Investigating the Role of Standing Blood Pressure Measurement and the Association Between High-Density Lipoprotein and Skeletal Muscle Mitochondrial Function in Pre-Hypertensive Humans

Abstract

Cardiovascular disease (CVD) is the leading cause of death in the United States. Importantly, two main driving forces behind developing CVD is the presence of hypertension (HTN) and dyslipidemia. Despite this, there are critical knowledge gaps related to 1) obtaining an accurate clinical assessment of blood pressure (BP), and 2) the mechanisms by which dyslipidemia evoke enhanced cardiometabolic disease risk. Specifically, this dissertation aimed to 1) investigate the role of standing office BP measurement in facilitating HTN diagnosis, and 2) characterize the associations between high-density lipoprotein (HDL) and skeletal muscle mitochondrial function. Herein, we are the first to observe that standing BP measurements are highly accurate in detecting HTN when compared to seated BP. These findings demonstrate standing BP as a novel tool to enhance the accuracy of office BP assessment. Likewise, we are the first to demonstrate higher levels of HDL cholesterol and apolipoprotein A-I are independently associated with enhanced skeletal muscle mitochondrial function in humans. These findings are important because disruptions in skeletal muscle metabolism have been associated with exercise intolerance. In conclusion, our studies have direct implications on the screening of HTN and highlight the utility of measuring BP in both the seated and standing positions. Moreover, we provide evidence for future research aimed at establishing the causal relationship between HDL structure and function with exercise endurance in humans. These studies aimed at addressing two critical gaps in knowledge, and upon completion, have further elucidated more optimal methods of assessing office BP and provided an enhanced understanding of the relationship between dyslipidemia and cardiometabolic disorders