Visit-to-Visit Variability and Reduction in Blood Pressure After a 3-Month Cardiac Rehabilitation Program in Patients With Cardiovascular Disease

Abstract

SummaryVisit-to-visit variability (VVV) in blood pressure (BP) has been shown to be a predictor of cardiovascular events. It is unknown whether CR can improve VVV in BP as well as reducing BP. We enrolled 84 patients who had cardiovascular disease (CVD) and participated in a 3-month CR program. We measured systolic and diastolic BP (SBP and DBP), pulse pressure (PP), and heart rate (HR) before exercise training at each visit and determined VVV in BP or HR expressed as the standard deviation of the average BP or HR. Patients who had uncontrolled BP at baseline and who did not change their antihypertensive drugs throughout the study period showed a significant reduction of both SBP and DBP with a decrease in PP after 3 months. Patients who did not change their antihypertensive drugs were divided into larger (L-) and smaller (S-) VVV in the SBP groups and L-and S-VVV in the DBP groups according to the average value of VVV in SBP or DBP. In the L-VVV in the SBP and DBP groups, VVV in SBP and DBP in the 1st month was significantly decreased after the 3rd month in both groups. HR at baseline was significantly decreased after 3 months. In addition, CR induced a significant increase in the level of high-density lipoprotein cholesterol (HDL-C) in blood. In conclusion, CR improved VVV in BP in patients with L-VVV in BP and evoked a significant reduction in HR and an increase in HDL-C. These effects due to the CR program may be cardioprotective. (Int Heart J 2016; 57: 607-614) Key words: Cardioprotection, Heart rate, High-density lipoprotein cholesterol C ardiac rehabilitation (CR) is designed to help patients recovering from a heart attack, other various cardiovascular diseases, (CVD) or cardiac surgery. CR is a comprehensive therapy and can improve physical activity and psychological function, quality of life, and the prognosis in patients with CVD. 1-7)The prognostic value of blood pressure (BP) is based mainly on measurements obtained in a clinical setting. 7) High BP is a major risk factor for the onset and progression of CVD,8) and exercise training has been shown to reduce BP in patients with hypertension (HTN).9,10) A recent report indicated that visit-to-visit variability (VVV) in BP is reproducible and not a random phenomenon.11) The Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm reported that VVV in systolic BP (SBP) and maximum SBP were significantly associated with future risks of stroke and other CVD events independent of mean BP and other cardiovascular risk factors.12) Moreover, others have also indicated that VVV in BP is a predictor of the development of atherosclerotic diseases including stroke and myocardial infarction, and cardiovascular and all-cause mortality.12-15) Nonetheless, there is no recommendation on how to manage patients with CVD regarding the optimal control of VVV in BP.

Factors Associated with Visit-to-Visit Variability of Blood Pressure Measured as Part of Routine Clinical Care among Patients Attending Cardiology Outpatient Department of a Tertiary Care Centre in Northern Sri Lanka

“…Patients who had uncontrolled BP at baseline and who did not change their antihypertensive drugs throughout the study period showed a significant reduction of both SBP and DBP after 3 months. Patients who did not change their antihypertensive drugs were divided into high and low VVV in the SBP groups according to the average value of VVV in SBP or DBP and found that VVV in SBP and DBP in the 1st month was significantly decreased than the 3rd month in both groups [29]. Our study revealed considerable amount of the participants (26.6% CI: 22.5–31.1) had insufficient (sedentary) physical activity level, and 20.4% (16.7–24.6) reported as moderately active.…”

Difference in Prognosis between Continuation and Discontinuation of A 5-Month Cardiac Rehabilitation Program in Outpatients with Heart Failure with Preserved Ejection Fraction

“…We have studied CR for more than eight years and reported some beneficial effects in patients with cardiovascular diseases (CVD) [12][13][14][15][16][17]. We previously reported that a CR program significantly reduced blood pressure (BP) and visit-to-visit variability in BP, and patients with mild to moderate chronic kidney disease (CKD) who participated in our CR program showed an increase in their estimated glomerular filtration rate (eGFR) [14,15]. We also reported that long-term CR in elderly CVD outpatients helped to maintain the anaerobic threshold (AT), left ventricular EF (LVEF), plasma levels of brain natriuretic peptide (BNP) and eGFR for 5 years [16].…”

Cardiac rehabilitation in patients with cardiovascular disease leads various hemodynamic parameters obtained using simple non-invasive tests to their appropriate levels

“…Comprehensive cardiac rehabilitation (CR) has been shown to improve cardiac function and prognosis in patients with cardiovascular disease (CVD) [1] , [2] . Recently, we reported that a 3-month CR program significantly decreased blood pressure (BP) [3] and improved atherosclerosis and sympathetic nerve as assessed by 3 simple non-invasive tests: BP and severity of atherosclerosis [arterial velocity pulse index (AVI) and arterial pressure volume index (API)] were determined using PASESA® (AVE-1500, Shisei Datum, Tokyo, Japan), an index of total autonomic nerve activity and a coefficient of variation of the R-R interval (CVRR) were determined using eHEART® (Parama-Tec, Fukuoka, Japan), and absolute and relative differences in BP between arms, pressure rate product (PRP), mean total peripheral resistance index (TPR), stroke volume (SV), and cardiac index (CI) were determined using nico® (Parama-Tec, Fukuoka, Japan) [4] . These 3 easy-to-use devices, PASESA® [5] , nico PS-501® (North Parama Inc., Tokyo, Japan) [6] and eHEART® [7] , are currently available for clinical use in Japan.…”