Investigating the effect of isometric handgrip training frequency on cardiovascular health in medicated hypertensives

Hypertension (HTN) is expected to affect approximately 50% of the world’s adult population by 2025 and accounts for 10 million deaths worldwide each year. Historically, HTN has been defined as systolic blood pressure (SBP) greater than 140 mmHg and/or diastolic blood pressure (DBP) greater than 90 mmHg. However, it has been recently suggested that the risks of HTN begin at even lower BP levels and in the United States HTN is now defined as ≥130/80 mmHg. HTN increases the presence of many independent risk factors and/or indicators for cardiovascular disease (CVD) such as increased arterial stiffness and reduced cardiovagal baroreflex sensitivity (cvBRS). This study aimed to investigate the minimum training frequency necessary to maintain decreases in BP following an initial 8-week training period by training individuals 0, 1, or 3 times per week for 4 weeks. Sixteen individuals with medicated hypertension (age 65±9 years) were recruited and performed 8 weeks of IHG 3 times per week and were then allocated to one of 3 training frequency groups; 0, 1 or 3 times for a subsequent 4 weeks. Statistically significant decreases in SBP and DBP were observed in all participants following the initial 8-week IHG training program (-9±10mmHg, p=0.004; -5±6mmHg, p=0.006), as well as at 12 weeks (-9±10 p=0.047; -5±7, p=0.051). cvBRS did not demonstrate any significant changes, while carotid-toe pulse wave velocity (ctPWV), a measure of systemic arterial stiffness, demonstrated a significant main effect for time (p=0.002). Post-hoc testing revealed significant decreases in ctPWV at 12 weeks (-1.0±1.1, p=0.002), as well as a significant decrease from 8 to 12 weeks (-0.73±1.1, p=0.017). As for trained limb arterial stiffness, carotid-radial pulse wave velocity (crPWV) demonstrated a significant effect for group (p=0.045) and time (p=0.015). Post-hoc testing revealed that there was no significant difference between groups, however there was a significant decrease in crPWV at 12 weeks (-1.4±1.7, p=0.010). These findings suggest that IHG at a training frequency lower than traditionally prescribed may maintain the decrease in SBP and DBP with the inclusion of improvements in arterial stiffness both systemically and in the trained limb over time. Thus, these results support the prescription of IHG in the treatment of HTN

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents

Hemodynamics and Sleep Architecture Following Acute Alcohol Ingestion in College Age Males

Hypertension is a progressive disease characterized by elevated blood pressures which can cause damage to arteries and increases afterload leading to myocardial remodeling and a progressively worsening cardiovascular function. This increase in afterload requires an increase in contractility which further results in higher blood pressures. Many factors, including alcohol, can exacerbate these symptoms and have been shown to accelerate the disease process. The effects of alcohol ingestion can range from decreases in arterial compliance to heightened nocturnal blood pressure. When nocturnal blood pressure does not dip (decrease below average resting values) the impact is realized with increases in all-cause morbidity and mortality. The reduction or elimination of a dip in blood pressure has been shown to be strongly correlated with many forms of cardiovascular disease. Heightened nocturnal blood pressure may be attributed to the disruption of sleep architecture which is a condition worsened by alcohol ingestion. However, little is known regarding the effects of alcohol ingestion on sleep architecture and nocturnal blood pressure. Therefore, the purpose of this study was to investigate the effects of acute alcohol ingestion on hemodynamics and sleep architecture in a young, healthy cohort

Changes in arterial stiffness and other cardiovascular risk variables following specific exercise programmes

June 2012 Arterial stiffness is one of the major risk factors and markers of cardiovascular disease (CVD). An increase in the arterial stiffness is influenced by various factors such as age, lifestyle, genetics and the presence of other cardiovascular risks such as obesity and diabetes. Arterial stiffness is a consistent thread in this thesis. This thesis investigates the effects of exercise-based management programmes for CVD and risk factors with a focus on carotid-radial applanation tonometry which is a specific non-invasive technique for measuring arterial stiffness. Erectile dysfunction is a marker of CVD and is associated with endothelial dysfunction that leads to arterial stiffness. The effects of centrebased, supervised and exercise-based cardiac rehabilitation (CR) programmes were studied on the changes in arterial stiffness, erectile dysfunction and quality of life of patients with CVD. Despite the effectiveness of CR programmes, there is poor attendance at these programmes and unsupervised home-based, IT (information technology)-supported programmes could improve patient participation and cost effectiveness. Moreover, earlier identification of risks and appropriate management can reduce the incidence of CVD. There are no such programmes for early stages of CVD in practice, especially in developing countries such as India. A 12-week, IT-supported home-based exercise programme in India, for patients with metabolic syndrome was developed and studied. In general, arterial stiffness was improved in both centre-based and home-based exercise programmes. There were acute increases in arterial stiffness following exercise in healthy Caucasians and South Asians as well as people with metabolic syndrome. Carotid-radial pulse wave analysis could be a simple and reliable prognostic tool in exercise based rehabilitation programmes

Effects of Aerobic Exercise on Cognitive and Cerebrovascular Function in Hypertensive Adults

The presence of hypertension in middle-age is a major risk factor for later-life development of cognitive and cardiovascular disease. Exercise is widely recommended to combat vascular and brain aging in hypertension. We sought to compare the effects of a single bout of aerobic exercise on 1) arterial stiffness and cerebral hemodynamics and 2) cognitive function in middle-aged adults with controlled-hypertension and without hypertension. Vascular and cognitive measures were assessed pre and post 30-min of aerobic exercise at ≈55% maximal oxygen consumption. Arterial stiffness and cerebral hemodynamics were measured non-invasively. Cognitive function was measured using a computerized testing battery that included executive function and memory tasks. Acute aerobic exercise resulted in similar 1) increases in arterial stiffness and cerebral hemodynamic pulsatility, and 2) accelerated executive function and memory reaction time post-exercise in adults with and without hypertension. Based on these results, we investigated if adults with hypertension had differential vascular contributions to cognitive activity. We measured cerebrovascular hemodynamics non-invasively during cognitive activity as a measure of neurovascular coupling. Adults with and without hypertension exhibit similar increases in large artery stiffness and decreases in extracranial hemodynamic pulsatility during cognitive activity, indicating similar neurovascular coupling between groups. In conclusion, these data indicate that middle-aged adults with controlled-hypertension experience similar 1) vascular responses to acute exercise and cognitive activity, and 2) beneficial changes in cognitive function following acute exercise as their counterparts without hypertension. Our results will be interpreted and explored in the context of hypertension severity and underscore the importance of optimal blood pressure control

Improved diagnostic accuracy for hypertension

Practical and accurate blood pressure (BP) measurement techniques are needed to ensure adequate diagnostics and treatment of hypertension. Recently, novel monitors have appeared on the market including timer-equipped home monitors and standalone noninvasive central BP monitors. The aim of this study was to clarify how BP measures obtained with these novel measurement methods compare to current measurement methods, and whether they could improve the diagnostics for hypertensive end-organ damage compared with conventional measurements in a cardiovascular substudy (N=290) of the Finnish population-based DILGOM study. Participants underwent 24-hour ambulatorymonitoring, office BP measurements, and daytime and night-time home measurements. Hypertensive end-organ damage was assessed with pulse wave velocity (PWV) measurements, carotid intima-media thickness (IMT) and left ventricular mass index (LVMI). The participants preferred office BP measurement, while ambulatory monitoring was the least acceptable method. Mean night-time BP levels were comparable between ambulatory and home monitoring, and the agreement between the methods in detecting night-time hypertension was substantial. Instead, the agreement in detecting nondipping patterns was weak. Home and ambulatory night-time BP values correlated similarly with end-organ damage, except that there was a slightly stronger correlation between ambulatory systolic BP (SBP) and PWV compared with corresponding home BP. Surprisingly, we found that brachial SBP and pulse pressure were similarly or even more strongly correlated to end-organ damage than the corresponding noninvasive central measures. To conclude, home night-time monitoring is a convenient, accurate, wellaccepted and widely available alternative to ambulatory monitoring in detecting night-time hypertension. In comparison to measurements with conventional office BP, estimated central hemodynamics with a novel stand-alone monitor do not seem to improve the diagnostics of end-organ damage.Verenpaineen uudet mittausmenetelmät Kohonneen verenpaineen asianmukaista diagnosointia ja hoitoa tarvitaan käytännöllisiä ja tarkkoja mittausmenetelmiä. Useita uusia mittareita on ilmaantunut markkinoille, mukaan lukien ajastimella varustetut kotimittarit sekä mittarit, joilla pystytään arvioimaan kajoamattomasti sentraalista eli aortan ja suurten suonten verenpainetta. Väitöskirjan tarkoituksena oli selvittää, miten nämä uudet mittaustavat vertautuvat perinteisiin menetelmiin ja parantavatko ne kohde-elinvaurioiden diagnostiikkaa verrattuna perinteisiin menetelmiin suomalaisessa DILGOM-väestötutkimuksen sydän- ja verisuonitutkimusalaryhmässä (N=290). Tutkimushenkilöille tehtiin verenpaineen vuorokausirekisteröinti, mittaukset vastaanotolla sekä kotona päivä- ja yöaikaan. Verenpaineen pääte-elinvaurioiden arviointiin käytettiin pulssiaallon nopeutta, kaulasuonten intima-media paksuutta ja vasemman kammion massaindeksiä. Tutkittavat pitivät eniten verenpaineen mittaamisesta vastaanotolla ja vähiten verenpaineen vuorokausirekisteröinnistä. Vuorokausirekisteröinnillä ja kotimittarilla mitatut yölliset verenpainetasot vastasivat hyvin toisiaan ja yhteneväisyys yöllisen kohonneen verenpaineen diagnosoinnissa menetelmien välillä oli huomattavan hyvä. Sitä vastoin verenpaineen poikkeavan päivä-yövaihtelun diagnostinen yhteneväisyys menetelmien välillä oli heikko. Mittausmenetelmästä riippumatta yöllisen verenpaineen yhteys pääte-elinvaurioihin oli samankaltainen lukuun ottamatta pulssiaallon nopeutta, minkä yhteys vuorokausirekisteröinnin kanssa oli hieman kotimittausta vahvempi. Yllättäen olkavarresta mitattu verenpaine oli yhtä hyvin ja osin jopa vahvemmin yhteydessä pääte-elinvaurioihin kuin kajoamattomasti mitattu sentraalinen verenpaine. Yhteenvetona todetaan, että verenpaineen yöaikainen mittaus kotimittarilla on käytännöllinen, tarkka, miellyttävä ja laajasti saatavilla oleva vaihtoehto verenpaineen vuorokausirekisteröinnille yöaikaisen kohonneen verenpaineen todentamiseen. Kajoamattoman sentraalisen verenpaineen arvioiminen tutkimuksessa käytetyllä helppokäyttöisellä automaattimittarilla ei näytä tuovan lisäetua pääteelinvaurioiden diagnostiikassa tavanomaiseen vastaanotolla olkavarresta mitattuun verenpaineeseen verrattuna

Vascular health and mental health in collegiate female varsity athletes, club sport athletes and recreationally active women

The number of women participating in collegiate athletics has increased since Title IX was passed, which supports equal access to men and women in government-funded programs. Female student athletes are under increased pressure to maintain fitness while meeting academic standards, thus resulting in mental health concerns (i.e., depression and anxiety) and related poor lifestyle habits (i.e. problematic alcohol drinking and disturbed sleep quality). While high fitness imparts cardiovascular health benefits, such mental health concerns and poor lifestyle habits negatively impact cardiovascular health. Cardiovascular health is particularly concerning for women, as cardiovascular disease is a leading cause of death in this group and recent data suggest increased rates of cardiovascular health-related hospitalizations in young women. PURPOSE: To compare vascular health, fitness, mental health and lifestyle habits of collegiate varsity athletes, club sport athletes and recreationally active (RA) women. METHODS: Eight Division 1 varsity athletes ( age 20±1 yrs, BMI 24.1±1.6 kg/m2) and 12 club sport athletes (age 20±2 yrs, BMI 24.5±3.2 kg/m2), were matched to 20 RA women (age 20±2 yrs, BMI 24.3±3.0 kg/m2) based on age and height. Cardiovascular health assessment included measures of pulse pressure (PP) and carotid-femoral pulse wave velocity (PWV). Fitness was broadly defined as cardiorespiratory fitness, strength, flexibility and balance assessed using a YMCA Step Test and estimated VO2max, hand grip strength, sit-and-reach and balancing on a firm and foam surface over a force platform, respectively. Generally accepted and validated questionnaires were used to subjectively assess depression, anxiety, alcohol consumption behaviors, sleep quality and physical activity. Physical activity and sleep were further objectively assessed using accelerometry. RESULTS: Varsity athletes had higher PP (p\u3c0.05) but similar aortic stiffness (p\u3e0.05) compared to club and RA. Varsity athletes had greater estimated VO2max and average strength compared to RA (p\u3c0.05). Varsity athletes spent less time in sedentary and greater time in vigorous activity assessed through the analysis of accelerometer data compared to both the club and RA women (p\u3c0.05). There were no differences in anxiety or depression scores or lifestyle habits between the varsity athletes and RA. CONCLUSION: Despite having greater levels of fitness, more optimal physical activity habits and comparable mental health as female club sport athletes or non-athletes, female collegiate varsity athletes had higher pulse pressure. Given that the higher PP occurred concomitant with similar aortic stiffness and mean arterial pressure, we suggest that increased PP in this setting is a reflection of an exercise adaption related to cardiac structure and function

Acoustic sensing as a novel approach for cardiovascular monitoring at the wrist

Cardiovascular diseases are the number one cause of deaths globally. An increased cardiovascular risk can be detected by a regular monitoring of the vital signs including the heart rate, the heart rate variability (HRV) and the blood pressure. For a user to undergo continuous vital sign monitoring, wearable systems prove to be very useful as the device can be integrated into the user's lifestyle without affecting the daily activities. However, the main challenge associated with the monitoring of these cardiovascular parameters is the requirement of different sensing mechanisms at different measurement sites. There is not a single wearable device that can provide sufficient physiological information to track the vital signs from a single site on the body. This thesis proposes a novel concept of using acoustic sensing over the radial artery to extract cardiac parameters for vital sign monitoring. A wearable system consisting of a microphone is designed to allow the detection of the heart sounds together with the pulse wave, an attribute not possible with existing wrist-based sensing methods. Methods: The acoustic signals recorded from the radial artery are a continuous reflection of the instantaneous cardiac activity. These signals are studied and characterised using different algorithms to extract cardiovascular parameters. The validity of the proposed principle is firstly demonstrated using a novel algorithm to extract the heart rate from these signals. The algorithm utilises the power spectral analysis of the acoustic pulse signal to detect the S1 sounds and additionally, the K-means method to remove motion artifacts for an accurate heartbeat detection. The HRV in the short-term acoustic recordings is found by extracting the S1 events using the relative information between the short- and long-term energies of the signal. The S1 events are localised using three different characteristic points and the best representation is found by comparing the instantaneous heart rate profiles. The possibility of measuring the blood pressure using the wearable device is shown by recording the acoustic signal under the influence of external pressure applied on the arterial branch. The temporal and spectral characteristics of the acoustic signal are utilised to extract the feature signals and obtain a relationship with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively. Results: This thesis proposes three different algorithms to find the heart rate, the HRV and the SBP/ DBP readings from the acoustic signals recorded at the wrist. The results obtained by each algorithm are as follows: 1. The heart rate algorithm is validated on a dataset consisting of 12 subjects with a data length of 6 hours. The results demonstrate an accuracy of 98.78%, mean absolute error of 0.28 bpm, limits of agreement between -1.68 and 1.69 bpm, and a correlation coefficient of 0.998 with reference to a state-of-the-art PPG-based commercial device. A high statistical agreement between the heart rate obtained from the acoustic signal and the photoplethysmography (PPG) signal is observed. 2. The HRV algorithm is validated on the short-term acoustic signals of 5-minutes duration recorded from each of the 12 subjects. A comparison is established with the simultaneously recorded electrocardiography (ECG) and PPG signals respectively. The instantaneous heart rate for all the subjects combined together achieves an accuracy of 98.50% and 98.96% with respect to the ECG and PPG signals respectively. The results for the time-domain and frequency-domain HRV parameters also demonstrate high statistical agreement with the ECG and PPG signals respectively. 3. The algorithm proposed for the SBP/ DBP determination is validated on 104 acoustic signals recorded from 40 adult subjects. The experimental outputs when compared with the reference arm- and wrist-based monitors produce a mean error of less than 2 mmHg and a standard deviation of error around 6 mmHg. Based on these results, this thesis shows the potential of this new sensing modality to be used as an alternative, or to complement existing methods, for the continuous monitoring of heart rate and HRV, and spot measurement of the blood pressure at the wrist.Open Acces