Determinants of systolic blood pressure response during exercise in overweight subjects

Influence of cardiorespiratory fitness on obesity-associated inflammation in women and men: The FATCOR study

BACKGROUND AND AIMS

Cardiorespiratory fitness has been postulated to lower chronic inflammation in obesity. We assessed sex-specific associations of inflammation with cardiorespiratory fitness in overweight and obese persons.

METHODS AND RESULTS

Peak oxygen uptake (VO2max) was measured by treadmill in 566 participants (age 48 ± 9 years, 60% women) with body mass index >27.0 kg/m2 in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. Fitness was identified from age- and sex specific reference levels of VO2max. The inflammatory markers C-reactive protein (CRP), serum amyloid A (SAA), kynurenine:tryptophan ratio (KTR) and pyriodoxic acid ratio (PAr) were measured by mass spectrometry. In the total study population 63% had obesity and 74% were cardiorespiratory unfit. Unfit women had the highest fat percentage and the highest serum levels of CRP and SAA (p < 0.05). In multivariable linear regression analyses in women, higher CRP (β -0.15, p = 0.001), SAA (β -0.10, p = 0.03) and PAr (β -0.09, p = 0.03) were associated with lower VO2max after adjusting for confounders. In multivariable analyses in men, higher PAr (β -0.14, p = 0.02) was associated with lower VO2max. In multivariable analyses in obese women, higher CRP and PAr remained associated with lower VO2max (p < 0.05), while in obese men there was no significant association. When normalizing VO2max for fat-free mass (VO2maxFFM) higher CRP, SAA and PAr index were associated with lower VO2maxFFM in women, while only higher PAr index was associated with lower VO2maxFFM in men.

CONCLUSION

The association of inflammation with lower cardiorespiratory fitness was more pronounced in women than men, in particular when obesity was present.

CLINICAL TRIAL REGISTRATION

URL: http://www.

CLINICALTRIALS

gov NCT02805478.

Effect of bariatric surgery on blood pressure response to exercise in a severely obese population

BACKGROUND

Exaggerated blood pressure response to exercise is a cardiovascular risk factor associated to higher morbidity and mortality. Severely obese patients have an increased risk of exercise-induced hypertension (EIH). We aimed to assess the blood pressure response to exercise in patients with severe obesity who underwent bariatric surgery as well as the main determinants of this response.

METHODS

We used data from the ACTIVE clinical trial, in which 60 severely obese patients who underwent bariatric surgery were enrolled. Anthropometric measurements, abdominal and mid-thigh computed tomography scans and maximal exercise testing were performed before bariatric surgery, as well as 3 and 6 months post-surgery. EIH was defined as a maximal SBP ≥210 mmHg for men and ≥190 mmHg for women.

RESULTS

At baseline, 62% of patients had EIH. At 6 months, we observed an EIH resolution rate of 39%. The main determinant of EIH resolution was sex. Actually, patients with EIH resolution were mostly women without resting hypertension and a lower amount of visceral adipose tissue.

CONCLUSION

These results suggest that bariatric surgery is efficient to resolve EIH, particularly in women with initially a better anthropometric profile.

Does fitness improve the cardiovascular risk profile in obese subjects?

BACKGROUND AND AIMS

Good cardiorespiratory fitness has been suggested to reduce the risk of cardiovascular disease in obesity. We explored the association of fitness with the prevalences of major cardiovascular risk factor like hypertension (HT), diabetes and metabolic syndrome (MetS) in overweight and obese subjects.

METHODS AND RESULTS

Clinical data from 491 participants in the FAT associated CardiOvasculaR dysfunction (FATCOR) study were analyzed. Physical fitness was assessed by ergospirometry, and subjects with at least good level of performance for age and sex were classified as fit. HT subtypes were identified from clinic and 24-h ambulatory blood pressure in combination. Diabetes was diagnosed by oral glucose tolerance test. MetS was defined by the American Heart Association and National Heart, Lung and Blood Institute criteria. The participants were on average 48 years old (60% women), and mean body mass index (BMI) was 32 kg/m². 28% of study participants were classified as fit. Fitness was not associated with lower prevalences of HT or HT subtypes, diabetes, MetS or individual MetS components (all p > 0.05). In multivariable regression analysis, being fit was characterized by lower waist circumference, BMI < 30 kg/m², non-smoking and a higher muscle mass (all p < 0.05).

CONCLUSION

In the FATCOR population, fitness was not associated with a lower prevalence of major cardiovascular risk factors like HT, diabetes or MetS. Given the strong association of cardiovascular risk factor burden with risk of clinical cardiovascular disease, these findings challenge the notion that fitness alone is associated with lower risk of cardiovascular disease in obesity.

Masked hypertension in obesity: potential predictors and arterial damage

Background

Masked hypertension (MHT), defined as normal office blood pressure (BP) but high ambulatory BP, has been associated with increased cardiovascular risk. Although MHT has been associated with obesity, there is limited knowledge on the prevalence and covariates of MHT in obese cohorts.

Methods

Office and ambulatory BP recordings and other cardiovascular risk factors were assessed in 323 obese participants included in the fat-associated cardiovascular dysfunction study (mean age 48.9±9.0 years, 55% women, mean BMI 32.3±4.4 kg/m²). Office BP 130–139/85–89 mmHg was considered high-normal. Subclinical arterial damage was identified as carotid–femoral pulse wave velocity more than 10 m/s by applanation tonometry or carotid plaque by ultrasound (maximal intima–media thickness ≥1.5 mm).

Results

MHT was present in 17.1% of the population. Patients with MHT had a higher prevalence of metabolic syndrome, high-normal office BP, and were more often male compared with the normotensive (NT) individuals (all P<0.05), but were younger and had lower prevalence of diabetes and subclinical arterial damage than the sustained hypertensive group (all P<0.05). In multinomial logistic regression analysis, MHT was associated with the presence of metabolic syndrome and high-normal office BP compared with NT individuals, and lower pulse wave velocity and fewer carotid plaques than sustained hypertension (all P<0.05).

Conclusion

In obese patients, MHT was associated with the presence of metabolic syndrome and high-normal office BP compared with NT individuals, but less subclinical arterial damage than sustained hypertensive patients.

Upper normal values of blood pressure response to exercise in Olympic athletes

BACKGROUND

Exercise test is widespread performed in athletes to assess cardiovascular adaptations during effort; however, scarce information exists relative to the behavior of blood pressure during exercise in athletes. We sought to define the normal values and upper limits of blood pressure response to exercise in a large population of elite, healthy athletes.

METHODS

A total of 1,876 healthy, normotensive elite athletes (aged 25 ± 6 years, 64% male) underwent a comprehensive clinical evaluation including maximal bicycle exercise test.

RESULTS

At maximum exercise, the systolic blood pressure increased significantly (Δ = +69 ± 18 mm Hg; P< .001), whereas diastolic blood pressure showed minimal change (Δ = +1 ± 7 mm Hg; P= .001). The upper reference values were 220 mm Hg in male and 200 mm Hg in female athletes for systolic blood pressure, and 85 mm Hg in male and 80 mm Hg in female for diastolic blood pressure. A subgroup of 142 athletes (7.5%) showed high blood pressure response to exercise, that is, increase in systolic and/or diastolic blood pressure above the 95th percentile. Multivariate logistic regression analysis showed that endurance and mixed sport disciplines, body mass index, and baseline systolic blood pressure were the strongest determinants for high blood pressure response to exercise.

CONCLUSION

The gender-specific reference values for systolic and diastolic blood pressure at maximum exercise in athletes were defined. A small subset (7.5%) of athletes showed higher blood pressure response, in the absence of target organ disease or metabolic abnormalities, and associated with superior physical performance and larger cardiac remodeling.