Elevated exercise blood pressure in middle-aged women is associated with altered left ventricular and vascular stiffness

Sarma, Satyam; Howden, Erin J.; Carrick–Ranson, Graeme; Lawley, Justin S.; Hearon, Christopher M.; Samels, Mitchel; Everding, Braden; Livingston, Sheryl; Adams‐Huet, Beverley; Palmer, M. Dean; Levine, Benjamin D.

doi:10.1152/japplphysiol.00458.2019

Cited by 12 publications

(13 citation statements)

References 43 publications

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“…Apart from hard endpoints, a study conducted in Japan showed that cardio-ankle vascular index, another arterial stiffness parameter, was independently and significantly associated with hospitalization of HFpEF patients after adjustment for hypertension, diabetes, and renal function ( 13 ). It seemed that the difference of arterial stiffness in patients with/without HFpEF was more likely to be observed during exercise ( 14 , 15 ).…”

Section: Does Arterial Stiffness Relate To Hfpef?mentioning

confidence: 99%

Association Between Arterial Stiffness and Heart Failure With Preserved Ejection Fraction

Chen

Liu

2021

Front. Cardiovasc. Med.

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Cardiovascular diseases are the leading cause of mortality in the world. Heart failure with preserved ejection fraction (HFpEF) accounts for about half of all heart failure. Unfortunately, the mechanisms of HFpEF are still unclear, leading to little progress of effective treatment of HFpEF. Arterial stiffness is the decrement of arterial compliance. The media of large arteries degenerate in both physiological and pathological conditions. Many studies have proven that arterial stiffness is an independent risk factor for cardiovascular disorders including diastolic dysfunction. In this perspective, we discussed if arterial stiffness is related to HFpEF, and how does arterial stiffness contribute to HFpEF. Finally, we briefly summarized current treatment strategies on arterial stiffness and HFpEF. Though some new drugs were developed, the safety and effectiveness were not adequately assessed. New pharmacologic treatment for arterial stiffness and HFpEF are urgently needed.

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Section: Does Arterial Stiffness Relate To Hfpef?mentioning

confidence: 99%

Association Between Arterial Stiffness and Heart Failure With Preserved Ejection Fraction

Chen

Liu

2021

Front. Cardiovasc. Med.

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“…В литературе также сообщается о большей частоте церебрального атеросклероза, острых нарушений мозгового кровообращения, гипертрофии ЛЖ и нарушения диастолической функции ЛЖ у пациентов с ГРН [6]. Что касается частоты встречаемости ХСНсФВ у пациентов с ГРН, то она остаётся практически не изученной, однако в небольшом исследовании Sarma S, et al на выборке из 47 женщин среднего возраста была показана вероятная взаимосвязь между этими явлениями [10].…”

Section: Discussionunclassified

“…Также впервые мы показали более частую встречаемость ХСНсФВ у пациентов с ГРН, что ранее в литературе освещено недостаточно и лишь в исследовании со значительно меньшей выборкой [10]. Безусловным недостатком работы является её кросссекционный характер, в связи с чем необходимо дальнейшее наблюдение включённых больных и мониторинг конечных точек, проведение аналогичных исследований на более крупной выборке (которое позволит выявить более выраженное ремоделирование сосудов в группе больных с ГРН), а также изучение влияния оптимальной терапии ГБ при повторном тестировании пациентов с ГРН.…”

Section: Discussionunclassified

Cardiovascular risk profiles and stress echocardiography results in patients with hypertensive response to exercise

et al. 2021

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Aim. To compare markers of high cardiovascular risk and stress echocardiography results depending on the type of blood pressure (BP) response to exercise in patients without obstructive coronary artery disease.Material and methods. Our single-center cross-sectional study included 96 patients without hemodynamically significant coronary artery stenosis according to coronary angiography or multislice computed tomography angiography. All patients underwent physical examination, cardiovascular risk stratification, electrocardiography, extracranial cerebrovascular ultrasound, echocardiography, treadmill exercise stress echocardiography.Results. According to the test results, the patients were divided into groups with a hypertensive response (n=41) and a normal response to exercise (n=55). Patients with hypertensive response to exercise had significantly higher values of left ventricular mass index (100,0 (90,0; 107,0) g/m2 vs 76,0 (68,0; 91,0) g/m2, p<0,0000001) and left atrial volume index (36,7 (32,0; 46,0) ml/m2 vs 29,7 (26,3; 32,0) ml/m2, p=0,000003). There was also a higher level of cardiovascular SCORE risk (5,0 (2,0; 6,0) vs 2,0 (1,0; 3,0), p=0,004); patients more often had associated clinical conditions (36,6% vs 12,7%, χ2=7,57, p=0,006) and left ventricular diastolic dysfunction (39,02% vs 78,18%, χ2=15,21, p=0,0001). Pathological BP increase during stress echocardiography was associated with worse exercise tolerance (7,4 (5,6; 10,0) METs vs 10,2 (8,4; 11,95) METs, p=0,000041) and more frequent transient regional contractility impairment (46,34% vs 1,8%, p<0,00001), mainly of the lateral and inferior left ventricular walls.Conclusion. Despite the absence of coronary artery stenosis, patients with hypertensive response to exercise are significantly more likely to have markers of high cardiovascular risk and require more careful monitoring of risk factors. Also, the hypertensive response to exercise is associated with more frequent regional contractility impairment even without coronary artery stenosis.

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“…Several studies have also shown relationships between EEBP and adverse cardiac structure [ 33 , 34 , 35 , 36 ] and function [ 37 ], indicative of hypertensive heart disease. Sarma et al also recently reported EEBP during submaximal exercise to be related to increased left ventricular and aortic stiffness in otherwise healthy middle-aged women, proposing that EEBP could serve as a sentinel for heart failure with preserved ejection fraction [ 38 ]. An additional benefit of measuring BP at a fixed submaximal workload rather than peak/maximal BP is that this circumvents the confounding effect of workload and cardiorespiratory fitness [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

Schultz

Currie

Hedman

et al. 2022

IJERPH

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High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ~70% age-predicted heart rate maximum, stage 1–2 of a standard Bruce treadmill protocol). If exercise systolic BP is raised (≥170 mmHg), uncontrolled high BP should be assumed and should trigger correspondence with a primary care physician to encourage follow-up care to ascertain true BP control (i.e., home, or ambulatory BP) alongside a hypertension-guided exercise and lifestyle intervention to lower CVD risk related to high BP.

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Elevated exercise blood pressure in middle-aged women is associated with altered left ventricular and vascular stiffness

Cited by 12 publications

References 43 publications

Association Between Arterial Stiffness and Heart Failure With Preserved Ejection Fraction

Association Between Arterial Stiffness and Heart Failure With Preserved Ejection Fraction

Cardiovascular risk profiles and stress echocardiography results in patients with hypertensive response to exercise

The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

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