The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.
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ABSTRACT:
SUBMITTER: Wijkman MO
PROVIDER: S-EPMC8031265 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:High blood pressure (BP) is frequent in acute ischemic stroke (IS). However, the impact of BP change patterns during acute phase on clinical outcomes is not conclusive. This study aims to investigate the association between the acute-phase BP trajectories and clinical outcomes in IS patients with high admission BP. The cohort consisted of 316 IS patients with admission systolic BP (SBP) ≥160 mm Hg. SBP trajectories during the first 7 days after onset were characterized using a random effects model. The patients were classified into three groups based on the SBP trajectory curve parameters: sustained high SBP (T1), moderate decrease (T2), and rapid decrease in SBP (T3). Poor outcomes were defined as modified Rankin scale score ≥3 in 3 months after onset. The relationship between SBP trajectory groups and the outcome was examined in multivariable logistic regression models. The decreasing trend was greater in the favorable than in the poor outcome group (P = 0.028 for difference in linear slopes). The incidence of poor outcomes was 25.9%, 13.5%, and 9.8% in T1 (n = 54), T2 (n = 170), and T3 (n = 92) groups, respectively. Compared with T1 group, the decrease in SBP in T2 and T3 groups was significantly associated with lower risk of the poor outcome (odds ratio = 0.25, 95% confidence interval = 0.10-0.67, P = 0.006). These findings suggest that a decrease in BP in the acute phase is predictive of favorable outcomes in IS patients. BP trajectories have a greater power to detect the association than individual BP values at one time-point.
| S-EPMC8030386 | biostudies-literature
Project description:IntroductionExaggerated blood pressure response to exercise (EEBP = SBP ≥ 190 mmHg for women and ≥210 mmHg for men) during cardiopulmonary exercise test (CPET) is a predictor of cardiovascular risk. Sympathetic hyperactivation and decreased baroreflex sensitivity (BRS) seem to be involved in the progression of metabolic syndrome (MetS) to cardiovascular disease.ObjectiveTo test the hypotheses: (1) MetS patients within normal clinical blood pressure (BP) may present EEBP response to maximal exercise and (2) increased muscle sympathetic nerve activity (MSNA) and reduced BRS are associated with this impairment.MethodsWe selected MetS (ATP III) patients with normal BP (MetS_NT, n = 27, 59.3% males, 46.1 ± 7.2 years) and a control group without MetS (C, n = 19, 48.4 ± 7.4 years). We evaluated BRS for increases (BRS+) and decreases (BRS-) in spontaneous BP and HR fluctuations, MSNA (microneurography), BP from ambulatory blood pressure monitoring (ABPM), and auscultatory BP during CPET.ResultsNormotensive MetS (MetS_NT) had higher body mass index and impairment in all MetS risk factors when compared to the C group. MetS_NT had higher peak systolic BP (SBP) (195 ± 17 vs. 177 ± 24 mmHg, P = 0.007) and diastolic BP (91 ± 11 vs. 79 ± 10 mmHg, P = 0.001) during CPET than C. Additionally, we found that MetS patients with normal BP had lower spontaneous BRS- (9.6 ± 3.3 vs. 12.2 ± 4.9 ms/mmHg, P = 0.044) and higher levels of MSNA (29 ± 6 vs. 18 ± 4 bursts/min, P < 0.001) compared to C. Interestingly, 10 out of 27 MetS_NT (37%) showed EEBP (MetS_NT+), whereas 2 out of 19 C (10.5%) presented (P = 0.044). The subgroup of MetS_NT with EEBP (MetS_NT+, n = 10) had similar MSNA (P = 0.437), but lower BRS+ (P = 0.039) and BRS- (P = 0.039) compared with the subgroup without EEBP (MetS_NT-, n = 17). Either office BP or BP from ABPM was similar between subgroups MetS_NT+ and MetS_NT-, regardless of EEBP response. In the MetS_NT+ subgroup, there was an association of peak SBP with BRS- (R = -0.70; P = 0.02), triglycerides with peak SBP during CPET (R = 0.66; P = 0.039), and of triglycerides with BRS- (R = 0.71; P = 0.022).ConclusionNormotensive MetS patients already presented higher peak systolic and diastolic BP during maximal exercise, in addition to sympathetic hyperactivation and decreased baroreflex sensitivity. The EEBP in MetS_NT with apparent well-controlled BP may indicate a potential depressed neural baroreflex function, predisposing these patients to increased cardiovascular risk.
| S-EPMC8219920 | biostudies-literature
Project description:Background High sodium (Na+) intake is a widespread cardiovascular disease risk factor. High Na+ intake impairs endothelial function and exaggerates sympathetic reflexes, which may augment exercising blood pressure (BP) responses. Therefore, this study examined the influence of high dietary Na+ on BP responses during submaximal aerobic exercise. Methods and Results Twenty adults (8F/12M, age=24±4 years; body mass index 23.0±0.6 kg·m-2; VO2peak=39.7±9.8 mL·min-1·kg-1; systolic BP=111±10 mm Hg; diastolic BP=64±8 mm Hg) participated in this randomized, double-blind, placebo-controlled crossover study. Total Na+ intake was manipulated via ingestion of capsules containing either a placebo (dextrose) or table salt (3900 mg Na+/day) for 10 days each, separated by ?2 weeks. On day 10 of each intervention, endothelial function was assessed via flow-mediated dilation followed by BP measurement at rest and during 50 minutes of cycling at 60% VO2peak. Throughout exercise, BP was assessed continuously via finger photoplethysmography and every 5 minutes via auscultation. Venous blood samples were collected at rest and during the final 10 minutes of exercise for assessment of norepinephrine. High Na+ intake increased urinary Na+ excretion (placebo=140±68 versus Na+=282±70 mmol·24H-1; P<0.001) and reduced flow-mediated dilation (placebo=7.2±2.4 versus Na+=4.2±1.7%; P<0.001). Average exercising systolic BP was augmented following high Na+ (placebo=?30.0±16.3 versus Na+=?38.3±16.2 mm Hg; P=0.03) and correlated to the reduction in flow-mediated dilation (R=-0.71, P=0.002). Resting norepinephrine concentration was not different between conditions (P=0.82). Norepinephrine increased during exercise (P=0.002), but there was no Na+ effect (P=0.26). Conclusions High dietary Na+ augments BP responses during submaximal aerobic exercise, which may be mediated, in part, by impaired endothelial function.
| S-EPMC7660875 | biostudies-literature
Project description:Background and purposeElevated blood pressure (BP) in acute ischemic stroke is common. A raised BP is related to mortality and disability, yet excessive BP lowering can be detrimental. The optimal BP management in acute ischemic stroke remains insufficient and relies on expert consensus statements. Permissive hypertension is recommended during the first 24-h after stroke onset, yet there is ongoing uncertainty regarding the most appropriate blood BP management in the acute phase of ischemic stroke. This study aims to develop a decision support tool for improving the management of extremely high BP during the first 24 h after acute ischemic stroke by using machine learning (ML) tools.MethodsThis diagnostic accuracy study used retrospective data from MIMIC-III and eICU databases. Decision trees were constructed by a hierarchical binary recursive partitioning algorithm to predict the BP-lowering of 10-30% off the maximal value when antihypertensive treatment was given in patients with an extremely high BP (above 220/110 or 180/105 mmHg for patients receiving thrombolysis), according to the American Heart Association/American Stroke Association (AHA/ASA), the European Society of Cardiology, and the European Society of Hypertension (ESC/ESH) guidelines. Regression trees were used to predict the time-weighted average BP. Implementation of synthetic minority oversampling technique was used to balance the dataset according to different antihypertensive treatments. The model performance of the decision tree was compared to the performance of neural networks, random forest, and logistic regression models.ResultsIn total, 7,265 acute ischemic stroke patients were identified. Diastolic BP (DBP) is the main variable for predicting BP reduction in the first 24 h after a stroke. For patients receiving thrombolysis with DBP <120 mmHg, Labetalol and Amlodipine are effective treatments. Above DBP of 120 mmHg, Amlodipine, Lisinopril, and Nicardipine are the most effective treatments. However, successful treatment depends on avoiding hyponatremia and on kidney functions.ConclusionThis is the first study to address BP management in the acute phase of ischemic stroke using ML techniques. The results indicate that the treatment choice should be adjusted to different clinical and BP parameters, thus, providing a better decision-making approach.
| S-EPMC8882601 | biostudies-literature
Project description:Resistant hypertension is a specific condition that affects approximately 10% of subjects with hypertension, and is characterized by persistently high blood pressure levels even using therapy of three or more antihypertensive agents or with blood pressure control using therapy with four or more antihypertensive agents. Changes in lifestyle, such as physical exercise, are indicated for controlling blood pressure. However, investigating studies about this therapy in individuals with resistant hypertension are few.This is a randomized controlled clinical trial. Forty-eight patients with resistant hypertension will be submitted to perform four short-term interventions: aerobic exercise sessions (mild-, moderate- and high-intensity) and control session, in random order and on separate days. After the short-term sessions, the patients will be randomly allocated into four groups for 8 weeks of follow-up: mild-, moderate- and high-intensity aerobic exercise, and a control group. The primary outcome is the occurrence of blood pressure reduction (office and ambulatory analysis, and acute and chronic effects). Secondary outcomes are autonomic and hemodynamic mechanisms: cardiac and vasomotor autonomic modulation, spontaneous baroreflex sensitivity, forearm blood flow and vascular resistance.The importance of exercise for hypertension has been known for decades, but little is known about the effects on patients with resistant hypertension. This study will help to understand whether different aerobic exercise intensities can induce different responses, as well as by what mechanisms adjustments in blood pressure levels may occur.ClinicalTrials.gov, ID: NCT02670681 . Registered on 28 January 2016 (first version); Brazilian Registry Platform Clinical Trials: protocol RBR-5q24zh . Registered on 24 June 2015.
| S-EPMC5457580 | biostudies-literature
Project description:PurposeThis study aims to investigate the effects of acute cycling on blood pressure (BP), arterial function, and heart rate variability (HRV) in men living with HIV (MLHIV) using combined antiretroviral therapy (cART).MethodsTwelve MLHIV (48.7 ± 9.2 years; 25.2 ± 2.8 kg m-2) and 13 healthy controls (41.2 ± 9.9 years; 26.3 ± 2.9 kg m-2) performed a cycling bout (ES) (intensity: 50% oxygen uptake reserve; duration: time to achieve 150 kcal-MLHIV: 24.1 ± 5.5 vs. controls: 23.1 ± 3.0 min; p = 0.45), and a 20-min non-exercise session (NES).ResultsAt rest (p < 0.05), MLHIV presented higher brachial systolic/diastolic BP (SBP/DBP: 123.2 ± 14.2/76.8 ± 6.3 vs. 114.3 ± 5.1/71.6 ± 2.6 mmHg) and central BP (cSBP/cDBP: 108.3 ± 9.3/76.5 ± 6.5 vs. 101.6 ± 4.9/71.3 ± 4.4 mmHg) vs. controls but lower absolute maximal oxygen uptake (2.1 ± 0.5 vs. 2.5 ± 0.3 L min-1) and HRV indices reflecting overall/vagal modulation (SDNN: 24.8 ± 7.1 vs. 42.9 ± 21.3 ms; rMSSD: 20.5 ± 8.5 vs. 38.1 ± 22.8 ms; pNN50: 3.6 ± 4.2 vs. 13.6 ± 11.3%). DBP postexercise lowered in controls vs. MLHIV (∼4 mmHg, p < 0.001; ES: 0.6). Moreover, controls vs. MLHIV had greater reductions (p < 0.05) in augmentation index (-13.6 ± 13.7 vs. -3.1 ± 7.2% min-1; ES: 2.4), and HRV indices up to 5 min (rMSSD: -111.8 ± 32.1 vs. -75.9 ± 22.2 ms min-1; ES: 3.8; pNN50: -76.3 ± 28.3 vs. -19.0 ± 13.7% min-1; ES: 4.4). Within-group (ES vs. NES; p < 0.05) reductions occurred in controls for SBP (∼10 mmHg, 2 h), DBP (∼6 mmHg, 20, 30, and 70 min), cSBP (∼9 mmHg, 30 min), cDBP (∼7 mmHg, 30 and 70 min), augmentation index (∼10%, 30 min), and pNN50 (∼20%; up to 2 h), while in MLHIV only cSBP (∼6 mmHg, 70 min) and cDBP (∼4 mmHg, 30 min) decreased. Similar increases (up to 5 min) in heart rate (∼22 bpm) and decreases in SDNN (∼18 ms) and rMSSD (∼20 ms) occurred in both groups.ConclusionMLHIV under cART exhibited attenuated postexercise hypotension vs. healthy controls, which seemed to relate with impairments in vascular function.
| S-EPMC8320391 | biostudies-literature
Project description:Background Although the effect of blood pressure on poststroke outcome is well recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 5514 patients with acute ischemic stroke at ≥2 of 7 prespecified time points during the first year after stroke among those enrolled in a multicenter prospective registry. Longitudinal SBPs were categorized using a group-based trajectory model. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to 1 year after stroke. The study subjects were categorized into 4 SBP trajectory groups: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). In the first 3 groups, SBP decreased during the first 3 to 7 days and remained steady thereafter. In the slowly dropping SBP group, SBPs decreased from 182 to 135 mm Hg during the first 30 days, then paralleled the trajectory of the moderate SBP group. Compared with the reference, the moderate SBP group, the slowly dropping SBP group was at higher risk for the primary outcome (adjusted hazard ratio [HR], 1.32; 95% CI, 1.05‒1.65) and mortality (adjusted HR, 1.35; 95% CI, 1.03‒1.78). Primary outcome rates were similarly high in the persistently high SBP group. Conclusions Four 1-year longitudinal SBP trajectories were identified in patients with acute ischemic stroke. Patients in the slowly dropping SBP and persistently high SBP trajectory groups were prone to adverse cardiovascular outcomes after stroke.
| S-EPMC9075074 | biostudies-literature
Project description:To verify if acute intake of beetroot juice potentiates post-exercise hypotension (PEH) in hypertensive postmenopausal women. Thirteen hypertensive postmenopausal women (58.1 ± 4.62 years and 27.4 ± 4.25 kg/m²) were recruited to participate in three experimental sessions, taking three different beverages: Beetroot juice (BJ), placebo nitrate-depleted BJ (PLA), and orange flavored non-caloric drink (OFD). The participants performed moderate aerobic exercise training on a treadmill, at 65-70% of heart rate reserve (HRR), for 40 min. After an overnight fast, the protocol started at 07h when the first resting blood pressure (BP) was measured. The beverage was ingested at 07h30 and BP was monitored until the exercise training started, at 09h30. After the end of the exercise session, BP was measured every 15 min over a 90-min period. Saliva samples were collected at rest, immediately before and after exercise, and 90 min after exercise for nitrite (NO2-) analysis. There was an increase in salivary NO2- with BJ intake when compared to OFD and PLA. A slight increase in salivary NO2- was observed with PLA when compared to OFD (p < 0.05), however, PLA resulted in lower salivary NO2- when compared to BJ (p < 0.001). There were no changes in salivary NO2- with the OFD. Systolic and diastolic BP decreased (p < 0.001) on all post exercise time points after all interventions, with no difference between the three beverages. Acute BJ intake does not change PEH responses in hypertensive postmenopausal women, even though there is an increase in salivary NO2-.
| S-EPMC6627101 | biostudies-literature
Project description:We investigated whether fatigue from sustained aerobic swimming provides a sub-lethal endpoint to define tolerance of acute warming in fishes, as an alternative to loss of equilibrium (LOE) during a critical thermal maximum (CTmax) protocol. Two species were studied, Nile tilapia (Oreochromis niloticus) and pacu (Piaractus mesopotamicus). Each fish underwent an incremental swim test to determine gait transition speed (UGT), where it first engaged the unsteady anaerobic swimming mode that preceded fatigue. After suitable recovery, each fish was exercised at 85% of their own UGT and warmed 1°C every 30 min, to identify the temperature at which they fatigued, denoted as CTswim Fish were also submitted to a standard CTmax, warming at the same rate as CTswim, under static conditions until LOE. All individuals fatigued in CTswim, at a mean temperature approximately 2°C lower than their CTmax Therefore, if exposed to acute warming in the wild, the ability to perform aerobic metabolic work would be constrained at temperatures significantly below those that directly threatened survival. The collapse in performance at CTswim was preceded by a gait transition qualitatively indistinguishable from that during the incremental swim test. This suggests that fatigue in CTswim was linked to an inability to meet the tissue oxygen demands of exercise plus warming. This is consistent with the oxygen and capacity limited thermal tolerance (OCLTT) hypothesis, regarding the mechanism underlying tolerance of warming in fishes. Overall, fatigue at CTswim provides an ecologically relevant sub-lethal threshold that is more sensitive to extreme events than LOE at CTmax.
| S-EPMC7225124 | biostudies-literature
Project description:Cognitive enhancements following a single bout of exercise are frequently attributed to increases in cerebral blood flow, however to date we have little understanding of the extent to which such bouts of exercise actually even influence cerebral blood flow following the cessation of exercise. To gain such insight, both regional and global changes in cerebral blood flow were assessed using 3D pseudo-continuous arterial spin-labeled magnetic resonance imaging in a sample of 41 preadolescent children. Using a within-participants randomized crossover design, cerebral blood flow as assessed prior to and following 20-min of either aerobic exercise or an active-control condition during two separate, counterbalanced sessions. The aerobic exercise condition consisted of walking/jogging on a motor driven treadmill at an intensity of approximately 70% of age-predicted maximum heart rate (HR?=?136.1?±?11.1?bpm). The active control condition consisted of walking on the treadmill at the lowest possible intensity (0.5 mph and 0% grade; HR?=?92.0?±?12.2?bpm). Findings revealed no differences in cerebral blood flow following the cessation of exercise relative to the active control condition. These findings demonstrate that cerebral blood flow may not be altered in preadolescent children following the termination of the exercise stimulus during the period when cognitive enhancements have previously been observed.
| S-EPMC6240392 | biostudies-literature