Exercise Blood Pressure Response, Albuminuria, and Arterial Stiffness in Hypertension

Tsioufis, Costas; Dimitriadis, Kyriakos; Thomopoulos, Costas; Tsiachris, Dimitriοs; Selima, Maria; Stefanadi, Elli; Tousoulis, Dimitrios; Kallikazaros, Ioannis; Stefanadis, Christodoulos

doi:10.1016/j.amjmed.2008.05.035

Cited by 46 publications

(41 citation statements)

References 32 publications

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“…A blunted microvascular vasodilator response to acute exercise may therefore be one explanation of an exaggerated exercise SBP. Previous studies have also reported exaggerated SBP being associated with carotid intima-media thickness, 29 arterial stiffness 30 and brachial artery flow-mediated vasodilation. 31 Thus, individuals with an exaggerated SBP response to exercise may display a degree of impaired vascular structure and functioning, such as endothelial dysfunction, arteriosclerosis and arterial stiffness.…”

Section: Discussionmentioning

confidence: 95%

Hemodynamic variables during exercise in childhood and resting systolic blood pressure levels 6 years later in adolescence: the European Youth Heart Study

et al. 2010

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The aim of this study was to analyze whether systolic blood pressure (SBP), heart rate (HR) and rate pressure product (RPP) during exercise in childhood can predict resting SBP levels in adolescence independent of resting SBP and conventional cardiovascular risk factors. We studied this in a sample of Danish children followed longitudinally for 6 years. The study comprised 226 children randomly sampled at age 9, who had their blood pressure and HR measured during ergometer exercise to exhaustion and was reassessed in adolescence. SBP and RPP during exercise in stage two of the test were positively associated with future resting SBP, independent of resting SBP in childhood (P ¼ 0.045 and P ¼ 0.013, respectively). After additional adjustment for conventional cardiovascular risk factors the associations with SBP and RPP during stage two on future resting SBP only slightly materially change, although only RPP remained significant (P ¼ 0.059 and P ¼ 0.012, respectively). No significant independent associations were observed for HR during exercise, but associations were in the same direction. Our results supports that measuring SBP and RPP, during a standard acute ergometer exercise test in children, improves the prediction of future SBP levels during rest in adolescence independent of resting SBP and conventional cardiovascular risk factors.

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Section: Discussionmentioning

confidence: 95%

Hemodynamic variables during exercise in childhood and resting systolic blood pressure levels 6 years later in adolescence: the European Youth Heart Study

et al. 2010

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“…Previous studies have shown that arterial stiffness is associated with an exaggerated BP response to exercise, obesity, IR, 30 and poor CRF. 12,31 One factor typically observed in individuals with IR and/or abdominal fat accumulation is a decrease in NO bioavailability, which could be the result of increased blood glucose and free fatty acid concentrations and an increased superoxide production by adipocytes. 32 This impairment could also be related to inflammation with visceral fat producing several proinflammatory cytokines 14 or the result of an inappropriately elevated cyclic GMP stimulated by NO, therefore impairing vasodilation.…”

Section: Discussionmentioning

confidence: 99%

Insulin Resistance, Low Cardiorespiratory Fitness, and Increased Exercise Blood Pressure

Huot

Arsenault²,

Gaudreault³

et al. 2011

Hypertension

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Abstract-Individuals with insulin resistance and low cardiorespiratory fitness are frequently found to have an increased waist circumference and high exercise blood pressure. We tested the hypothesis that the relationships among insulin resistance, low cardiorespiratory fitness, and increased exercise blood pressure may be mediated by an elevated waist circumference. This study included 317 apparently healthy men and women (mean age: 34.8Ϯ12.8 years; mean body mass index: 26.1Ϯ5.2 kg/m 2 ). Exercise blood pressure values were measured using a submaximal ergometer test evaluating physical working capacity. Plasma insulin and glucose levels were measured during a 3-hour oral glucose tolerance test. Multivariate regression analyses showed that waist circumference accounted for 32.8% (PϽ0.0001) and 45.1% (PϽ0.0001) of the variance in exercise systolic blood pressure in men and women, respectively. Participants were classified into tertiles according to either insulin response, measured during the oral glucose tolerance test, or fitness levels and then further subdivided into 2 subgroups using sex-specific waist circumference thresholds. Individuals with an increased waist circumference (Ն94 cm and Ն80 cm for men and women, respectively) had higher exercise systolic blood pressure compared with individuals with low waist circumference, irrespective of their level of insulin resistance (10.6 versus 6.8, 12.2 versus 7.7, and 13.2 versus 8.7 mm Hg/metabolic equivalent, respectively, for the low, intermediate, and high tertiles; PϽ0.05) or fitness levels (13.1 versus 8.2, 12.0 versus 7.9, and 10.6 versus 7.1 mm Hg/metabolic equivalent, respectively, for the low, intermediate, and high tertiles; PϽ0.05). Individuals with a higher waist circumference have elevated exercise systolic blood pressure, regardless of their insulin sensitivity or level of cardiorespiratory fitness.

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“…Most importantly, levels of albuminuria below the threshold cutoff values are associated with worsening blood pressure (BP), atherosclerotic plaque development and overall cardiovascular mortality [12,13]. Furthermore, hypertensives with augmented albuminuria are accompanied by both increased incidence of LVH and particularly of the concentric type and deterioration of aortic stiffness [8,16,17,18]. In its own right, large artery stiffness significantly determines pressure overload to cardiac muscle and consequently affects LV geometry [19,20].…”

Section: Introductionmentioning

confidence: 99%

Parallel Deterioration of Albuminuria, Arterial Stiffness and Left Ventricular Mass in Essential Hypertension: Integrating Target Organ Damage

et al. 2011

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Background: Albuminuria, arterial stiffening and left ventricular hypertrophy (LVH) constitute target organ damage. We estimated whether increased urinary albumin excretion, assessed by albumin-to-creatine ratio (ACR), and carotid to femoral pulse wave velocity (c-f PWV) were accompanied by augmented left ventricular (LV) mass index (LVMI) in hypertension. Methods: In 428 non-diabetic untreated hypertensives (257 men, mean age = 52 years, office blood pressure (BP) = 146/93 mm Hg) the distributions of ACR and c-f PWV were split by the median (8 mg/g and 7.8 m/s, respectively). Results: Age, male sex, 24 h systolic BP, ACR and c-f PWV were the independent predictors of LVMI (R² = 0.478, p < 0.0001). Among patients with low ACR (n = 198), those with high c-f PWV (n = 84) compared to those with low c-f PWV (n = 114) were characterized by increased LVMI (by 8.9 g/m², p = 0.012) and prevalence of LVH (30 vs. 14%, p = 0.015). Similarly among patients with high ACR (n = 230), those with high c-f PWV (n = 123) compared to those with low c-f PWV (n = 107) exhibited heightened LVMI (by 13.6 g/m², p = 0.001). Conclusions: Increased ACR in conjunction with pronounced arterial stiffness is accompanied by augmented LV mass and higher LVH rates. Furthermore, the interrelationships between albuminuria, c-f PWV and LVMI suggest parallel target organ damage progression.

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Exercise Blood Pressure Response, Albuminuria, and Arterial Stiffness in Hypertension

Cited by 46 publications

References 32 publications

Hemodynamic variables during exercise in childhood and resting systolic blood pressure levels 6 years later in adolescence: the European Youth Heart Study

Hemodynamic variables during exercise in childhood and resting systolic blood pressure levels 6 years later in adolescence: the European Youth Heart Study

Insulin Resistance, Low Cardiorespiratory Fitness, and Increased Exercise Blood Pressure

Parallel Deterioration of Albuminuria, Arterial Stiffness and Left Ventricular Mass in Essential Hypertension: Integrating Target Organ Damage

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