Muscle Weakness Is Associated With an Increase of Left Ventricular Mass Through Excessive Blood Pressure Elevation During Exercise in Patients With Hypertension

Abstract

SummaryAutonomic imbalance in hypertension induces excessive blood pressure (BP) elevation during exercise, thereby increasing left ventricular mass (LVM). Although muscle weakness enhances autonomic imbalance by stimulating muscle sympathetic activity during exercise, it is unclear whether muscle weakness is associated with an increase of LVM in patients with hypertension. This study aimed to investigate the relationships between muscle weakness, BP elevation during exercise, and LVM in these patients. Eighty-six hypertensive patients aged 69 ± 8 years with controlled resting BP (ie, < 140/90 mmHg) were recruited. Plasma brain natriuretic peptide (BNP), left ventricular mass index (LVMI), and knee extension muscle strength were measured. Changes in plasma noradrenaline (NORA) and brachial-ankle pulse wave velocity (ba-PWV) were assessed before and after an ergometer exercise test performed at moderate intensity (ΔNORA and ΔPWV, respectively). A difference between baseline and peak systolic BP during the exercise test was defined as BP elevation during exercise (ΔSBP). Relationships between muscle strength, ΔNORA, ΔPWV, ΔSBP, BNP, and LVMI were analyzed, and significant factors increasing LVM were identified using univariate and multivariate regression analyses. Muscle strength was negatively correlated with ΔNORA (r = -0.202, P = 0.048), ΔPWV (r = -0.328, P = 0.002), ΔSBP (r = -0.230, P = 0.033), BNP (r = -0.265, P = 0.014), and LVMI (r = -0.233, P = 0.031). LVMI was positively correlated with ΔPWV (r = 0.246, P = 0.023) and ΔSBP (r = 0.307, P = 0.004). Muscle strength was a significant independent factor associated with LVMI (β = -0.331, P = 0.010). Our findings suggest that muscle weakness is associated with an increase of LVM through excessive BP elevation during exercise in patients with hypertension. ( 1-3) Hypertension-related LVM increase leads to the progression of left ventricular dysfunction, which can result in chronic heart failure.4) Left ventricular hypertrophy (LVH) is also known to be a strong risk factor for future cardiac events and mortality. 4) Therefore, the prevention of LVM increase is considered a promising therapeutic strategy, in addition to BP control, in patients with hypertension.Patients with hypertension have been known to exhibit an autonomic imbalance even in ordinary activities of daily living (ADL), which indicates elevated sympathetic activity and reduced parasympathetic activity.5,6) Accordingly, an unexpected increase in sympathetic activity can excessively elevate BP and/or heart rate (HR) during exercise, even at low or moderate intensity. 7) One previous study reported that hypertensive patients who had increased sympathetic activity during exercise developed LVH more rapidly compared to those without autonomic imbalance. 8)Skeletal muscles are known to accumulate metabolites such as lactic acid during exercise. 9) These metabolites stimulate the rostral ventrolateral medulla, which is the center of the sympathetic system, via metabolite-sensitive receptors in skeletal m...

Characterisation of N-terminal pro-brain natriuretic peptide in dialysis patients and its reduced prognostic significance in the elderly

“…Kamada et al . recently showed a significant negative correlation between skeletal muscle strength and BNP or left ventricular mass index (LVMI) in haemodialysis patients 29 . They proposed that potentially activated sympathetic nerve system due to weak muscle strength facilitated LVMI increase.…”

Inverse Association between Exercising Blood Pressure Response and Left Ventricular Chamber Size and Mass in Women Who Habitually Resistance Train

“…Prior research examining the relationship between eSBP and LVM has primarily found a direct association between these variables [12,16,[25][26][27][28][29][30][31][32][33][34][35][36][37][38], but this is not a universal finding [12,27,28,30,39,40]. When examining the results that do not support the association between eSBP and LVM, the participants did not habitually exercise [12,27,28,30,39,40].…”