1.
Exercise-induced hypertension in men with metabolic syndrome: anthropometric, metabolic, and hemodynamic features.
Gaudreault, V, Després, JP, Rhéaume, C, Alméras, N, Bergeron, J, Tremblay, A, Poirier, P
Metabolic syndrome and related disorders. 2013;(1):7-14
Abstract
OBJECTIVE Metabolic syndrome is associated with increased cardiac morbidity. The aim of this study was to evaluate exercise-induced hypertension (EIH) in men with metabolic syndrome and to explore potential associations with anthropometric and metabolic variables. METHODS A total of 179 normotensive men with metabolic syndrome underwent a maximal symptom-limited treadmill test. Blood pressure was measured at 5-min rest prior to exercise testing (anticipatory blood pressure), at every 3 min during the exercise, and during the recovery period. EIH was defined as maximum systolic blood pressure (SBP) ≥220 mmHg and/or maximum diastolic blood pressure (DBP) ≥100 mmHg. RESULTS Of the 179 men, 87 (47%) presented EIH. Resting blood pressure values at baseline were 127±10/83±6 mmHg in EIH and 119±9/80±6 mmHg (P=0.01 for both) in normal blood pressure responders to exercise. Anticipatory SBP and DPS were higher in the group with EIH (P=0.001). Subjects with EIH presented higher waist circumference (WC) (P<0.01), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (ApoB) levels as well as insulin resistance (all P<0.05). Abdominal subcutaneous adipose tissue and total body fat mass were comparable between groups. Subjects with EIH had higher abdominal visceral adipose tissue (P<0.001). The best predictors of EIH were resting SBP and abdominal obesity. Each increment of 5 cm in WC was associated with an odds ratio of 1.30 (1.20-1.68) for EIH. CONCLUSION About half of our subjects with metabolic syndrome showed EIH. These men are characterized by a worsened metabolic profile. Our data suggest that a treadmill exercise test may be helpful to identify a potentially higher risk metabolic syndrome subset of subjects.
2.
[Calcium antagonists in the preoperative preparation of pregnant women with gestosis].
Shepetovskaia, NL, Piovarova, GM, Gur'ianov, VA, Tolmachev, GN, Volodin, AV
Anesteziologiia i reanimatologiia. 2007;(6):20-4
Abstract
Differential preoperative preparation of pregnant women with gestosis, which is aimed at eliminating dysfunction of the universal secondary calcium messenger and preventing further disorders caused by calcium antagonists, is accompanied by positive changes in the basic links of development of the general adaptation syndrome--the autonomic nervous and cardiovascular systems. A physiologically required reduction in total peripheral vascular resistance (TPVE) is achieved in pregnant women with hyper- and eukinetic hemodynamics. In pregnant women with hypokinetic type, who receive hydroxyethyl starch-130/04 solution in the infusion therapy protocol, there is elimination of its pathological increase and there is a tendency for its physiological reduction. Obviating the discrepancy between cardiac index and TPVE causes a change of the hyper- and hypokinetic hemodynamic types to the eukinetic one, which is attended by development of physiological sympathicotonia and by almost complete normalization of water metabolic parameters in pregnant women with gestosis.
3.
The impact of growth hormone/insulin-like growth factor-I axis and nocturnal breathing disorders on cardiovascular features of adult patients with Prader-Willi syndrome.
Marzullo, P, Marcassa, C, Campini, R, Eleuteri, E, Minocci, A, Priano, L, Temporelli, P, Sartorio, A, Vettor, R, Liuzzi, A, et al
The Journal of clinical endocrinology and metabolism. 2005;(10):5639-46
Abstract
CONTEXT Adult patients with Prader-Willi syndrome (PWS) are prone to develop obesity, GH deficiency (GHD), and their related complications, with cardiopulmonary failure explaining more than half of PWS fatalities. OBJECTIVE AND STUDY PARTICIPANTS This study was undertaken to examine the effect of GHD and sleep breathing disorders on cardiovascular risk factors and heart features of 13 PWS (age 26.9 +/- 1.2 yr) and 13 age-, gender-, and body mass index-matched obese individuals (age 26.2 +/- 0.8 yr). RESULTS Compared with controls, PWS patients had lower GH response to arginine+GHRH, IGF-I levels, triglycerides, total and LDL-cholesterol, insulin, and insulin resistance measured by a homeostatic model approach. Dual-energy x-ray absorptiometry, abdominal computed tomography scans, and polysomnography revealed a greater fat mass, similar abdominal fat, but greater sleep breathing disorders in PWS than obese subjects. Echocardiography showed no systolic or diastolic alteration, although PWS had lower left ventricle (LV) mass (135.7 +/- 7.7 vs. 163.5 +/- 8.4 g, P < 0.05) and near significantly lower values of LV end-diastole diameter (P = 0.08), compared with obese controls. Baseline radionuclide angiography documented comparable values of systolic and diastolic values between groups. However, adrenergic stimulation with dobutamine caused a lower increase of LV ejection fraction (71.9 +/- 1.9 vs. 76.3 +/- 1.2%, P < 0.05) and heart rate (103 +/- 6.9 vs. 128 +/- 2.8 beats/min, P < 0.05) in PWS than obese individuals. By multivariate analysis, nocturnal oxygen desaturation and IGF-I levels were main significant predictors of LV mass and heart rate in PWS patients. CONCLUSIONS PWS differs from simple obesity by a healthier metabolic profile, impaired nocturnal breathing, decreased heart geometry, and systolic and chronotropic performance. GHD and the predictive role of IGF-I on structural and functional heart parameters suggest a GH/IGF-I-mediated control of cardiac risk in PWS.