Association Between Exercise Systolic Blood Pressure and Risk of Stroke in Men With and Without Cardiovascular Disease

PURPOSE

We tested the hypothesis that an exaggerated exercise systolic blood pressure (ESBP) would be associated with the risk of stroke in men with and without a history of cardiovascular disease (CVD).

METHODS

An ESBP was defined as a maximal systolic blood pressure (SBP) ≥ 210 mmHg during graded exercise testing on a stationary bike until volitional fatigue in 2410 men aged 42 to 61 yr at baseline.

RESULTS

Over a median 27-yr follow-up, 419 incident stroke events occurred. In a multivariable adjusted model, men with an ESBP had a significantly increased risk of stroke in the entire cohort (HR = 1.41: 95% CI, 1.15-1.74). This association was still significant following further adjustment for resting SBP (HR = 1.25: 95% CI, 1.01-1.56). In subgroup analysis, ESBP was modestly associated with an increased risk of stroke in men with a history of CVD (HR = 1.37: 95% CI, 0.98-1.93), with no strong evidence of an association in men without a history of CVD (HR = 1.20: 95% CI, 0.90-1.60).

CONCLUSIONS

These findings suggest that the heightened risk of stroke related to ESBP response in a general population-based sample of men may be primarily driven by a history of CVD. The results underscore the importance of considering exercise blood pressure response when interpreting stress tests, particularly in individuals with pre-existing CVD.

Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review

Sudden cardiac death (SCD) is rare among athletes. However, hypertrophic cardiomyopathy is the leading cause of SCD among those <35 years of age. Meanwhile, coronary artery disease (CAD) is the primary SCD cause among those ≥35 years of age. CAD-induced plaque ruptures are believed to be a significant cause of cardiovascular diseases in middle-aged individuals who participate in extreme long-distance running activities such as marathons. A total of 1970 articles related to EIH were identified using search terms. Out of these, 1946 studies were excluded for reasons such as arterial hypertension, exercise-induced pulmonary hypertension, the absence of exercise stress testing (EST), and a lack of relevance to EIH. The study analyzed 24 studies related to both long-distance runners with exercise-induced hypertension (EIH) and the general public. Among these, 11 studies were quasi-experimentally designed studies used in randomized controlled trials (RCTs) on long-distance runners with EIH. Additionally, 12 studies utilized cohort designs, and one study with a quasi-experimental design was conducted among the general population. Recent studies suggest that an imbalance between oxygen demand and supply due to ventricular hypertrophy may be the actual cause of cardiovascular disease, regardless of CAD. Exercising excessively over an extended period can reduce endothelial function and increase arterial stiffness, which in turn increases afterload and leads to an excessive increase in blood pressure during exercise. Exercise-induced hypertension (EIH), which increases the morbidity rate of resting hypertension and is a risk factor for cardio-cerebro-vascular diseases, is more prevalent in middle-aged long-distance runners than in runners from other age groups, and it increases the prevalence of critical arrhythmias, such as atrial fibrillation or ventricular arrhythmias. EIH is associated with angiotensin II activity, and angiotensin II receptor blockers show promising effects in middle-aged runners. Further, guidelines for preventing excessive participation in races and restricting exercise intensity and frequency would be useful. This review identifies EIH as a potential risk factor for cardiovascular diseases and describes how EIH induces SCD.

Association of central blood pressure with an exaggerated blood pressure response to exercise among elite athletes

PURPOSE

The systolic blood pressure/workload (SBP/MET) slope was recently reported to be a reliable parameter to identify an exaggerated blood pressure response (eBPR) in the normal population and in athletes. However, it is unclear whether an eBPR correlates with central blood pressure (CBP) and vascular function in elite athletes.

METHODS

We examined 618 healthy male elite athletes (age 25.8 ± 5.1 years) of mixed sports with a standardized maximum exercise test. CBP and vascular function were measured non-invasively with a validated oscillometric device. The SBP/MET slope was calculated and the threshold for an eBPR was set at > 6.2 mmHg/MET. Two groups were defined according to ≤ 6.2 and > 6.2 mmHg/MET, and associations of CBP and vascular function with the SBP/MET slope were compared for each group.

RESULTS

Athletes with an eBPR (n = 180, 29%) displayed a significantly higher systolic CBP (102.9 ± 7.5 vs. 100 ± 7.7 mmHg, p = 0.001) but a lower absolute (295 ± 58 vs. 384 ± 68 W, p < 0.001) and relative workload (3.14 ± 0.54 vs. 4.27 ± 1.1 W/kg, p < 0.001) compared with athletes with a normal SBP/MET slope (n = 438, 71%). Systolic CBP was positively associated with the SBP/MET slope (r = 0.243, p < 0.001). In multiple logistic regression analyses, systolic CBP (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.045-1.155, p < 0.001) and left atrial volume index (LAVI) (OR 1.282, CI 1.095-1.501, p = 0.002) were independent predictors of an eBPR.

CONCLUSION

Systolic CBP and LAVI were independent predictors of an eBPR. An eBPR was further associated with a lower performance level, highlighting the influence of vascular function on the BPR and performance of male elite athletes.

Exercise-Induced Blood Pressure Dynamics: Insights from the General Population and the Athletic Cohort

Blood pressure (BP) dynamics during graded exercise testing provide important insights into cardiovascular health, particularly in athletes. These measurements, taken during intense physical exertion, complement and often enhance our understanding beyond traditional resting BP measurements. Historically, the challenge has been to distinguish 'normal' from 'exaggerated' BP responses in the athletic environment. While basic guidelines have served their purpose, they may not fully account for the complex nature of BP responses in today's athletes, as illuminated by contemporary research. This review critically evaluates existing guidelines in the context of athletic performance and cardiovascular health. Through a rigorous analysis of the current literature, we highlight the multifaceted nature of exercise-induced BP fluctuations in athletes, emphasising the myriad determinants that influence these responses, from specific training regimens to inherent physiological nuances. Our aim is to advocate a tailored, athlete-centred approach to BP assessment during exercise. Such a paradigm shift is intended to set the stage for evidence-based guidelines to improve athletic training, performance and overall cardiovascular well-being.

Mild Left Ventricular Hypertrophy in Middle-Age Male Athletes as a Sign of Masked Arterial Hypertension

Mild left ventricular hypertrophy (LVH) has been considered as one of the possible structural, physiological adaptations to regular, intensive physical activity. However, it may also appear as one of the subclinical complications of hypertension. In athletes, the differential diagnosis between these two entities may be complicated as regular physical activity may potentially mask the presence of arterial hypertension. We sought to determine the relation between LVH in middle-age athletes and the presence of hypertension. The study included 71 healthy, male long-time amateur athletes (mean age 41 ± 6 years, 83% endurance and 17% power sports) without known hypertension or any other cardiovascular diseases and with normal self-measured and office blood pressure. All subjects underwent resting electrocardiogram, transthoracic echocardiography, maximal exercise test on a treadmill and ambulatory blood pressure monitoring. LVH was diagnosed as left ventricular wall diameter >11 mm. Hypertension was defined as mean 24 h systolic blood pressure (SBP) ≥ 130 mmHg and/or diastolic blood pressure (DBP) ≥ 80 mmHg. Exaggerated blood pressure response (EBPR) to exercise was defined as SBP ≥ 210 mmHg. LVH (range > 11 to 14 mm) was found in 20 subjects (28%) and hypertension was diagnosed in 33 subjects (46%). Athletes with LVH were more likely to have hypertension than those without LVH (70% vs. 37%, p = 0.01). EBPR to exercise was found equally common in athletes with and without LVH (35% vs. 29%, p = 0.68), but more often in subjects with hypertension (51% vs. 13%, p < 0.001). Presence of LVH and hypertension was equally common in the studied endurance and power sport athletes (p = 0.66 and p = 0.79, respectively). In comparison to athletes without LVH, those with LVH had larger left atrial size (26 ± 6 vs. 21 ± 4 cm2, p < 0.001) and a tendency for lower left ventricular diastolic function (E/A 1.2 ± 0.4 vs. 1.5 ± 0.4, p = 0.05) and a larger ascending aorta diameter (34 ± 3 vs. 32 ± 3, p = 0.05), but a similar left ventricular end-diastolic diameter (51 ± 3 vs. 51 ± 4, p = 0.71). The presence of mild left ventricular hypertrophy in middle-age male amateur athletes with normal home and office blood pressure may be considered as a potential sign of masked hypertension. It should not be overlooked as an element of a physiological adaptation to exercise and may warrant further medical evaluation with ambulatory blood pressure monitoring.

Prediction of exercise sudden death in rabbit exhaustive swimming using deep neural network

Background and objective

Moderate exercise contributes to good health. However, excessive exercise may lead to cardiac fatigue, myocardial damage and even exercise sudden death. Monitoring the heart health has important implication to prevent exercise sudden death. Diagnosis methods such as electrocardiogram, echocardiogram, blood pressure and histological analysis have shown that arrhythmia and left ventricular fibrosis are early warning symptoms of exercise sudden death. Heart sounds (HS) can reflect the changes of cardiac valve, cardiac blood flow and myocardial function. Deep learning has drawn wide attention because of its ability to recognize disease. Therefore, a deep learning method combined with HS was proposed to predict exercise sudden death in New Zealand rabbits. The objective is to develop a method to predict exercise sudden death in New Zealand rabbits.

Methods

This paper proposed a method to predict exercise sudden death in New Zealand rabbits based on convolutional neural network (CNN) and gated recurrent unit (GRU). The weight-bearing exhaustive swimming experiment was conducted to obtain the HS of exercise sudden death and surviving New Zealand rabbits (n = 11/10) at four different time points. Then, the improved Viola integral method and double threshold method were employed to segment HS signals. The segmented HS frames at different time points were taken as the input of a combined CNN and GRU called CNN–GRU network to complete the prediction of exercise sudden death.

Results

In order to evaluate the performance of proposed network, CNN and GRU were used for comparison. When the fourth time point segmented HS frames were taken as input, the result shows that the proposed network has better performance with an accuracy of 89.57%, a sensitivity of 89.38% and a specificity of 92.20%. In addition, the segmented HS frames at different time points were input into CNN–GRU network, and the result shows that with the progress of the experiment, the prediction accuracy of exercise sudden death in New Zealand rabbits increased from 50.98 to 89.57%.

Conclusion

The proposed network shows good performance in classifying HS, which proves the feasibility of deep learning in exploring exercise sudden death. Further, it may have important implications in helping humans explore exercise sudden death.