Neural Control of Cardiovascular Function During Exercise in Hypertension

Abstract

During both static and dynamic exercise hypertensive subjects can experience robust increases in arterial pressure to such an extent that heavy exercise is often not recommended in these patients due to the dangerously high levels of blood pressure sometimes observed. Currently, the mechanisms mediating this cardiovascular dysfunction during exercise in hypertension are not fully understood. The major reflexes thought to mediate the cardiovascular responses to exercise in normotensive healthy subjects are central command, arterial baroreflex and responses to stimulation of skeletal muscle mechano-sensitive and metabo-sensitive afferents. This review will summarize our current understanding of the roles of these reflexes and their interactions in mediating the altered cardiovascular responses to exercise observed in hypertension. We conclude that much work is needed to fully understand the mechanisms mediating excessive pressor response to exercise often seen in hypertensive patients.

Cardiovascular response to postural perturbations of different intensities in healthy young adults

“…Automatic adjustments to physical stress can be centrally‐ and/or reflex‐mediated (Dombrowski et al, 2018 ). The role of baroreflex regulation of blood pressure is complex, representing contributions from central neural systems (McCloskey & Mitchell, 1972 ), as well as ascending feedback from baroreceptor, chemoreceptor, and mechanosensors located in skeletal muscle (see Raven et al, 2019 ).…”

Interplay between baroreflex sensitivity, obesity and related cardiometabolic risk factors (Review)

“…Individuals with hypertension can suffer significant increases in arterial pressure during physical exercise. Central command and arterial baroreflex are hypothesized to mediate the cardiovascular responses to exercise in normotensive healthy persons ( 81 ). Fukuma et al ( 82 ) enrolled patients with heart disease and studied the relationship between changes in heart rate and blood pressure increments (or decrements) in response to exercise.…”

Recent advances in exercise pressor reflex function in health and disease

“…Herein, we provide a general overview of these diseases and studies conducted so far in both animal and human, followed by a discussion of potential mechanisms for an exaggerated reflex. For additional and complementary reading on the effect of cardiovascular related diseases on the exercise pressor reflex, we refer the reader to other recently published reviews (Cristina-Oliveira et al, 2020;Dombrowski et al, 2018;Grotle et al, 2019c;Mitchell, 2017;Vianna et al, 2019).…”

“…Whether the metaboreflex is accentuated or attenuated may also depend on how the reflex is measured. For example, if assessing the metaboreflex by its ability to raise arterial BP or cardiac output, one could conclude that the reflex is attenuated whereas if assessing the reflex by its ability to raise peripheral vasoconstriction one could conclude that the reflex is accentuated (Dombrowski et al, 2018;Hammond et al, 2000). Further studies are warranted to comprehensively determine the effect of disease progression on the expression of mechanoreflex and metaboreflex activation before a complete synthesis is possible.…”