ORCID Profile
0000-0003-3458-1811
Current Organisation
Menzies Research Institute Tasmania
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Publications
Low exercise blood pressure and risk of cardiovascular events and all-cause mortality: Systematic review and meta-analysis
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.ATHEROSCLEROSIS.2014.08.029
Abstract: The independent prognostic significance of abnormally low systolic blood pressure (SBP) during exercise stress testing (LowExBP) across different clinical and exercise conditions is unknown. We sought by systematic review and meta-analysis to determine the association between cardiovascular/all-cause outcomes and LowExBP across different patient clinical presentations, exercise modes, exercise intensities and categories of LowExBP. Seven online databases were searched for longitudinal studies reporting the association of LowExBP with risk of fatal and non-fatal cardiovascular events and/or all-cause mortality. LowExBP was defined as either: SBP drop below baseline failure to increase >10 mmHg from baseline or lowest SBP quantile among reporting studies. After review of 13,257 studies, 19 that adjusted for resting SBP were included in the meta-analysis, with a total of 45,895 participants (average follow-up, 4.4 ± 3.0 years). For the whole population, LowExBP was associated with increased risk for fatal and non-fatal cardiovascular events and all-cause mortality (hazard ratio [HR]: 2.01, 95% confidence interval [CI]: 1.59-2.53, p < 0.001). In continuous analyses, a 10 mmHg decrease in exercise SBP was associated with higher risk (n = 9 HR: 1.13, 95% CI: 1.06-1.20, p < 0.001). LowExBP was associated with increased risk regardless of clinical presentation (coronary artery disease, heart failure, hypertrophic cardiomyopathy or peripheral artery disease), exercise mode (treadmill or bike), exercise intensity (moderate or maximal), or LowExBP category (all p < 0.05). However, bias toward positive results was apparent (Eggers test p < 0.001 and p = 0.009). Our data show that irrespective of clinical or exercise conditions, LowExBP independently predicts fatal and non-fatal cardiovascular events and all-cause mortality.
Reproducibility of cardiac output derived by impedance cardiography during postural changes and exercise
Publisher: Springer Science and Business Media LLC
Date: 2012
Evaluation of a Brachial Cuff and Suprasystolic Waveform Algorithm Method to Noninvasively Derive Central Blood Pressure
Publisher: Oxford University Press (OUP)
Date: 05-09-2014
DOI: 10.1093/AJH/HPU163
Abstract: Central blood pressure (BP) can be estimated noninvasively by analyzing brachial artery waveforms. In this study, our aim was to assess the validity of a brachial cuff-based (suprasystolic) technique for estimating central BP (CBPestimated) by comparison with invasive aortic BP (CBPinvasive). Eighty-four simultaneous CBPestimated (Pulsecor R7.0) and CBPinvasive measures were recorded in 47 patients (aged 63±10 years, 62% male) undergoing coronary angiography. Measures were captured at baseline and acutely following intravenous glyceryl trinitrate (GTN 100-200 μg). Mean CBPinvasive systolic BP (SBP) and diastolic BP (DBP) were compared with CBPestimated SBP and DBP calibrated with brachial SBP and DBP recorded from the Pulsecor device. To test validity of the central BP algorithm, measures of CBPestimated SBP were also compared with CBPinvasive SBP following recalibration with invasive mean arterial pressure (MAP) and DBP. At baseline, mean difference ± standard deviation between CBPestimated SBP and CBPinvasive SBP was -7±9mm Hg (intraclass correlation coefficient (ICC) = 0.86 P < 0.001) with similar underestimation post-GTN (-6±9mm Hg ICC = 0.90 P < 0.001). Recalibration of CBPestimated SBP with invasive MAP and DBP resulted in closer mean difference to CBPinvasive SBP (-2±7mm Hg ICC = 0.95 P < 0.001) at baseline but not post-GTN (-6±7mm Hg ICC = 0.95 P < 0.001). The Pulsecor algorithm to derive central BP has acceptable validity when calibrated with invasive pressures. However, accuracy is compromised when noninvasive brachial cuff BP calibration is used.
Comparison of manual and automated auscultatory blood pressure during graded exercise among people with type 2 diabetes
Publisher: Wiley
Date: 22-10-2019
DOI: 10.1111/JCH.13717
Validity and reliability of central blood pressure estimated by upper arm oscillometric cuff pressure
Publisher: Oxford University Press (OUP)
Date: 04-2012
DOI: 10.1038/AJH.2011.238
Abstract: Noninvasive central blood pressure (BP) independently predicts mortality, but current methods are operator-dependent, requiring skill to obtain quality recordings. The aims of this study were first, to determine the validity of an automatic, upper arm oscillometric cuff method for estimating central BP (O(CBP)) by comparison with the noninvasive reference standard of radial tonometry (T(CBP)). Second, we determined the intratest and intertest reliability of O(CBP). To assess validity, central BP was estimated by O(CBP) (Pulsecor R6.5B monitor) and compared with T(CBP) (SphygmoCor) in 47 participants free from cardiovascular disease (aged 57 ± 9 years) in supine, seated, and standing positions. Brachial mean arterial pressure (MAP) and diastolic BP (DBP) from the O(CBP) device were used to calibrate in both devices. Duplicate measures were recorded in each position on the same day to assess intratest reliability, and participants returned within 10 ± 7 days for repeat measurements to assess intertest reliability. There was a strong intraclass correlation (ICC = 0.987, P < 0.001) and small mean difference (1.2 ± 2.2 mm Hg) for central systolic BP (SBP) determined by O(CBP) compared with T(CBP). Ninety-six percent of all comparisons (n = 495 acceptable recordings) were within 5 mm Hg. With respect to reliability, there were strong correlations but higher limits of agreement for the intratest (ICC = 0.975, P < 0.001, mean difference 0.6 ± 4.5 mm Hg) and intertest (ICC = 0.895, P < 0.001, mean difference 4.3 ± 8.0 mm Hg) comparisons. Estimation of central SBP using cuff oscillometry is comparable to radial tonometry and has good reproducibility. As a noninvasive, relatively operator-independent method, O(CBP) may be as useful as T(CBP) for estimating central BP in clinical practice.
Persistent elevation of central pulse pressure during postural stress in patients with type 2 diabetes mellitus
Publisher: Springer Science and Business Media LLC
Date: 20-12-2013
DOI: 10.1038/JHH.2012.60
Abstract: An abnormal increase or decrease in blood pressure (BP) in response to postural stress is associated with increased risk of developing hypertension and stroke. However, the haemodynamic responses contributing to changes in central BP with postural stress are not well characterised. We aimed to determine this in controls compared to patients with type 2 diabetes mellitus (T2DM), whom we hypothesised would have an abnormal postural response. 41 participants (20 control, 21 T2DM) underwent measurement of brachial and central BP (by radial tonometry), with simultaneous bioimpedance cardiography (to determine stroke volume (SV) and cardiac output (CO)) and heart rate variability in seated and standing postures. Systemic vascular resistance (SVR mean arterial pressure/CO), and arterial elastance (EA end systolic pressure/SV) were calculated. Postural changes were defined as seated minus standing values. Central pulse pressure (PP) was higher in patients with T2DM and did not change from seated-to-standing positions, whereas there was a significant decrease upon standing in controls (P<0.05). The change in central systolic BP (SBP) correlated with change in SVR and EA in controls (r=0.67 and 0.68, P 0.05, respectively). SV was the only significant correlate of change in central SBP in T2DM patients (r=0.62, P 0.05). We conclude that central haemodynamic responses to postural stress are altered in patients with T2DM and result in persistent elevation of central PP while standing. This may contribute to increased cardiovascular risk associated with T2DM.
Cardiorespiratory fitness, fatness, and the acute blood pressure response to exercise in adolescence
Publisher: Wiley
Date: 08-05-2021
DOI: 10.1111/SMS.13976
Abstract: Exaggerated exercise blood pressure (BP) is associated with cardiovascular risk factors in adolescence. Cardiorespiratory fitness and adiposity (fatness) are independent contributors to cardiovascular risk, but their interrelated associations with exercise BP are unknown. This study aimed to determine the relationships between fitness, fatness, and the acute BP response to exercise in a large birth cohort of adolescents. 2292 adolescents from the Avon Longitudinal Study of Parents and Children (aged 17.8 ± 0.4 years, 38.5% male) completed a sub‐maximal exercise step test that allowed fitness (VO 2 max ) to be determined from workload and heart rate using a validated equation. Exercise BP was measured immediately on test cessation and fatness calculated as the ratio of total fat mass to total body mass measured by DXA. Post‐exercise systolic BP decreased stepwise with tertile of fitness (146 (18) 142 (17) 141 (16) mmHg) but increased with tertile of fatness (138 (15) 142 (16) 149 (18) mmHg). In separate models, fitness and fatness were associated with post‐exercise systolic BP adjusted for sex, age, height, smoking, and socioeconomic status (standardized β: −1.80, 95%CI: −2.64, −0.95 mmHg/SD and 4.31, 95%CI: 3.49, 5.13 mmHg/SD). However, when fitness and fatness were included in the same model, only fatness remained associated with exercise BP (4.65, 95%CI: 3.69, 5.61 mmHg/SD). Both fitness and fatness are associated with the acute BP response to exercise in adolescence. The fitness‐exercise BP association was not independent of fatness, implying the cardiovascular protective effects of cardiorespiratory fitness may only be realized with more favorable body composition.
Central Blood Pressure Physiology: A (More) Critical Analysis
Publisher: Oxford University Press (OUP)
Date: 25-03-2015
DOI: 10.1093/AJH/HPU238
Out-of-office and central blood pressure for risk stratification: a cross-sectional study in patients treated for hypertension.
Publisher: Wiley
Date: 28-09-2011
DOI: 10.1111/J.1365-2362.2011.02595.X
Abstract: Central blood pressure (BP) predicts mortality independent of office brachial BP. Whether central BP may be useful to differentiate BP control requires examination and was the first aim of this study. Secondly, we sought to determine the variability in central BP among patients from different categories of BP control [controlled hypertension (CH), masked hypertension (MH), white coat (WCHT) and uncontrolled hypertension (UH)]. We assessed patients with uncomplicated hypertension using measurement of central BP (SphygmoCor 8.1), brachial BP and 24-h ambulatory BP monitoring. BP control was defined according to guidelines using office BP and 24-h BP. Of the 201 patients (63 ± 8 years, 51% men), 67 (33%) were classified as CH 59 (29%) with MH 31 (15%) with WCHT and 44 (22%) with UH. There were no differences in central BP parameters (augmentation pressure, augmentation index, pulse pressure) between patients with CH and MH or between patients with WCHT and UH (P > 0·05 for all). However, there was significant overlap in central systolic BP between BP control categories. For ex le, 27% of patients with normal brachial systolic BP had central systolic BP above age- and gender-specific normal values, including patients from three classifications of BP control (CH: n = 27 MH: n = 22 and WCHT: n = 4). Office central BP alone cannot delineate categories of BP control. However, given the high degree of variability in central BP among patients from different categories of BP control, measurement of central BP may result in significant reclassification of risk related to BP.
Response to A New Exercise Central Hemodynamics Paradigm: Time for Reflection or Expansion?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Lifestyle Change Diminishes a Hypertensive Response to Exercise in Type 2 Diabetes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2011
Type-2 Diabetes and the Clinical Importance of Exaggerated Exercise Blood Pressure.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2022
DOI: 10.1161/HYPERTENSIONAHA.122.19420
Abstract: Exaggerated exercise blood pressure (EEBP) during clinical exercise testing is associated with poor blood pressure (BP) control and cardiovascular disease (CVD). Type-2 diabetes (T2DM) is thought to be associated with increased prevalence of EEBP, but this has never been definitively determined and was the aim of this study. Clinical exercise test records were analyzed from 13 268 people (aged 53±13 years, 59% male) who completed the Bruce treadmill protocol (stages 1–4, and peak) at 4 Australian public hospitals. Records (including BP) were linked to administrative health datasets (hospital and emergency admissions) to define clinical characteristics and classify T2DM (n=1199) versus no T2DM (n=12 069). EEBP was defined as systolic BP ≥90th percentile at each test stage. Exercise BP was regressed on T2DM history and adjusted for CVD and risk factors. Prevalence of EEBP (age, sex, preexercise BP, hypertension history, CVD history and aerobic capacity adjusted) was 12% to 51% greater in T2DM versus no T2DM (prevalence ratio [95% CI], stage 1, 1.12 [1.02–1.24] stage 2, 1.51 [1.41–1.61] stage 3, 1.25 [1.10–1.42] peak, 1.18 [1.09–1.29]). At stages 1 to 3, 8.6% to 15.8% (4.8%–9.7% T2DM versus 3.5% to 6.1% no-T2DM) of people with ‘normal’ preexercise BP ( /90 mm Hg) were identified with EEBP. Exercise systolic BP relative to aerobic capacity (stages 1–4 and peak) was higher in T2DM with adjustment for all CVD risk factors. People with T2DM have higher prevalence of EEBP and exercise systolic BP independent of CVD and many of its known risk factors. Clinicians supervising exercise testing should be alerted to increased likelihood of EEBP and thus poor BP control warranting follow-up care in people with T2DM.
Associations and clinical relevance of aortic-brachial artery stiffness mismatch, aortic reservoir function, and central pressure augmentation
Publisher: American Physiological Society
Date: 10-2015
DOI: 10.1152/AJPHEART.00317.2015
Abstract: Central augmentation pressure (AP) and index (AIx) predict cardiovascular events and mortality, but underlying physiological mechanisms remain disputed. While traditionally believed to relate to wave reflections arising from proximal arterial impedance (and stiffness) mismatching, recent evidence suggests aortic reservoir function may be a more dominant contributor to AP and AIx. Our aim was therefore to determine relationships among aortic-brachial stiffness mismatching, AP, AIx, aortic reservoir function, and end-organ disease. Aortic (aPWV) and brachial (bPWV) pulse wave velocity were measured in 359 in iduals (aged 61 ± 9, 49% male). Central AP, AIx, and aortic reservoir indexes were derived from radial tonometry. Participants were stratified by positive (bPWV aPWV), negligible (bPWV ≈ aPWV), or negative stiffness mismatch (bPWV aPWV). Left-ventricular mass index (LVMI) was measured by two-dimensional-echocardiography. Central AP and AIx were higher with negative stiffness mismatch vs. negligible or positive stiffness mismatch (11 ± 6 vs. 10 ± 6 vs. 8 ± 6 mmHg, P 0.001 and 24 ± 10 vs. 24 ± 11 vs. 21 ± 13%, P = 0.042). Stiffness mismatch (bPWV-aPWV) was negatively associated with AP ( r = −0.18, P = 0.001) but not AIx ( r = −0.06, P = 0.27). Aortic reservoir pressure strongly correlated to AP ( r = 0.81, P 0.001) and AIx ( r = 0.62, P 0.001) independent of age, sex, heart rate, mean arterial pressure, and height (standardized β = 0.61 and 0.12, P ≤ 0.001). Aortic reservoir pressure independently predicted abnormal LVMI (β = 0.13, P = 0.024). Positive aortic-brachial stiffness mismatch does not result in higher AP or AIx. Aortic reservoir function, rather than discrete wave reflection from proximal arterial stiffness mismatching, provides a better model description of AP and AIx and also has clinical relevance as evidenced by an independent association of aortic reservoir pressure with LVMI.
Aortic Reservoir Pressure Corresponds to Cyclic Changes in Aortic Volume
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
DOI: 10.1161/ATVBAHA.114.303573
Abstract: Aortic reservoir pressure indices independently predict cardiovascular events and mortality. Despite this, there has never been a study in humans to determine whether the theoretical principles of the mathematically derived aortic reservoir pressure (RP derived ) and excess pressure (XP derived ) model have a real physiological basis. This study aimed to directly measure the aortic reservoir (AR direct by cyclic change in aortic volume) and determine its relationship with RP derived , XP derived , and aortic blood pressure (BP). Ascending aortic BP and Doppler flow velocity were recorded via intra-arterial wire in 10 men (aged 62±12 years) during coronary artery bypass surgery. Simultaneous ascending aortic transesophageal echocardiography was used to measure AR direct . Published mathematical formulae were used to determine RP derived and XP derived . AR direct was strongly and linearly related to RP derived during systole ( r =0.988 P .001) and diastole ( r =0.985 P .001). Peak cross-correlation ( r =0.98) occurred at a phase lag of 0.004 s into the cardiac cycle, suggesting close temporal agreement between waveforms. The relationship between aortic BP and AR direct was qualitatively similar to the cyclic relationship between aortic BP and RP derived , with peak cross-correlations occurring at identical phase lags (AR direct versus aortic BP, r =0.96 at 0.06 s RP derived versus aortic BP, r =0.98 at 0.06 s). RP derived is highly correlated with changes in proximal aortic volume, consistent with its physiological interpretation as corresponding to the instantaneous volume of blood stored in the aorta. Thus, aortic reservoir pressure should be considered in the interpretation of the central BP waveform.
Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis
Publisher: Oxford University Press (OUP)
Date: 27-12-2013
DOI: 10.1093/AJH/HPS053
Abstract: The prognostic relevance of a hypertensive response to exercise (HRE) is ill-defined in in iduals undergoing exercise stress testing. The study described here was intended to provide a systematic review and meta-analysis of published literature to determine the value of exercise-related blood pressure (BP) (independent of office BP) for predicting cardiovascular (CV) events and mortality. Online databases were searched for published longitudinal studies reporting exercise-related BP and CV events and mortality rates. We identified for review 12 longitudinal studies with a total of 46,314 in iduals without significant coronary artery disease, with total CV event and mortality rates recorded over a mean follow-up of 15.2±4.0 years. After adjustment for age, office BP, and CV risk factors, an HRE at moderate exercise intensity carried a 36% greater rate of CV events and mortality (95% CI, 1.02-1.83, P = 0.039) than that of subjects without an HRE. Additionally, each 10mm Hg increase in systolic BP during exercise at moderate intensity was accompanied by a 4% increase in CV events and mortality, independent of office BP, age, or CV risk factors (95% CI, 1.01-1.07, P = 0.02). Systolic BP at maximal workload was not significantly associated with the outcome of an increased rate of CV, whether analyzed as a categorical (HR=1.49, 95% CI, 0.90-2.46, P = 0.12) or a continuous (HR=1.01, 95% CI, 0.98-1.04, P = 0.53) variable. An HRE at moderate exercise intensity during exercise stress testing is an independent risk factor for CV events and mortality. This highlights the need to determine underlying pathophysiological mechanisms of exercise-induced hypertension.
Exercise Central (Aortic) Blood Pressure Is Predominantly Driven by Forward Traveling Waves, Not Wave Reflection
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
DOI: 10.1161/HYPERTENSIONAHA.111.00584
Abstract: Exercise hypertension independently predicts cardiovascular mortality, although little is known about exercise central hemodynamics. This study aimed to determine the contribution of arterial wave travel and aortic reservoir characteristics to central blood pressure (BP) during exercise. We hypothesized that exercise central BP would be principally related to forward wave travel and aortic reservoir function. After routine diagnostic coronary angiography, invasive pressure and flow velocity were recorded in the ascending aorta via sensor-tipped intra-arterial wires in 10 participants (age, 55±10 years 70% men) free of coronary artery disease with normal left ventricular function. Measures were recorded at baseline and during supine cycle ergometry. Using wave intensity analysis, dominant wave types throughout the cardiac cycle were identified (forward and backward, compression, and decompression), and aortic reservoir and excess pressure were calculated. Central systolic BP increased significantly with exercise (Δ=19±12 mm Hg P .001). This was associated with increases in systolic forward compression waves (Δ=12×10 6 ±17×10 6 W·m −2 ·s −1 P =0.045) and forward decompression waves in late systole (Δ=9×10 6 ±6×10 6 W·m −2 ·s −1 P .001). Despite significant augmentation in BP (Δ=9±6 mm Hg P =0.002), reflected waves did not increase in magnitude (Δ=−1×10 6 ±3×10 6 W·m −2 ·s −1 P =0.2). Excess pressure rose significantly with exercise (Δ=16±9 mm Hg P .001), and reservoir pressure integral fell (Δ=−5×10 5 ±5×10 5 Pa·s P =0.010). Change in reflection coefficient negatively correlated with change in central systolic BP ( r =−0.68 P =0.03). We conclude that elevation of exercise central BP is principally because of increases in aortic forward traveling waves generated by left ventricular ejection. These findings have relevance to understanding central BP waveform morphology and pathophysiology of exercise hypertension.
Myocardial Perfusion and the J Curve Association Between Diastolic Blood Pressure and Mortality
Publisher: Oxford University Press (OUP)
Date: 29-01-2013
DOI: 10.1093/AJH/HPS077
Abstract: The J-curve relationship between brachial diastolic blood pressure (DBP) and mortality is believed to be mediated through reduced myocardial perfusion. This study aimed to determine the relationship between DBP and subendocardial perfusion in patients with and without coronary artery disease (CAD) and to examine central hemodynamic variables that may explain the risk associated with low DBP (aortic stiffness, central pulse pressure, and augmentation index). Brachial DBP and radial tonometry were measured in 134 patients with CAD (aged 76±7years 69% male), 134 in iduals without a prior cardiovascular event (control subjects) (aged 77±2years 69% male) and 47 patients (aged 63±10years) during dobutamine stress echocardiography. Central hemodynamics and subendocardial viability ratio (SEVR), a marker of subendocardial perfusion, were recorded by tonometry. There was no difference in DBP or SEVR between control subjects and CAD patients (P > 0.05), nor was there a difference in SEVR across quartiles of DBP in CAD patients (P = 0.07) or control subjects (P = 0.14). After adjustment for age and height, associations between DBP and SEVR in control subjects (r = 0.185 P = 0.03) and CAD patients (r = 0.204 P = 0.02) were attenuated (P = 0.07 and P = 0.11, respectively). There were no significant relationships between DBP and central hemodynamics (P > 0.05 for all). At peak dobutamine stress, SEVR was significantly reduced in patients with inducible ischemia vs. those with nonischemic response (84±17 vs. 101±22% P = 0.01). However, DBP was not significantly different (65±14 vs. 67±15mm Hg P = 0.32). Brachial DBP is a poor marker of subendocardial perfusion. The J-curve relationship between DBP and mortality is unlikely attributable to reduced myocardial perfusion or adverse central hemodynamics.
Masked hypertension and submaximal exercise blood pressure among adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC)
Publisher: Wiley
Date: 22-08-2019
DOI: 10.1111/SMS.13525
Abstract: Masked hypertension is associated with increased cardiovascular risk but is undetectable by clinic blood pressure (BP). Elevated systolic BP responses to submaximal exercise reveal the presence of masked hypertension in adults, but it is unknown whether this is the case during adolescence. We aimed to determine if exercise BP was raised in adolescents with masked hypertension, and its association with cardiovascular risk markers. A total of 657 adolescents (aged 17.7 ± 0.3 years 41.9% male) from the Avon longitudinal study of parents and children (ALSPAC) completed a step-exercise test with pre-, post-, and recovery-exercise BP, clinic BP and 24-hour ambulatory BP. Masked hypertension was defined as clinic BP <140/90 mm Hg and 24-hour ambulatory BP ≥130/80 mm Hg. Assessment of left-ventricular (LV) mass index and carotid-femoral pulse wave velocity (aortic PWV) was also undertaken. Thresholds of clinic, pre-, post-, and recovery-exercise systolic BP were explored from ROC analysis to identify masked hypertension. Fifty participants (7.8%) were classified with masked hypertension. Clinic, pre-, post-, and recovery-exercise systolic BP were associated with masked hypertension (AUC ≥ 0.69 for all, respectively), with the clinic systolic BP threshold of 115 mm Hg having high sensitivity and specificity and exercise BP thresholds of 126, 150, and 130 mm Hg, respectively, having high specificity and negative predictive value (in idually or when combined) for ruling out the presence of masked hypertension. Additionally, this exercise systolic BP above the thresholds was associated with greater left-ventricular mass index and aortic PWV. Submaximal exercise systolic BP is associated with masked hypertension and adverse cardiovascular structure in adolescents. Exercise BP may be useful in addition to clinic BP for screening of high BP and cardiovascular risk in adolescents.
The influence of fitness on exercise blood pressure and its association with cardiac structure in adolescence
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/SMS.13645
Abstract: Exaggerated exercise blood pressure (BP) is associated with altered cardiac structure and increased cardiovascular risk. Fitness modifies these associations, but the effect in healthy adolescents is unknown. We performed an observational study to determine the influence of fitness on post‐exercise BP, and on its relationship with cardiac structure in adolescents. 4835 adolescents from the Avon Longitudinal Study of Parents and Children, (15.4 (0.3) years, 49% male) completed a submaximal cycle test. Fitness was estimated as physical work capacity 170 adjusted for lean body mass and post‐exercise BP measured immediately posttest. Cardiovascular structure and function, including left ventricular (LV) mass (n = 1589), left atrium (LA) size (n = 1466), cardiac output (CO, n = 1610), and total peripheral resistance (TPR, n = 1610) were measured at rest by echocardiography 2.4 (0.4) years later. Post‐exercise systolic BP increased stepwise by fitness tertile (131.2 mm Hg [130.4, 132.1] 137.3 mm Hg [136.5, 138.0] 142.3 mm Hg [141.5, 143.1]). Each 5 mm Hg of post‐exercise systolic BP was associated with 2.46 g [1.91, 3.01] greater LV mass, 0.02 cm [0.02, 0.03] greater LA size, and 0.25 g/m 2.7 [0.14, 0.36] greater LV mass index. Adjustment for fitness abolished associations (0.29 g [−0.16, 0.74] 0.01 cm [−0.001, 0.014] and 0.08 g/m 2.7 [−0.001, 0.002]). Similar associations between post‐exercise systolic BP and each outcome were found between the lowest and highest fitness thirds. CO increased with fitness third (difference 0.06 L/min [−0.05, 0.17] 0.23 L/min [0.12, 0.34]) while TPR decreased (difference −0.13 mm Hg·min/L [−0.84,0.59] −1.08 mm Hg·min/L [−0.1.80, 0.35]). Post‐exercise systolic BP increased with fitness, which modified its association with cardiac structure. Higher CO, but lower TPR suggests a physiologically adapted cardiovascular system with greater fitness, highlighting the importance of fitness in adolescence.
General practitioners maintain a focus on blood pressure management rather than absolute cardiovascular disease risk management
Publisher: Wiley
Date: 13-04-2021
DOI: 10.1111/JEP.13569
Abstract: Absolute cardiovascular disease (aCVD) risk assessment is recommended in CVD prevention guidelines. Yet, General Practitioners (GPs) often focus on single risk factors, including blood pressure (BP). Pathology services may be suitable to undertake high‐quality automated unobserved BP (AOBP) measurement and aCVD risk assessment. This study explored GP attitudes towards AOBP measurement via pathology services and the role of BP in aCVD risk management. A brief survey was completed, after which a focus group (n = 8 GPs) and interviews (n = 10 GPs) explored attitudes to AOBP and aCVD risk via pathology services with an ex le pathology report discussed. Verbatim transcripts were thematically coded. GPs predominantly used doctor‐measured BP despite low levels of confidence. High BP measured by AOBP reported with aCVD risk via pathology services, would prompt a follow‐up response. However, GPs focused on BP management. GPs were concerned about AOBP equivalency to routine BP measurements. After protocol explanation, GPs reported AOBP could value‐add to care delivery. GPs lacked familiarity of AOBP and maintained a focus on BP management in the context of absolute CVD risk. Targeted education on AOBP and BP management as part of absolute CVD risk is needed to support guideline‐directed care in practice.
Postmortem analysis of cardiovascular deaths in schizophrenia: A 10-year review
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.SCHRES.2013.08.029
Abstract: Schizophrenia is a devastating mental disorder, associated with mortality rates up to three times higher than those in the general population. This post-mortem study sought to investigate the causes of death in a consecutive series of schizophrenia cases, with a specific focus on cardiovascular disease and sudden death. A 10-year review of autopsies in schizophrenia related-cases performed at the Department of Forensic Medicine in Sydney, Australia was undertaken. Premorbid clinical and demographic information was recorded, as well as the key pathological findings and final cause of death. From 2003 to 2012, there were 19,478 postmortem examinations performed of which 683 (3.5%) were deaths in people with a history of schizophrenia. In these cases, the mean age at death was 51years (range 18-93years), with 43% in the 41-60year age group. Males comprised 67% of cases. Overall, 62% of cases had a BMI≥25kg/m(2), indicating overweight or obese in iduals. The three primary causes of death were "cardiovascular" (23%), "suicide" (20%), and "drug toxicity" (17%). In 11% of cases (n=72), no definitive cause of death was found, the so-called "unexplained" cases. In conclusion, patients with schizophrenia have premature mortality. The major contributing factors include cardiovascular diseases, suicide and drug toxicity. The "unexplained" and frequently sudden deaths may suggest underlying cardiac arrhythmias as a cause of death in a subgroup of schizophrenia patients.
Ambulatory and central haemodynamics during progressive ascent to high-altitude and associated hypoxia
Publisher: Springer Science and Business Media LLC
Date: 13-03-2014
DOI: 10.1038/JHH.2014.15
Abstract: High-altitude hypoxia causes major cardiovascular changes, which may result in raised resting brachial blood pressure (BP). However, the effect of high-altitude hypoxia on more sensitive measures of BP control (such as 24 h ambulatory BP and resting central BP) is largely unknown. This study aimed to assess this and compare high-altitude responses to resting brachial BP, as well as determine the haemodynamic correlates of acute mountain sickness (AMS) during a progressive trekking ascent to high-altitude. Measures of oxygen saturation (pulse oximetry), 24 h ambulatory BP, resting brachial and central BP (Pulsecor) were recorded in 10 adults (aged 27±4, 30% male) during a 9-day trek to Mount Everest base c , Nepal. Data were recorded at sea level (stage 1 <450 m above sea level (ASL)) and at progressive ascension to 3440 m ASL (stage 2), 4350 m ASL (stage 3) and 5164 m ASL (stage 4). The Lake Louise score (LLS) was used to quantify AMS symptoms. Total LLS increased stepwise from sea level to stage 4 (0.3±0.7 vs 4.4±2.0, P=0.012), whereas oxygen saturation decreased to 77±9% (P=0.001). The highest recordings of 24 h ambulatory, daytime, night time, brachial and central systolic BP and diastolic BP were achieved at stage 3, which were significantly greater than at sea level (P<0.005 for all). Twenty-four-hour ambulatory heart rate (HR) and night HR correlated with oxygen saturation (r=-0.741 and -0.608, both P<0.001) and total LLS (r=0.648 and r=0.493, both P<0.001). We conclude that 24 h ambulatory BP, central BP and HR are elevated during high-altitude hypoxia, but AMS symptoms are only related to tachycardia.
Exploring the direct and indirect effects of cardiovascular disease risk factors on exercise blood pressure
Publisher: Wiley
Date: 25-09-2023
DOI: 10.1111/SMS.14480
Masked hypertension is “unmasked” by low-intensity exercise blood pressure
Publisher: Informa UK Limited
Date: 30-03-2011
DOI: 10.3109/08037051.2011.566251
Abstract: Masked hypertension (MH) independently predicts mortality but cannot be diagnosed from clinic blood pressure (BP) taken under resting conditions. We sought to determine if MH could be identified from BP taken during a single bout of low-intensity exercise. BP was recorded at rest and during brief low-level cycling exercise (60-70% of age-predicted maximal heart rate) in 75 untreated subjects with a hypertensive response to exercise (aged 54 ± 9 years). All subjects underwent 24-h ambulatory BP monitoring (ABPM) and MH was defined as clinic BP < 140/90 mmHg and ABPM BP ≥ 130/80 mmHg. There were 42 (56%) patients with MH, and at rest systolic (SBP) was higher in subjects with MH compared with those without MH (127 ± 9 vs 120 ± 9 mmHg p < 0.05). During exercise, MH subjects had significantly higher SBP (188 ± 22 vs 168 ± 15 mmHg p < 0.05), with a greater change from baseline (61 ± 21 vs 48 ± 15 mmHg p < 0.05). Low-level exercise SBP was independently associated with MH, and if ≥ 175 mmHg, identified MH with 74% sensitivity and 67% specificity (p < 0.001). MH can be identified in untreated in iduals from low-intensity exercise SBP. Further research on the diagnostic value of BP during early phases of exercise stress testing is needed.
Clinical Relevance of Exaggerated Exercise Blood Pressure
Publisher: Elsevier BV
Date: 10-2015
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