Exaggerated Exercise Blood Pressure as a Marker of Baroreflex Dysfunction in Normotensive Metabolic Syndrome Patients

Autor(es)

Dutra-Marques, Akothirene C. ^[1] ; Rodrigues, Sara ^[1] ; Cepeda, Felipe X. ^[1] ; Toschi-Dias, Edgar ^{[2, 1]} ; Rondon, Eduardo ^[1] ; Carvalho, Jefferson C. ^[1] ; Alves, Maria Janieire N. N. ^[1] ; Braga, Ana Maria F. W. ^[1] ; Rondon, Maria Urbana P. B. ^[3] ; Trombetta, Ivani C. ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Inst Coracao, Hosp Clin HCFMUSP, Fac Med, Sao Paulo - Brazil

^[2] Univ Metodista Sao Paulo, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Phys Educ & Sport, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: FRONTIERS IN NEUROSCIENCE; v. 15, JUN 9 2021.
• Citações Web of Science: 0

Resumo

Introduction Exaggerated blood pressure response to exercise (EEBP = SBP >= 190 mmHg for women and >= 210 mmHg for men) during cardiopulmonary exercise test (CPET) is a predictor of cardiovascular risk. Sympathetic hyperactivation and decreased baroreflex sensitivity (BRS) seem to be involved in the progression of metabolic syndrome (MetS) to cardiovascular disease. Objective To test the hypotheses: (1) MetS patients within normal clinical blood pressure (BP) may present EEBP response to maximal exercise and (2) increased muscle sympathetic nerve activity (MSNA) and reduced BRS are associated with this impairment. Methods We selected MetS (ATP III) patients with normal BP (MetS\_NT, n = 27, 59.3% males, 46.1 +/- 7.2 years) and a control group without MetS (C, n = 19, 48.4 +/- 7.4 years). We evaluated BRS for increases (BRS+) and decreases (BRS-) in spontaneous BP and HR fluctuations, MSNA (microneurography), BP from ambulatory blood pressure monitoring (ABPM), and auscultatory BP during CPET. Results Normotensive MetS (MetS\_NT) had higher body mass index and impairment in all MetS risk factors when compared to the C group. MetS\_NT had higher peak systolic BP (SBP) (195 +/- 17 vs. 177 +/- 24 mmHg, P = 0.007) and diastolic BP (91 +/- 11 vs. 79 +/- 10 mmHg, P = 0.001) during CPET than C. Additionally, we found that MetS patients with normal BP had lower spontaneous BRS- (9.6 +/- 3.3 vs. 12.2 +/- 4.9 ms/mmHg, P = 0.044) and higher levels of MSNA (29 +/- 6 vs. 18 +/- 4 bursts/min, P < 0.001) compared to C. Interestingly, 10 out of 27 MetS\_NT (37%) showed EEBP (MetS\_NT+), whereas 2 out of 19 C (10.5%) presented (P = 0.044). The subgroup of MetS\_NT with EEBP (MetS\_NT+, n = 10) had similar MSNA (P = 0.437), but lower BRS+ (P = 0.039) and BRS- (P = 0.039) compared with the subgroup without EEBP (MetS\_NT-, n = 17). Either office BP or BP from ABPM was similar between subgroups MetS\_NT+ and MetS\_NT-, regardless of EEBP response. In the MetS\_NT+ subgroup, there was an association of peak SBP with BRS- (R = -0.70; P = 0.02), triglycerides with peak SBP during CPET (R = 0.66; P = 0.039), and of triglycerides with BRS- (R = 0.71; P = 0.022). Conclusion Normotensive MetS patients already presented higher peak systolic and diastolic BP during maximal exercise, in addition to sympathetic hyperactivation and decreased baroreflex sensitivity. The EEBP in MetS\_NT with apparent well-controlled BP may indicate a potential depressed neural baroreflex function, predisposing these patients to increased cardiovascular risk. (AU)

• Processo FAPESP: 16/16831-7 - Marcadores metabólicos/inflamatórios e balanço simpato-vagal em pacientes com síndrome metabólica e apneia obstrutiva do sono: efeito da dieta hipocalórica e treinamento físico
• Beneficiário: Felipe Xerez Cepêda Fonseca
• Modalidade de apoio: Bolsas no Exterior - Estágio de Pesquisa - Doutorado
• Processo FAPESP: 11/17533-6 - Aspectos autonômicos, metabólicos e inflamatórios da associação da síndrome metabólica com a apnéia obstrutiva do sono: efeito da dieta hipocalórica e do treinamento físico
• Beneficiário: Ivani Credidio Trombetta
• Modalidade de apoio: Auxílio à Pesquisa - Regular
• Processo FAPESP: 15/03274-0 - Marcadores metabólicos/inflamatórios e balanço simpato-vagal em pacientes com síndrome metabólica e apneia obstrutiva do sono: efeito da dieta hipocalórica e treinamento físico
• Beneficiário: Felipe Xerez Cepêda Fonseca
• Modalidade de apoio: Bolsas no Brasil - Doutorado
• Processo FAPESP: 13/07651-7 - Valor prognóstico do padrão oscilatório da atividade nervosa simpática muscular em pacientes com insuficiência cardíaca
• Beneficiário: Edgar Toschi Dias
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado