Excessive SBP elevation during moderate exercise discriminates patients at high risk of developing left ventricular hypertrophy from hypertensive patients.

OBJECTIVE: Hypertensive patients show an excessive elevation of SBP during exercise, although optimal blood pressure (BP) control is required to prevent development of left ventricular hypertrophy (LVH). This study examined whether excessive SBP elevation during moderate exercise is associated with new-onset LVH in these patients. METHODS: A total of 143 hypertensive patients without LVH whose BP had been maintained below 140/90 mmHg with antihypertensives performed cycle ergometer exercise test at moderate intensity to assess SBP elevation during exercise (ΔSBP). Left ventricular mass index (LVMI) was assessed by echocardiography once a year to identify new-onset LVH. Patients were divided into three groups according to tertiles of ΔSBP. We examined the associations between ΔSBP and new-onset LVH using the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS: The patients (100 men, 65.3 ±â€Š9.1 years) had resting BP of 126 ±â€Š16/75 ±â€Š11 mmHg. New-onset LVH developed in 47 patients (32.9%) within a follow-up period of 2.5 ±â€Š1.6 years. Higher ΔSBP was significantly associated with higher incidence of LVH (P < 0.001): 12.8, 27.1, and 58.3% in the lowest, middle, and highest tertiles, respectively. In multivariate analysis, ΔSBP was a significant independent determinant of new-onset LVH (hazard ratio for 10 mmHg increase in ΔSBP, 1.45; 95% CI 1.22-1.73; P < 0.001). In comparison with the lowest tertile, the hazard ratios of the middle and highest tertiles for incidence of LVH were 3.16 (95% CI 1.07-9.32) and 6.43 (95% CI 2.35-17.62), respectively. CONCLUSION: Excessive SBP elevation during moderate exercise can be used to identify hypertensive patients at high risk of developing LVH.

Muscle Weakness Is Associated With an Increase of Left Ventricular Mass Through Excessive Blood Pressure Elevation During Exercise in Patients With Hypertension.

Autonomic imbalance in hypertension induces excessive blood pressure (BP) elevation during exercise, thereby increasing left ventricular mass (LVM). Although muscle weakness enhances autonomic imbalance by stimulating muscle sympathetic activity during exercise, it is unclear whether muscle weakness is associated with an increase of LVM in patients with hypertension. This study aimed to investigate the relationships between muscle weakness, BP elevation during exercise, and LVM in these patients. Eighty-six hypertensive patients aged 69 ± 8 years with controlled resting BP (ie, < 140/90 mmHg) were recruited. Plasma brain natriuretic peptide (BNP), left ventricular mass index (LVMI), and knee extension muscle strength were measured. Changes in plasma noradrenaline (NORA) and brachial-ankle pulse wave velocity (ba-PWV) were assessed before and after an ergometer exercise test performed at moderate intensity (ΔNORA and ΔPWV, respectively). A difference between baseline and peak systolic BP during the exercise test was defined as BP elevation during exercise (ΔSBP). Relationships between muscle strength, ΔNORA, ΔPWV, ΔSBP, BNP, and LVMI were analyzed, and significant factors increasing LVM were identified using univariate and multivariate regression analyses. Muscle strength was negatively correlated with ΔNORA (r = -0.202, P = 0.048), ΔPWV (r = -0.328, P = 0.002), ΔSBP (r = -0.230, P = 0.033), BNP (r = -0.265, P = 0.014), and LVMI (r = -0.233, P = 0.031). LVMI was positively correlated with ΔPWV (r = 0.246, P = 0.023) and ΔSBP (r = 0.307, P = 0.004). Muscle strength was a significant independent factor associated with LVMI (ß = -0.331, P = 0.010). Our findings suggest that muscle weakness is associated with an increase of LVM through excessive BP elevation during exercise in patients with hypertension.

Stretching Exercises Improve Vascular Endothelial Dysfunction Through Attenuation of Oxidative Stress in Chronic Heart Failure Patients With an Implantable Cardioverter Defibrillator.

PURPOSE: Endurance training improves oxidative stress and vascular endothelial dysfunction in patients with chronic heart failure (CHF). However, patients with CHF and an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) often avoid endurance training for fear of ICD shock. Recent studies have reported that stretching exercises enhance antioxidant activity and improve vascular responses. Therefore, we aimed to assess the effects of 4 weeks of stretching exercises on oxidative stress and vascular endothelial function in patients with CHF with an ICD or CRT-D. METHODS: Fifty sedentary patients with CHF (78% males; mean age = 70 ± 9 years; left ventricular ejection fraction = 26% ± 8%) with an ICD or CRT-D were randomly divided into a group that performed 4 weeks of stretching exercises (stretching group) and a group that continued a sedentary lifestyle (control group). We compared the reactive hyperemia peripheral arterial tonometry (RH-PAT) index and blood parameters, such as von Willebrand factor (vWF), malondialdehyde-modified low-density lipoprotein cholesterol (MDA-LDL), reactive oxygen species (ROS), high-sensitivity C-reactive protein, pentraxin 3, and fibrinogen between the 2 groups before and after the 4-week study period. RESULTS: In the stretching group, a significant increase in the RH-PAT index and significant decreases in vWF, MDA-LDL, ROS, and fibrinogen concentrations were observed after the study compared with before (all P < .05). No significant changes were observed in the control group. CONCLUSION: Four weeks of stretching exercises improved vascular endothelial dysfunction through attenuation of oxidative stress in sedentary patients with CHF with an ICD or CRT-D.

A Single Session of Neuromuscular Electrical Stimulation Enhances Vascular Endothelial Function and Peripheral Blood Circulation in Patients With Acute Myocardial Infarction.

This study aimed to investigate whether a single session of neuromuscular electrical stimulation (NMES) can enhance vascular endothelial function and peripheral blood circulation in patients with acute myocardial infarction (AMI). Thirty-four male patients with AMI were alternately assigned to 2 groups, and received NMES with muscle contraction (NMES group, n = 17) or without muscle contraction (control group, n = 17) after admission. NMES was performed for quadriceps and gastrocnemius muscles of both legs for 30 minutes. We measured systolic blood pressure as a parameter of cardiovascular responses and the low-frequency component of blood pressure variability as an index of sympathetic activity. Reactive hyperemia peripheral arterial tonometry (RH-PAT) index and transcutaneous oxygen pressure in foot (Foot-tcPO2) were also measured as parameters of vascular endothelial function and peripheral blood circulation, respectively. All patients completed the study without severe adverse events. Systolic blood pressure and the low-frequency component increased significantly during the NMES session in both groups (P < 0.01 and P < 0.05, respectively). However, elevation from systolic blood pressure at rest was < 10 mmHg in both groups. In the NMES group, the RH-PAT index and Foot-tcPO2 increased significantly after NMES (P < 0.05 and P < 0.001, respectively). No significant changes were observed in these parameters throughout the session in the control group. In conclusion, a single session of NMES with muscle contraction enhanced vascular endothelial function, leading to improvement in peripheral blood circulation without inducing excessive cardiovascular and autonomic responses in patients with AMI (UMIN000014196).

Low-intensity resistance training with blood flow restriction improves vascular endothelial function and peripheral blood circulation in healthy elderly people.

PURPOSE: The present study aimed to investigate the effects of low-intensity resistance training with blood flow restriction (BFR resistance training) on vascular endothelial function and peripheral blood circulation. METHODS: Forty healthy elderly volunteers aged 71 ± 4 years were divided into two training groups. Twenty subjects performed BFR resistance training (BFR group), and the remaining 20 performed ordinary resistance training without BFR. Resistance training was performed at 20 % of each estimated one-repetition maximum for 4 weeks. We measured lactate (Lac), norepinephrine (NE), vascular endothelial growth factor (VEGF) and growth hormone (GH) before and after the initial resistance training. The reactive hyperemia index (RHI), von Willebrand factor (vWF) and transcutaneous oxygen pressure in the foot (Foot-tcPO2) were assessed before and after the 4-week resistance training period. RESULTS: Lac, NE, VEGF and GH increased significantly from 8.2 ± 3.6 mg/dL, 619.5 ± 243.7 pg/mL, 43.3 ± 15.9 pg/mL and 0.9 ± 0.7 ng/mL to 49.2 ± 16.1 mg/dL, 960.2 ± 373.7 pg/mL, 61.6 ± 19.5 pg/mL and 3.1 ± 1.3 ng/mL, respectively, in the BFR group (each P < 0.01). RHI and Foot-tcPO2 increased significantly from 1.8 ± 0.2 and 62.4 ± 5.3 mmHg to 2.1 ± 0.3 and 68.9 ± 5.8 mmHg, respectively, in the BFR group (each P < 0.01). VWF decreased significantly from 175.7 ± 20.3 to 156.3 ± 38.1 % in the BFR group (P < 0.05). CONCLUSIONS: BFR resistance training improved vascular endothelial function and peripheral blood circulation in healthy elderly people.

Six-minute walk distance is an independent predictor of hospital readmission in patients with chronic heart failure.

Patients with chronic heart failure (CHF) are frequently readmitted to the hospital due to disease progression. Although a shorter 6-minute walk distance (6MWD) is correlated with poor prognosis, 6MWD is not considered a clinical indicator for predicting hospital readmission.We investigated whether 6MWD measured at the time of hospital discharge predicted readmission due to heart failure in CHF patients.Patients admitted to the hospital for the first time due to heart failure were enrolled. After 6MWD was measured at discharge, patients were followed-up for 3 years. Clinical characteristics, 6MWD and readmission due to heart failure were evaluated in 252 patients (68.5 ± 11.8 years old, 162 males). Significant factors that affected readmission were extracted and cut-off values were determined using multivariate logistic regression analysis and receiver operating characteristic curves.Of 252 CHF patients, 103 were readmitted within 3 years. 6MWD at the time of discharge was significantly shorter in readmitted patients than non-readmitted patients (P < 0.001) and was a significant predictor of readmission (P < 0.001). The odds ratio for readmission was 1.22 (P < 0.001) with each 10-meter decrease in 6MWD. The 6MWD cut-off value was determined to be 390 meters, with a sensitivity of 0.75 and a specificity of 0.77.6MWD measured at the time of discharge is an independent predictor of hospital readmission in CHF patients, with a cut-off value of 390 meters.