Delayed Blood Pressure Recovery Ratio and Its Relation to Endothelial Function and Left Ventricular Diastolic Function in Prediabetics

Mahfouz, Ragab A.; Dewedar, Ashraf; Elawady, Waleed; Salem, and Abdelhakem; Goda, Mohamed

doi:10.1111/echo.12489

Cited by 6 publications

(9 citation statements)

References 33 publications

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“…The systematic search resulted in the inclusion of 193 from a total of 4641 potential articles (Figure ). From the 193 studies included in the analyses, vascular reactivity was assessed in a total of 26570 patients that were considered healthy (n = 7226), overweight (n = 7605), or those with obesity (n = 1758) or that were diagnosed with metabolic sy...…”

Section: Resultsmentioning

confidence: 99%

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

et al. 2019

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This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (−0.41%, 95% CI, −0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (−4.26%, 95% CI, −4.97 to −3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.

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Section: Resultsmentioning

confidence: 99%

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

et al. 2019

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“…Specifically, HRR was negatively correlated with post-exercise systolic and diastolic BP and was positively correlated with systolic and diastolic BPR, and these associations are consistent with the underlying understanding that after exercise sympathetic withdrawal and parasympathetic reactivation dramatically decrease HR and BP (Cole et al, 1999; Laborde et al, 2018; Laukkanen et al, 2004; Tanindi et al, 2015). This dynamic flux in sympathetic and parasympathetic activity is responsible for a number of hemodynamic changes including a drop in total peripheral resistance and cardiac output (Gourine & Ackland, 2019; Laukkanen et al, 2004; Mahfouz et al, 2014; Tanindi et al, 2015). Given that the sympathetic nervous system directly innervates vessel walls, this may partially explain the association between HRR and hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

“…Given that the sympathetic nervous system directly innervates vessel walls, this may partially explain the association between HRR and hemodynamics. Mahfouz et al (2014) reported abnormal HRR and poor systolic BPR were significantly correlated with impaired endothelial function and diastolic dysfunction among a sample of prediabetic patients (Mahfouz et al, 2014). Also, given the cohort of professional firefighters was largely hypertensive and overweight, it is reasonable to assume there may have undiagnosed cardiometabolic conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Before Number of heart beats per minute (bpm) Cardiac activity before exercise BP Before Pressure of circulating blood exerted on the vessel wall at both systole (i.e., contraction) and diastole (i.e., relaxation) (mmHg)Vascular function before exerciseWhelton et al (2018) RPP Before SBP Before X HR Before (mmHg X bpm) Myocardial workload and oxygen consumption at rest before exerciseGobel et al (1978) Recovery BP Recovery = SBP Max -SBP After (mmHg) Changes in sympathetic and parasympathetic activities, systemic vascular resistance, endothelial dysfunction, and baroreflex sensitivityLaukkanen et al (2004),Mahfouz et al (2014) …”

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confidence: 99%

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Correlates of Autonomic Function, Hemodynamics, and Physical Activity Performance During Exercise Stress Testing Among Firefighters

Dzikowicz

Carey

2022

Biological Research For Nursing

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Background Autonomic dysfunction is an important propagator of cardiometabolic disease and can be measured using multiple metrics such as heart rate variability (HRV) and heart rate recovery (HRR). The relationships between HRV and HRR have not been fully examined, nor have the relationships between HRV, HRR, and other physiological measures linked to cardiometabolic disease (e.g., blood pressure recovery). Evaluation of these additional relationships may provide new insights into the association between autonomic function and cardiometabolic disease especially among high-risk groups like firefighters. Methods 92 firefighters (96% male, 81% white) without overt cardiovascular disease underwent exercise testing with continuous heart rate (HR) and blood pressure (BP) monitoring. HRR was the difference between maximal HR and HR 1-minute post-exercise; BP recovery (BPR) was the difference between maximal BP and BP 2-minute post-exercise. Afterwards, participants underwent 24-hour electrocardiographic monitoring to measure HRV. Unadjusted Spearman correlations and adjusted partial Spearman correlations were computed. Between group analyses were also conducted with Kruskal–Wallis test. Results Associations between HRV and HRR poorly converged (RMSSD and HRR, unadjusted = 0.235; adjusted = 0.144). SDNN Index exhibited the strongest association with parasympathetic tone exhibited by overall lower HRs (unadjusted = −0.600; adjusted = −0.631). HRR demonstrated stronger associations with systolic and diastolic BP responses during exercise (SBP Recovery unadjusted = 0.267; adjusted = 0.297; DBP Recovery unadjusted = −0.276; adjusted = −0.232). Conclusions Overall, while HRV metrics converged and were associated with lower resting heart rates, HRV and HRR poorly converged. Interestingly, HRR was related with measures of hemodynamics indicating a potential relationship with vascular function during both maximal exercise and exercise recovery.

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“…Mahfouz et al . [ 19 ], suggested that abnormal HRR and delayed systolic blood pressure recovery after exercise were correlated with impaired endothelial function and diastolic dysfunction in prediabetics.…”

Section: Introductionmentioning

confidence: 99%

Delayed blood pressure recovery after exercise stress test is associated with autonomic dysfunction and pulse pressure in a middle-aged healthy group

Lee,

Kim,

et al. 2023

PLoS ONE

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Background Delayed heart rate (HR) and blood pressure recovery after exercise test is known as the reliable indexes of autonomic dysfunction. Here we tried to evaluate the serial changes in various indicators during exercise test and correlations with recovery of HR and blood pressure in a normotensive healthy middle-aged group. Methods A total of 122 patients without hypertension or diabetes was enrolled (mean age, 55.6 ± 11.0; male, 56.6%; mean blood pressure, 124.8 ± 16.6 / 81.5 ± 9.6 mmHg). Treadmill test was performed for evaluation of chest pain. Patients with coronary artery disease, positive treadmill test result, left ventricular dysfunction or renal failure were excluded. Heart rate recovery was calculated by subtracting the HR in the first or second minute of recovery period from the HR of peak exercise (HRR1 or HRR2). Systolic blood pressure in the 4th minute of recovery stage (SBPR4) was used to show delayed blood pressure recovery. Results Metabolic equivalents (METs) and HR in stage 2 to 4 were significantly correlated with both HRR1 and HRR2. Multiple regression analysis of HRR revealed significant correlation of METs and SBPR4. SBPR4 was significantly correlated with both HRR1 and HRR2 (HRR1, r = -0.376, p<0.001; HRR2, r = -0.244, p = 0.008) as well as SBP in the baseline to stage 3 and pulse pressure (r = 0.406, p<0.001). Conclusions Delayed BP recovery after peak exercise test revealed significant association with autonomic dysfunction and increased pulse pressure in normotensive middle-aged healthy group. It can be a simple and useful marker of autonomic dysfunction and arterial stiffness.

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Delayed Blood Pressure Recovery Ratio and Its Relation to Endothelial Function and Left Ventricular Diastolic Function in Prediabetics

Abstract: Abnormal HRR1 and delayed SBP response detected during recovery imply a significant correlation with impaired endothelial function and diastolic dysfunction in prediabetics.

Cited by 6 publications

References 33 publications

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

Correlates of Autonomic Function, Hemodynamics, and Physical Activity Performance During Exercise Stress Testing Among Firefighters

Delayed blood pressure recovery after exercise stress test is associated with autonomic dysfunction and pulse pressure in a middle-aged healthy group

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