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Central blood pressure may be more closely associated with cardiovascular events than peripheral blood pressure. The aim of the present study was to investigate central blood pressure responses to exercise. Apparently healthy 18 subjects were enrolled in the study (38 ± 6 years) and changes in central and brachial blood pressure were recorded in response to ergometer and hand-grip exercises. Central blood pressure was estimated using an automated device (Omron HEM-9000AI). Systolic brachial blood pressure was increased after both ergometer (from 119 ± 10 to 172 ± 16 mmHg; P. A chronic increase in blood pressure is a major risk factor for cardiovascular disease, whereas reducing blood pressure reduces cardiovascular events. Arterial pressure varies depending on the site in the arterial tree due to amplification of systolic blood pressure (SBP) and pulse pressure, from central to peripheral sites; thus, central blood pressure differs from peripheral blood pressure.
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- Beatmania The Sound Of Tokyo Isometric Exercises Pdf
Blood pressure measured over the brachial artery (peripheral blood pressure) is routinely used for individual risk evaluation and management of hypertension because it has been established as a powerful predictor of cardiovascular morbidity and mortality. However, recent studies suggest that central blood pressure is more closely associated with target organ damage than peripheral blood pressure. Furthermore, cardiovascular events are more closely associated with central rather than peripheral blood pressure,.Most evidence on blood pressure as a surrogate marker of cardiovascular events was derived from blood pressures obtained at rest. However, blood pressure changes every moment in response to physical and mental stress and peripheral blood pressure measured during exercise has been recognized as a marker of cardiovascular risk independent of resting peripheral blood pressure. The risk related to a hypertensive response to exercise may be better assessed by central blood pressure given the greater impact of central compared with peripheral blood pressure on left ventricular afterload and myocardial oxygen consumption. There have been a few studies investigating the effects of isotonic ergometer exercise on central blood pressure, but little is known about the effects of isometric exercise on central blood pressure.
Hemodynamic responses to isometric exercises differ from those to isotonic exercises and central blood pressure may respond differently to isometric and isotonic exercises. Thus, the aim of the present study was to compare the effects of isometric and isotonic exercise on central blood pressure. Drug therapy, especially for cardiovascular diseases, may modify the response of central and peripheral blood pressure to exercises and, thus, the present study included overall healthy subjects who were not taking any medication. Ergometer exercise markedly increased peripheral systolic blood pressure (from 119 ± 10 to 172 ± 16 mmHg; ), but not diastolic blood pressure (from 68 ± 10 to 73 ± 13 mmHg; ). Heart rate was also increased by ergometer exercise (from 62 ± 11 to 118 ± 11 b.p.m.; ). The augmentation index (AI) obtained from the radial arterial pressure waveform was markedly reduced by isotonic exercise (from 61.4 ± 12.4% to 42.2 ± 7.7%; ).
Ergometer exercise did not affect central blood pressure (from 114 ± 12 to 116 ± 13 mmHg; P = 0.39; ). Hand-grip exercise also increased peripheral systolic blood pressure (from 118 ± 8 to 122 ± 9 mmHg; ), but the increase was significantly smaller after hand-grip than ergometer exercise (4.0 ± 4.6 vs 54.5 ± 16.0 mmHg, respectively; P.
In the present study, central systolic blood pressure was increased after isometric hand-grip, but not isotonic ergometer, exercise. Because central blood pressure is a better index of cardiac load than peripheral blood pressure, the response of central blood pressure to hand-grip exercise may provide useful information when evaluating cardiovascular risk in overall healthy individuals.The most important finding of the present study is that central blood pressure responded differently to ergometer and hand-grip exercises. The precise mechanism underlying the different responses of central blood pressure to isotonic and isometric exercises is not clear, but changes in the pressure waveform of the radial artery and peripheral blood pressure after the exercises provide some clues as to the mechanism involved.
Ergometer exercise increased cardiac output and thereby increased the amplitude of the forward traveling wave. This may have resulted in an increase in the amplitude of the reflected wave.
However, peripheral arterial dilatation caused by the isotonic exercise may have reduced the amplitude of the reflected wave. Indeed, radial AI was markedly reduced although the amplitude of radial pulse pressure was increased after ergometer exercise. Central blood pressure may have been determined by the balance between an increase in cardiac output (increased forward traveling wave) and that in vascular relaxation (decreased reflected wave). Alternatively, the reduction in radial AI may be due to an increase in heart rate after exercise.
It is also possible that the elastic aorta buffered an increase in central aortic pressure caused by exercise. In contrast with the response to ergometer exercise, hand-grip exercise may have increased arterial resistance and thereby increased the amplitude of the radial reflected wave. This is compatible with the finding that radial AI was augmented after hand-grip exercise. Moreover, increased stiffness in the conduit artery may have augmented pulse wave velocity, resulting in an increase in radial AI and premature return of the reflected wave in late systole in the central aorta.
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These responses after the isometric exercise may have been related to the increase in central blood pressure observed after hand-grip exercise. Cardiac output may have been increased after hand-grip exercise, but this effect was smaller than that after ergometer exercise because peripheral blood pressure showed only a mild increase. Changes observed after hand-grip exercise can be summarized as a product of arterial contraction caused by the isometric exercise.In the present study, central blood pressure was estimated non-invasively using the Omron device. However, the superiority of central blood pressure over brachial blood pressure in the management of hypertension has been well established using the SphygmoCor device (AtCor Medical, Sydney, NSW, Australia), which records the radial pulse waveform and converts it to a central blood pressure waveform using a generalized transfer function.
Central blood pressure is then estimated by calibration against brachial blood pressure. The Omron device records the radial pulse waveform and SBP2 is obtained by calibration against brachial blood pressure. Central systolic blood pressure is estimated using a regression equation. Central systolic blood pressure values estimated by the Omron device are highly correlated with those estimated by a SphygmoCor device, and these non-invasive estimations show close correlation with invasive measurements of central blood pressure. However, both devices underestimate central systolic blood pressure, with the SphygmoCor device producing a larger deviation than the Omron device (average −15 vs −2 mmHg, respectively).
Thus, the central blood pressure response observed in the present study may reflect the response of arterial pressure in the ascending aorta. The finding that the central blood pressure value estimated by the Omron device was not significantly lower than peripheral blood pressure measured over the brachium may sound strange. However, this is quite natural, because the measurement of peripheral blood pressure using a cuff over the brachial artery underestimates brachial arterial blood pressure.In contrast with the results of the present study, increases in central blood pressure after ergometer exercise were observed in a previous study in which a SphygmoCor device was used to estimate central blood pressure.
In the present study, central blood pressure was measured after ergometer exercise to minimize artifact due to exercise, whereas in the previous study the hemodynamic measurements were performed during exercise. This may explain, at least in part, the differences between these two studies. Alternatively, the discrepancy between the present and previous studies may be attributable to differences in the methods used to estimate central blood pressure.Several studies have reported that peripheral blood pressure measured during exercise is a marker of cardiovascular risk independent of resting peripheral blood pressure. However, central blood pressure has been shown to be a more important determinant of vascular function and cardiovascular risk than peripheral blood pressure.
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An increase in central blood pressure means increased pulsatile stress in the aorta, as well as increased left ventricular afterload and myocardial oxygen consumption, which can be detected only after measurement (estimation) of central blood pressure because marked differences exist between central and peripheral blood pressure.