 and 0.12, P ≤ 0.001). Aortic reservoir pressure independently predicted abnormal LVMI (β = 0.13, P = 0.024). Positive aortic-brachial stiffness mismatch does not result in higher AP or AIx. Aortic reservoir function, rather than discrete wave reflection from proximal arterial stiffness mismatching, provides a better model description of AP and AIx and also has clinical relevance as evidenced by an independent association of aortic reservoir pressure with LVMI.
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Affiliation(s)
- Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alun D Hughes
- Institute for Cardiovascular Science, University College London, London, United Kingdom; and
| | - Justin E Davies
- International Centre for Circulatory Health, Imperial College London, London, United Kingdom
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia;
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Sugawara J, Tomoto T, Tanaka H. Impact of leg blood flow restriction during walking on central arterial hemodynamics. Am J Physiol Regul Integr Comp Physiol 2015; 309:R732-9. [PMID: 26246503 DOI: 10.1152/ajpregu.00095.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/03/2015] [Indexed: 01/09/2023]
Abstract
Walking exercise with limb blood flow restriction (BFR) has been shown to increase muscular mass and strength even if it is performed at low exercise intensities. Despite mounting evidence for its efficacy and the increasing popularity, the safety of BFR exercise in relation to cardiac loads has not been established. The aim of this study was to determine the response of central hemodynamics during the BFR exercise to assess its impact on cardiac load. Fifteen apparently healthy sedentary or recreationally active adults (10 men and 5 women, 27 ± 1 yr) underwent five bouts of 2-min constant treadmill walking at 2 mph with 1-min rest intervals either with or without BFR on both proximal thighs. Beat-by-beat blood pressure and hemodynamics (via Modelflow method) were measured, and central arterial hemodynamics were evaluated with pulse wave analyses via general transfer function. Incident wave amplitude (IWA) and reflected wave amplitude (RWA) were obtained by the wave separation analysis. Peripheral systolic blood pressure (SBP) increased more substantially during walking with BFR (43 ± 5% vs. baseline) than without BFR (11 ± 4% vs. baseline). Aortic SBP did not change significantly during walking without BFR, but there was a substantial elevation in aortic SBP (43 ± 5% vs. baseline) during walking with BFR. Significant effect of BFR was seen in IWA but not in RWA. These findings suggest that even during slow-speed walking, leg BFR induces substantial hypertensive responses in the aorta. However, this response could not be explained by the augmented wave reflection.
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Affiliation(s)
- Jun Sugawara
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan;
| | - Tsubasa Tomoto
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan; and
| | - Hirofumi Tanaka
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas
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Abstract
PURPOSE OF REVIEW To examine the putative measures of arterial stiffness and the mechanisms of adverse effects of stiffness on blood pressure and target organ damage using data from comprehensive hemodynamic profiles obtained in the Framingham Heart Study and the Age, Gene/Environment Susceptibility-Reykjavik Study. RECENT FINDINGS Once thought to be a consequence of longstanding hypertension, recent evidence suggests that aortic stiffness antedates and contributes to the pathogenesis of hypertension and target organ damage in the heart, brain, and kidneys. Carotid-femoral pulse-wave velocity (CFPWV) has emerged as the reference standard measure of aortic stiffness and a powerful predictor of cardiovascular disease risk. Augmentation index, a putative measure of arterial stiffness and wave reflection, has complex relations with stiffness and risk. Recent evidence suggests that wave reflection, which is a normal consequence of impedance mismatch between compliant aorta and stiff muscular arteries, is protective and limits the exposure of target organs to potentially harmful pulsatile energy. Aortic stiffening produces impedance matching that reduces wave reflection and exposes the microcirculation to excessive pulsatile stress, resulting in microvascular target organ damage and dysfunction. SUMMARY CFPWV provides a powerful new tool for risk stratification and elucidation of the pathogenesis of target organ damage in hypertension.
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Future Treatment of Hypertension: Shifting the Focus from Blood Pressure Lowering to Arterial Stiffness Modulation? Curr Hypertens Rep 2015; 17:67. [DOI: 10.1007/s11906-015-0569-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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36
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Does Measurement of Central Blood Pressure have Treatment Consequences in the Clinical Praxis? Curr Hypertens Rep 2015; 17:66. [DOI: 10.1007/s11906-015-0573-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Effect of moderate exercise-induced heat stress on carotid wave intensity. Eur J Appl Physiol 2015; 115:2223-30. [DOI: 10.1007/s00421-015-3203-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, UK
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Lefferts WK, Heffernan KS, Hultquist EM, Fehling PC, Smith DL. Vascular and central hemodynamic changes following exercise-induced heat stress. Vasc Med 2015; 20:222-9. [PMID: 25939655 DOI: 10.1177/1358863x14566430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study examined the effects of moderate exercise-induced heat stress (EIHS) on vascular function, central hemodynamic load and indices of coronary perfusion. Vascular-hemodynamic measures were collected in 12 healthy men (aged 22±3 years) pre and post 100 minutes of moderate, intermittent exercise in two randomized conditions: heat stress (HS; wearing firefighter personal protective equipment (PPE)), and no heat stress (NHS; wearing a cooling shirt and equivalent PPE weight). Aortic blood pressure, reflected wave pressure (Pb), systolic (SPTI) and diastolic pressure time-integral (DPTI), and aortic stiffness were assessed before and after each condition. SPTI was significantly greater, and DPTI and Pb were significantly lower for HS-post compared to NHS-post (p<0.05). Pulse wave velocity was not different between conditions. In conclusion, EIHS does not affect aortic stiffness, but increases indices of myocardial work and reduces indices of coronary perfusion which may be related to chronotropic responses to EIHS. The mismatch between oxygen demand and oxygen supply may increase cardiac vulnerability to ischemia during strenuous work in the heat.
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Affiliation(s)
- Wesley K Lefferts
- Skidmore College, Saratoga Springs, NY, USA Syracuse University, Syracuse, NY, USA
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Climie RED, Srikanth V, Keith LJ, Davies JE, Sharman JE. Exercise excess pressure and exercise-induced albuminuria in patients with type 2 diabetes mellitus. Am J Physiol Heart Circ Physiol 2015; 308:H1136-42. [DOI: 10.1152/ajpheart.00739.2014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/18/2015] [Indexed: 12/21/2022]
Abstract
Exercise-induced albuminuria is common in patients with type 2 diabetes mellitus (T2DM) in response to maximal exercise, but the response to light-moderate exercise is unclear. Patients with T2DM have abnormal central hemodynamics and greater propensity for exercise hypertension. This study sought to determine the relationship between light-moderate exercise central hemodynamics (including aortic reservoir and excess pressure) and exercise-induced albuminuria. Thirty-nine T2DM (62 ± 9 yr; 49% male) and 39 nondiabetic controls (53 ± 9 yr; 51% male) were examined at rest and during 20 min of light-moderate cycle exercise (30 W; 50 revolutions/min). Albuminuria was assessed by the albumin-creatinine ratio (ACR) at rest and 30 min postexercise. Hemodynamics recorded included brachial and central blood pressure (BP), aortic stiffness, augmented pressure (AP), aortic reservoir pressure, and excess pressure integral (Pexcess). There was no difference in ACR between groups before exercise ( P > 0.05). Exercise induced a significant rise in ACR in T2DM but not controls (1.73 ± 1.43 vs. 0.53 ± 1.0 mg/mol, P = 0.002). All central hemodynamic variables were significantly higher during exercise in T2DM (i.e., Pexcess, systolic BP and AP; P < 0.01 all). In T2DM (but not controls), exercise Pexcess was associated with postexercise ACR ( r = 0.51, P = 0.002), and this relationship was independent of age, sex, body mass index, heart rate, aortic stiffness, antihypertensive medication, and ambulatory daytime systolic BP (β = 0.003, P = 0.003). Light-moderate exercise induced a significant rise in ACR in T2DM, and this was independently associated with Pexcess, a potential marker of vascular dysfunction. These novel findings suggest that Pexcess could be important for appropriate renal function in T2DM.
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Affiliation(s)
- Rachel E. D. Climie
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Velandai Srikanth
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
- Stroke and Ageing Research Group, Monash Medical Centre, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Australia; and
| | - Laura J. Keith
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Justin E. Davies
- International Centre for Circulatory Health, Imperial College, London, United Kingdom
| | - James E. Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
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Schultz MG, Davies JE, Sharman JE. Central blood pressure physiology: a (more) critical analysis. Am J Hypertens 2015; 28:690-1. [PMID: 25810007 DOI: 10.1093/ajh/hpu238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 01/09/2023] Open
Affiliation(s)
- Martin G Schultz
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia;
| | - Justin E Davies
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - James E Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
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Systemic Vascular Load in Calcific Degenerative Aortic Valve Stenosis. J Am Coll Cardiol 2015; 65:423-33. [DOI: 10.1016/j.jacc.2014.10.067] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/13/2014] [Accepted: 10/21/2014] [Indexed: 01/09/2023]
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Nikolic SB, Adams MJ, Otahal P, Edwards LM, Sharman JE. Association of von Willebrand factor blood levels with exercise hypertension. Eur J Appl Physiol 2014; 115:1057-65. [PMID: 25539599 DOI: 10.1007/s00421-014-3087-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/16/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE A hypertensive response to moderate intensity exercise (HRE) is associated with increased cardiovascular risk. The mechanisms of an HRE are unclear, although previous studies suggest this may be due to haemostatic and/or haemodynamic factors. We investigated the relationships between an HRE with haemostatic and hemodynamic indices. METHODS Sixty-four participants (57 ± 10 years, 71 % male) with indication for exercise stress testing underwent cardiovascular assessment at rest and during moderate intensity exercise, from which 20 participants developed an HRE (defined as moderate exercise systolic BP ≥ 170 mmHg/men and ≥ 160 mmHg/women). Rest, exercise and post-exercise blood samples were analysed for haemostatic markers, including von Willebrand factor (vWf), and haemodynamic measures of brachial and central blood pressure (BP), aortic stiffness and systemic vascular resistance index (SVRi). RESULTS HRE participants had higher rest vWf compared with normotensive response to exercise (NRE) participants (1,927 mU/mL, 95 % CI 1,240-2,615, vs. 1,129 mU/mL, 95 % CI 871-1,386; p = 0.016). vWf levels significantly decreased from rest to post-exercise in HRE participants (p = 0.005), whereas vWf levels significantly increased from rest to exercise in NRE participants (p = 0.030). HRE participants also had increased triglycerides, rest BP, aortic stiffness and exercise SVRi (p < 0.05 for all). Rest vWf predicted exercise brachial systolic BP (β = 0.220, p = 0.043; adjusted R (2) = 0.451, p < 0.001) independent of age, sex, body mass index, triglycerides, rest brachial systolic BP and aortic stiffness. CONCLUSIONS Increased rest blood levels of vWf are independently associated with moderate intensity exercise systolic BP. These findings implicate abnormalities in haemostasis as a possible factor contributing to HRE at moderate intensity.
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Affiliation(s)
- Sonja B Nikolic
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia
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44
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Babcock MC, Lefferts WK, Hughes WE, Fitzgerald KL, Leyer BK, Redmond JG, Heffernan KS. Acute effect of high-intensity cycling exercise on carotid artery hemodynamic pulsatility. Eur J Appl Physiol 2014; 115:1037-45. [PMID: 25543325 DOI: 10.1007/s00421-014-3084-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/13/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Investigate the effects of acute high-intensity exercise on common carotid artery (CCA) dimensions, stiffness, and wave intensity. METHODS Fifty-five healthy men and women (22 ± 5 year; 24.5 ± 2.7 kg m(-2)) underwent 30 s of high-intensity cycling (HIC; Wingate anaerobic test). CCA diameter, stiffness [β-stiffness, Elastic Modulus (E p)], pulsatility index (PI), forward wave intensities [due to LV contraction (W 1) and LV suction (W 2)], and reflected wave intensity [negative area (NA)] were assessed using a combination of Doppler ultrasound, wave intensity analysis, and applanation tonometry at baseline and immediately post-HIC. RESULTS CCA β-stiffness, E p, PI and pulse pressure increased significantly immediately post-HIC (p < 0.05). CCA diameter decreased acutely post-HIC (p < 0.05). There were also significant increases in W 1 and NA and a significant decrease in W 2 (p < 0.05). A significant correlation was found between change in W 1 and PI (r = 0.438, p < 0.05), from rest to recovery as well as a significant inverse correlation between W 2 and PI (r = -0.378, p < 0.05). Change in PI was not associated with change in CCA stiffness or NA (p > 0.05). CONCLUSIONS Acute HIC results in CCA constriction and increases in CCA stiffness along with increases in hemodynamic pulsatility. The increase in pulsatility may be due to a combination of increased forward wave intensity from increased LV contractility into a smaller vessel (i.e. impaired matching of diameter and flow) coupled with reduced LV suction.
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Affiliation(s)
- Matthew C Babcock
- The Human Performance Laboratory, Department of Exercise Science, Syracuse University, Syracuse, NY, 13244, USA
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45
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Booysen HL, Woodiwiss AJ, Sibiya MJ, Hodson B, Raymond A, Libhaber E, Sareli P, Norton GR. Indexes of aortic pressure augmentation markedly underestimate the contribution of reflected waves toward variations in aortic pressure and left ventricular mass. Hypertension 2014; 65:540-6. [PMID: 25510830 DOI: 10.1161/hypertensionaha.114.04582] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although indexes of wave reflection enhance risk prediction, the extent to which measures of aortic systolic pressure augmentation (augmented pressures [Pa] or augmentation index) underestimate the effects of reflected waves on cardiovascular risk is uncertain. In participants from a community sample (age >16), we compared the relative contribution of reflected (backward wave pressures and the reflected wave index [RI]) versus augmented (Pa and augmentation index) pressure wave indexes to variations in central aortic pulse pressure (PPc; n=1185), and left ventricular mass index (LVMI; n=793). Aortic hemodynamics and LVMI were determined using radial applanation tonometry (SphygmoCor) and echocardiography. Independent of confounders, RI and backward wave pressures contributed more than forward wave pressures, whereas Pa and augmentation index contributed less than incident wave pressure to variations in PPc (P<0.0001 for comparison of partial r values). In those <50 years of age, while backward wave pressures (partial r=0.28, P<0.0001) contributed more than forward wave pressures (partial r=0.15, P<0.001; P<0.05 for comparison of r values), Pa (partial r=0.13, P<0.005) contributed to a similar extent as incident wave pressure (partial r=0.22, P<0.0001) to variations in LVMI. Furthermore, in those ≥50 years of age, backward wave pressures (partial r=0.21, P<0.0001), but not forward wave pressures (P=0.98), while incident wave pressure (partial r=0.23, P<0.0001), but not Pa (P=0.80) were associated with LVMI. Pa and augmentation index underestimated the effect of wave reflection on PPc and LVMI in both men and women. Thus, as compared with relations between indexes of aortic pressure augmentation and PPc or LVMI, strikingly better relations are noted between aortic wave reflection and PPc or LVMI.
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Affiliation(s)
- Hendrik L Booysen
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Moekanyi J Sibiya
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bryan Hodson
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Raymond
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Libhaber
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- From the Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology (H.L.B., A.J.W., M.J.S., B.H., A.R., P.S., G.R.N.) and Medicine (E.L.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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46
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Fok H, Guilcher A, Brett S, Jiang B, Li Y, Epstein S, Alastruey J, Clapp B, Chowienczyk P. Dominance of the Forward Compression Wave in Determining Pulsatile Components of Blood Pressure. Hypertension 2014; 64:1116-23. [DOI: 10.1161/hypertensionaha.114.04050] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Henry Fok
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Antoine Guilcher
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Sally Brett
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Benyu Jiang
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Ye Li
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Sally Epstein
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Jordi Alastruey
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Brian Clapp
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
| | - Phil Chowienczyk
- From the British Heart Foundation Centre (H.F., A.G., S.B., B.J., Y.L., P.C.) and Division of Imaging Sciences and Biomedical Engineering (S.E., J.A.), King’s College London, London, United Kingdom; and Guy’s and St Thomas Foundation Trust Hospital, London, United Kingdom (B.C.)
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47
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Torjesen AA, Wang N, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Forward and backward wave morphology and central pressure augmentation in men and women in the Framingham Heart Study. Hypertension 2014; 64:259-65. [PMID: 24866142 DOI: 10.1161/hypertensionaha.114.03371] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Central pressure augmentation is associated with greater backward wave amplitude and shorter transit time and is higher in women for reasons only partially elucidated. Augmentation also is affected by left ventricular function and shapes of the forward and backward waves. The goal of this study was to examine the relative contributions of forward and backward wave morphology to central pressure augmentation in men and women. From noninvasive measurements of central pressure and flow in 7437 participants (4036 women) aged from 19 to 90 years (mean age, 51 years), we calculated several variables: augmentation index, backward wave arrival time, reflection factor, forward wave amplitude, forward wave peak width, and slope of the backward wave upstroke. Linear regression models for augmentation index, adjusted for height and heart rate, demonstrated nonlinear relations with age (age: B=4.6±0.1%; P<0.001; age2: B=−4.2±0.1%; P<0.001) and higher augmentation in women (B=4.5±0.4%; P<0.001; model R2=0.35). Addition of reflection factor and backward wave arrival time improved model fit (R2=0.62) and reduced the age coefficients: age (B=2.3±0.1%; P<0.001) and age2 (B=−2.2±0.1%; P<0.001). Addition of width of forward wave peak, slope of backward wave upstroke, and forward wave amplitude further improved model fit (R2=0.75) and attenuated the sex coefficient (B=1.9±0.2%; P<0.001). Thus, shape and amplitude of the forward wave may be important correlates of augmentation index, and part of the sex difference in augmentation index may be explained by forward and backward wave morphology.
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48
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Lacy PS, Brunel P, Baschiera F, Botha J, Williams B. Effects of exercise on central aortic pressure before and after treatment with renin-angiotensin system blockade in patients with hypertension. J Renin Angiotensin Aldosterone Syst 2014; 16:1052-60. [PMID: 25070347 DOI: 10.1177/1470320314538879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Brachial blood pressure increases with exercise and an excessive rise predicts increased cardiovascular risk. Measurement of brachial blood pressure alone may exaggerate the true blood pressure elevation due to exercise-induced change to pressure amplification. Whether blood pressure-lowering treatment modulates pressure amplification during exercise is unknown. METHODS Thirty-two participants with stage 1-2 hypertension (mean age 59.2 years) received eight weeks' blood pressure lowering with either aliskiren (300mg, n=16) or valsartan (320mg, n=16). Brachial and central aortic pressure (CASP) were measured non-invasively during treadmill exercise (Bruce protocol) at baseline, after eight weeks' treatment and 48 hours following treatment withdrawal. RESULTS The rise in brachial blood pressure with exercise exceeded the rise in CASP, indicative of enhanced pressure amplification. Eight weeks' treatment elicited similar reductions in brachial blood pressure and CASP which did not differ between rest and peak exercise (p>0.05). The exercise-induced increase in systolic pressure amplification did not differ between baseline and following eight weeks' treatment (p>0.05). These effects remained unchanged following treatment withdrawal. CONCLUSION Blood pressure lowering does not directly influence the relationship between aortic and brachial pressure either at rest or during exercise in patients with hypertension, other than through proportionate lowering of both pressures. These effects remained unchanged 48 hours after a simulated missed medication dose.
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Affiliation(s)
- Peter S Lacy
- University College London and the National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK
| | | | | | | | - Bryan Williams
- University College London and the National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK
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49
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Schultz MG, Davies JE, Hardikar A, Pitt S, Moraldo M, Dhutia N, Hughes AD, Sharman JE. Aortic Reservoir Pressure Corresponds to Cyclic Changes in Aortic Volume. Arterioscler Thromb Vasc Biol 2014; 34:1597-603. [DOI: 10.1161/atvbaha.114.303573] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective—
Aortic reservoir pressure indices independently predict cardiovascular events and mortality. Despite this, there has never been a study in humans to determine whether the theoretical principles of the mathematically derived aortic reservoir pressure (RP
derived
) and excess pressure (XP
derived
) model have a real physiological basis. This study aimed to directly measure the aortic reservoir (AR
direct
; by cyclic change in aortic volume) and determine its relationship with RP
derived
, XP
derived
, and aortic blood pressure (BP).
Approach and Results—
Ascending aortic BP and Doppler flow velocity were recorded via intra-arterial wire in 10 men (aged 62±12 years) during coronary artery bypass surgery. Simultaneous ascending aortic transesophageal echocardiography was used to measure AR
direct
. Published mathematical formulae were used to determine RP
derived
and XP
derived
. AR
direct
was strongly and linearly related to RP
derived
during systole (
r
=0.988;
P
<0.001) and diastole (
r
=0.985;
P
<0.001). Peak cross-correlation (
r
=0.98) occurred at a phase lag of 0.004 s into the cardiac cycle, suggesting close temporal agreement between waveforms. The relationship between aortic BP and AR
direct
was qualitatively similar to the cyclic relationship between aortic BP and RP
derived
, with peak cross-correlations occurring at identical phase lags (AR
direct
versus aortic BP,
r
=0.96 at 0.06 s; RP
derived
versus aortic BP,
r
=0.98 at 0.06 s).
Conclusions—
RP
derived
is highly correlated with changes in proximal aortic volume, consistent with its physiological interpretation as corresponding to the instantaneous volume of blood stored in the aorta. Thus, aortic reservoir pressure should be considered in the interpretation of the central BP waveform.
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Affiliation(s)
- Martin G. Schultz
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
| | - Justin E. Davies
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
| | - Ashutosh Hardikar
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
| | - Simon Pitt
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
| | - Michela Moraldo
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
| | - Niti Dhutia
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
| | - Alun D. Hughes
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
| | - James E. Sharman
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia (M.G.S., A.H., J.E.S.); International Centre for Circulatory Health, Imperial College London, London, United Kingdom (J.E.D., M.M, N.D.); Royal Hobart Hospital, Hobart, Tasmania, Australia (S.P.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (A.D.H.)
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50
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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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