Slow Heart Rate Recovery Is Associated with Increased Exercise-induced Arterial Stiffness in Normotensive Patients without Overt Atherosclerosis
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BACKGROUND: This study evaluated whether blunted autonomic activity as measured by heart rate recovery (HRR) was associated with increased arterial stiffness, especially increased exercise-induced arterial stiffness, in normotensive patients without overt atherosclerosis. METHODS: One hundred fifty-four normotensive patients without overt atherosclerosis who had undergone a treadmill exercise test were consecutively enrolled. HRR was measured at one minute after exercise. Brachial-ankle pulse wave velocity (baPWV) at rest was measured, and carotid arterial stiffness indices at rest (CSI at rest) and after exercise (CSI after exercise) were assessed. RESULTS: Patients with slow HRR were older and tended to be male, and they had diabetes, higher resting and peak systolic blood pressures, higher resting heart rate, lower peak heart rate, lower metabolic equivalents, increased baPWV, and increased CSIs at rest and after exercise. HRR was inversely associated with baPWV and CSI after exercise when established cardiovascular risk factors were adjusted as confounding factors, and HRR was associated with CSI after exercise when resting systolic blood pressure and metabolic equivalent of tasks on cardiovascular risk factors were added as confounding factors. CONCLUSIONS: Sympathovagal imbalance demonstrated by slow HRR was associated with increased arterial stiffness and, above all, was closely associated with exercise-induced arterial stiffness in normotensive patients without overt atherosclerosis. This phenomenon might have been observed because blunt carotid arterial vasomotion following exercise results from autonomic dysfunction as well as vascular endothelial dysfunction.
Abstract
BACKGROUND: This study evaluated whether blunted autonomic activity as measured by heart rate recovery (HRR) was associated with increased arterial stiffness, especially increased exercise-induced arterial stiffness, in normotensive patients without overt atherosclerosis. METHODS: One hundred fifty-four normotensive patients without overt atherosclerosis who had undergone a treadmill exercise test were consecutively enrolled. HRR was measured at one minute after exercise. Brachial-ankle pulse wave velocity (baPWV) at rest was measured, and carotid arterial stiffness indices at rest (CSI at rest) and after exercise (CSI after exercise) were assessed. RESULTS: Patients with slow HRR were older and tended to be male, and they had diabetes, higher resting and peak systolic blood pressures, higher resting heart rate, lower peak heart rate, lower metabolic equivalents, increased baPWV, and increased CSIs at rest and after exercise. HRR was inversely associated with baPWV and CSI after exercise when established cardiovascular risk factors were adjusted as confounding factors, and HRR was associated with CSI after exercise when resting systolic blood pressure and metabolic equivalent of tasks on cardiovascular risk factors were added as confounding factors. CONCLUSIONS: Sympathovagal imbalance demonstrated by slow HRR was associated with increased arterial stiffness and, above all, was closely associated with exercise-induced arterial stiffness in normotensive patients without overt atherosclerosis. This phenomenon might have been observed because blunt carotid arterial vasomotion following exercise results from autonomic dysfunction as well as vascular endothelial dysfunction.
참고문헌 (38)
- Imai K, "Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure", J Am Coll Cardiol, 24, pp.1529~1535 (1994)
- Kleiger RE, "Decreased heart rate variability and its association with increased mortality after acute myocardial infarction", Am J Cardiol, 59, pp.256~262 (1987)
- Beltran A, "Arterial compliance abnormalities in isolated systolic hypertension", Am J Hypertens, 14, pp.1007~1011 (2001)
- Gedikli O, "Effects of prehypertension on arterial stiffness and wave reflections", Clin Exp Hypertens, 32, pp.84~89 (2010)
- Laurent S, "Expert consensus document on arterial stiffness : methodological issues and clinical applications", Eur Heart J, 27, pp.2588~2605 (2006)
- Koskinen T, "Relations between carotid artery distensibility and heart rate variability The Cardiovascular Risk in Young Finns Study", Auton Neurosci, 161, pp.75~80 (2011)
- Reneman RS, "Non-invasive ultrasound in arterial wall dynamics in humans : what have we learned and what remains to be solved", Eur Heart J, 26, pp.960~966 (2005)
- Van Bortel LM, "Clinical applications of arterial stiffness, Task Force III : recommendations for user procedures", Am J Hypertens, 15, pp.445~452 (2002)
- Chapleau MW, "Structural versus functional modulation of the arterial baroreflex", Hypertension, 26, pp.341~347 (1995)
- Carretta R, "Relationship between mechanical properties of the carotid artery wall and baroreflex function in acutely treated hypertensive patients", J Hypertens, 14, pp.1105~1110 (1996)
- Randall OS, "Relationship of age and blood pressure to baroreflex sensitivity and arterial compliance in man", Clin Sci Mol Med Suppl, 3, pp.357s~360s (1976)
- Katsube Y, "Decreased baroreflex sensitivity in patients with stable coronary artery disease is correlated with the severity of coronary narrowing", Am J Cardiol, 78, pp.1007~1010 (1996)
- Fletcher GF, "Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group", Circulation, 91, pp.580~615 (1995)
- Bland JM, "Statistical methods for assessing agreement between two methods of clinical measurement", Lancet, 1, pp.307~310 (1986)
- Chao AC, "Noninvasive assessment of spontaneous baroreflex sensitivity and heart rate variability in patients with carotid stenosis", Cerebrovasc Dis, 16, pp.151~157 (2003)
- 성지동, "The Effects of Short-duration Exercise on Arterial Stiffness in Patients with Stable Coronary Artery Disease", Journal of Korean Medical Science, 24(5), pp.795~799 (2009), 대한의학회
- Ekblom B, "Physical training, bradycardia, and autonomic nervous system", Scand J Clin Lab Invest, 32, pp.251~256 (1973)
- La Rovere MT, "Baroreflex sensitivity : measurement and clinical implications", Ann Noninvasive Electrocardiol, 13, pp.191~207 (2008)
- Nasr N, "Baroreflex sensitivity is impaired in bilateral carotid atherosclerosis", Stroke, 36, pp.1891~1895 (2005)
- Jae SY, "Slow heart rate recovery after exercise is associated with carotid atherosclerosis", Atherosclerosis, 196, pp.256~261 (2008)
- Liu HB, "Carotid arterial stiffness and hemodynamic responses to acute cycling intervention at different times during 12-week supervised exercise training period", Biomed Res Int, 2018, pp.2907548~ (2018)
- Fujie S, "Reduction of arterial stiffness by exercise training is associated with increasing plasma apelin level in middle-aged and older adults", PLoS One, 9, pp.e93545~ (2014)
- Beck DT, "Exercise training reduces peripheral arterial stiffness and myocardial oxygen demand in young prehypertensive subjects", Am J Hypertens, 26, pp.1093~1102 (2013)
- Mutter AF, "A systematic review on the effect of acute aerobic exercise on arterial stiffness reveals a differential response in the upper and lower arterial segments", Hypertens Res, 40, pp.146~172 (2017)
- Seo J, "Immediate impact of exercise on arterial stiffness in humans", World J Cardiovasc Dis, 3, pp.40~45 (2013)
- Kingwell BA, "Arterial compliance increases after moderate-intensity cycling", Am J Physiol, 273, pp.H2186~91 (1997)
- Endo T, "Role of nitric oxide in exercise-induced vasodilation of the forearm", Circulation, 90, pp.2886~2890 (1994)
- Sugawara J, "Effects of nitric oxide synthase inhibitor on decrease in peripheral arterial stiffness with acute low-intensity aerobic exercise", Am J Physiol Heart Circ Physiol, 287, pp.H2666~9 (2004)
- Boutouyrie P, "Sympathetic activation decreases medium-sized arterial compliance in humans", Am J Physiol, 267, pp.H1368~76 (1994)
- Munakata M, "Utility of automated brachial ankle pulse wave velocity measurements in hypertensive patients", Am J Hypertens, 16, pp.653~657 (2003)
- Benetos A, "Arterial alterations with aging and high blood pressure. A noninvasive study of carotid and femoral arteries", Arterioscler Thromb, 13, pp.90~97 (1993)
- Boutouyrie P, "Opposing effects of ageing on distal and proximal large arteries in hypertensives", J Hypertens Suppl, 10, pp.S87~91 (1992)
- Tomiyama H, "An impaired carotid sinus distensibility and baroreceptor sensitivity alter autonomic activity in patients with effort angina associated with significant coronary artery disease", Am J Cardiol, 78, pp.225~227 (1996)
- Tomiyama H, "Carotid arterial distensibility is an important determinant of improvement in autonomic balance after successful coronary angioplasty", J Hypertens, 18, pp.1621~1628 (2000)
- Giannattasio C, "Early impairment of large artery structure and function in type I diabetes mellitus", Diabetologia, 42, pp.987~994 (1999)
- Tanaka H, "Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness", J Hypertens, 27, pp.2022~2027 (2009)
- Yamashina A, "Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement", Hypertens Res, 25, pp.359~364 (2002)
- Wilkinson IB, "Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis", J Hypertens, 16, pp.2079~2084 (1998)