Data were collected from the initial graded exercise tests of 116 cardiac rehabilitation patients. Subjects were grouped according to their blood pressure response to exercise. Blood pressure groupings were typical systolic and typical diastolic (S_TD_T); typical systolic and atypical diastolic ( S_TD_AT); atypical systolic and typical diastolic (S_ATD_T); and both atypical systolic and diastolic blood pressure responses to exercise (S_ATD_AT). Groups were investigated for incidence of atypical responses (decrease, no increase, or excessive increase in systolic pressure and/or excessive increase or high diastolic pressure) and differences in physical characteristics, CVD status, predisposing CHD variables, medications prescribed, peak exercise cardiovascular responses and indicators of myocardial dysfunction. Results revealed atypical blood pressure responses in 65.5% of the subjects. No change in systolic pressure between the last two measured blood pressures was the most frequent atypical response exhibited. The S_ATD_AT pattern group was suggested to be at a higher health risk than the other groups based upon the tendency for higher percentages of subjects in this group exhibiting a history of myocardial infarction (80%), CABG (20%), angina ( 40%) and hypertension (47%). A high percentage of these subjects had been prescribed antihypertensive and antiarrhythmic medications, had "borderline" resting hypertension (X = 135.2/86.3 mmHg) and smoked (61.5%). Peak exercise data revealed a higher heart rate, higher systolic and diastolic pressures, higher RPE, more marked decreases in ECG changes and more supraventricular and ventricular arrhythmias than the other groups. These results based upon observed trends suggest that cardiac rehabilitation subjects with a combination of an atypical systolic and diastolic blood pressure response to exercise may require increased medical supervision during testing, more frequent measurements of blood pressure during testing and consideration of test termination. / M.S.

Autonomic nervous system activity is related to body weight regulation. Based on the MONA LISA hypothesis it has been suggested that most obese subjects and animals have low sympathetic nervous system activity. The aim of this study was to investigate whether there are differences in autonomic nervous system activity between lines of chickens selected for either high (HWS) or low body weight (LWS). In Exp. 1, various pharmacological agents were injected intravenously, and the changes in blood pressure (BP) and heart rate (HR) of both HWS and LWS chickens were compared. The results showed that the HWS birds had a greater increase in BP and HR than the LWS following injection of atropine, a muscarinic receptor blocker, and LWS birds had a greater decrease in BP and HR to propranolol, a beta- adrenergic receptor blocker than the HWS birds. These results suggested that HWS chickens have higher parasympathetic tone, whereas LWS chickens have a higher sympathetic nervous system tone regulating the cardiovascular system. HWS and LWS chickens displayed a similar response in BP and HR following injection of the ganglion blocker tetraethylammonium chloride. These results suggest that there is no significant difference in the central autonomic nervous system in the cardiovascular regulation between HWS and LWS together. Since there does not appear to be any differences in the activity of the autonomic nervous system activity at the level of the central nervous system, these findings imply that the difference in response to atropine and propranolol could be caused by differences in adrenal activity. The ratio of heart rate and blood pressure after the injection of phenylephrine showed significant difference between these two lines of birds, but not when phenylephrine was injected following atropine. This result indicated that HWS are more dependent on the parasympathetic nervous system to regulate the baroreceptor reflex. The percentage of adrenal and sympathetic impact on the regulation of heart rate showed that LWS females required greater adrenal activity than the other birds. In Exp. 2, the body weight and food intake responses of HWS and LWS chickens to ip injections of reserpine were compared. Reserpine caused a transitory decrease in food intake and body weight in both lines of birds. However HWS chickens recovered more slowly from the depression caused by reserpine than the LWS chickens. This could be due to lower sympathetic nervous system activity. In conclusion, it appears that HWS may have lower sympathetic activity than LWS. Combining the results of both experiments, it appears that the HWS birds have lower sympathetic and higher parasympathetic activity. Furthermore central nervous system autonomic activity in BP and HR regulation is not different between HWS and LWS, but the activity of the adrenal gland may be different between these two lines of birds. / Master of Science

Relevance: Heart disease is the leading cause of death worldwide. Observational and experimental evidence has shown that fruits high in polyphenols can reduce morbidity and mortality of heart disease. Introduction: This systematic review meta-analysis was conducted to evaluate the current evidence for anthocyanin-rich fruit supplementation amelioration of hypertension. Methods: Articles were identified, collected, screened, then data were analyzed via CMAv.2 for overall effect on blood pressure, nitric oxide, flow mediated dilation and pulse wave velocity. Results: The analysis showed a small, significant effect on diastolic blood pressure. No moderator groups had significant effects, though some individual subcategories showed significant effects. Conclusion: Diastolic blood pressure in humans can be beneficially influenced by consumption of anthocyanin-rich fruit.

Non-cardiac surgeries conducted globally each year often lead to cardiac complications,with myocardial injury commonly occurring within 30 days post-surgery. This thesis investigates the correlation between intra-operative signals and myocardial injuryusing machine learning models. The study focuses on analyzing intra-operative STelevation, heart rate, diastolic blood pressure, and pulse pressure variation. Multiplemachine learning models, including decision tree and random forest classifiers, weredeveloped and evaluated using two approaches: the sequence of event times and comprehensive event features.The results indicate that intra-operative physiological signals are valuable predictorsof myocardial injury, with random forest models generally outperforming decision treemodels. However, limited and unbalanced data posed challenges, affecting model performance variability. This research establishes a framework for enhancing predictivemodels and monitoring strategies to improve patient outcomes. / Icke-kirurgiska operationer som genomförs globalt varje år leder ofta till hjärtrelaterade komplikationer, där myokardskada vanligtvis uppstår inom 30 dagar efteroperationen. Denna avhandling undersöker sambandet mellan intraoperativa signaleroch myokardskada med hjälp av maskininlärningsmodeller. Studien fokuserar påatt analysera intraoperativa ST-höjning, hjärtfrekvens, diastoliskt blodtryck ochpulstrycksvariation. Flera maskininlärningsmodeller, inklusive beslutsträd- ochrandom forest-klassificerare, utvecklades och utvärderades med hjälp av två tillvägagångssätt: sekvensen av händelsetider och omfattande händelseegenskaper.Resultaten visar att intraoperativa fysiologiska signaler är värdefulla prediktorer förmyokardskada, där random forest-modeller generellt presterar bättre än beslutsträdmodeller. Begränsad och obalanserad data utgjorde dock utmaningar som påverkademodellens prestandavariabilitet. Denna forskning etablerar en ram för att förbättraprediktiva modeller och övervakningsstrategier för att förbättra patientutfall.

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Introdução. A progressão da síndrome metabólica (SMet) para a doença cardiovascular é complexa, multifatorial e pode estar associada, em parte, com a hiperativação simpática e com a diminuição da sensibilidade barorreflexa (SBR), mecanismos fortemente associados à hipertensão arterial (HAS). Adicionalmente, na hipertensão a resposta da pressão arterial (PA) durante o teste de esforço cardiopulmonar máximo (TECP) e na pressão arterial de 24h (MAPA) está prejudicada. Não é conhecido se pacientes com SMet mas sem hipertensão, apresentam estes prejuízos. Hipóteses. Pacientes com SMet com nível normal de PA clínica apresentam:(1) Resposta aumentada da PA pico e da PA de recuperação em resposta ao exercício máximo; (2) Prejuízo na PA de 24 horas Além disso, analisamos se estas alterações se correlacionam com a atividade nervosa simpática muscular (ANSM) e com a SBR. Métodos. Foram selecionados 72 pacientes recém-diagnosticados com SMet (ATP III), alocados em 3 grupos conforme a classificação da PA (segundo as Diretrizes 2013 ESH/ESC):, SMet hipertensos (HT, n=16, 51±9 anos, 33±4 kg/m2), SMet pré-hipertensos (PHT, n=29, 47±10 anos, 31±3 kg/m2) e SMet normotensos (NT, n=27, 46±7 anos, 32±4 kg/m2). Um grupo controle (C, n=19, 48±2 anos, 25±2 kg/m2) pareado por gênero e idade foi envolvido no estudo. Foram avaliados: a ANSM (microneurografia); a SBR (análise das flutuações espontâneas da PA sistólica e FC) para aumentos (SBR+) e diminuições da PA (SBR-); medidas auscultatórias da PA no pré-teste, pico, 1°, 2° e 4° min de recuperação (TECP); e PAS e PAD de 24 horas, vigília, sono e despertar (MAPA de 24h). O estudo foi dividido em duas partes: Parte 1 - todos os grupos com SMet (HT, PHT e NT) e C foram estudados; e Parte 2 - somente o grupo SMet NT foi comparado ao C. Resultados - Parte 1. Os grupos SMet (HT, PHT e NT) foram semelhantes entre si e apresentaram prejuízo quando comparado ao grupo C nas características físicas, na capacidade física e nos fatores de risco da SMet. Na PAS pico atingida no TECP, o grupo SMet HT apresentou valores superiores quando comparado com SMet PHT, NT, e C (217±23 vs. 202±22; 195±17; 177±24 mmHg; respectivamente; P=0,03). Apresentaram resposta da PAS exagerada (PAS >190 mmHg para mulheres e > 210 mmHg para homens) 81% no grupo HT, 55% no PHT, 37% no NT e 21% no C. Na MAPA, SMet HT apresentou maior PA de 24h que os outros 3 grupos. (P < 0,001). A ANSM foi maior nos grupos SMet HT, PHT e NT quando comparados ao C (33±7; 30±7; 29±6; vs. 18±1 disparos/min, respectivamente, P < 0,001). Somente o grupo SMet HT apresentou menor SBR+ quando comparado ao grupo C (6±3; 8±3; 9±3; vs. 11±5 mmHg/ms; P=0,002). Os grupos SMet HT e PHT apresentaram menor SBR-, enquanto SMet NT foi semelhante ao C (7±2; 9±4; 10±3; vs. 12±5 mmHg/ms; P < 0,05). Houve correlação entre a SBR- e a PAS pico (r=-0,32, P=0,04) com todos os sujeitos dos grupos da SMet e C. Resultados Parte 2. Exceto na PAS no 4º min de recuperação, o grupo SMet NT apresentou maior PAS e PAD comparado ao C em todos os momentos do TECP. O comportamento da PAS e PAD pela área sob a curva (ASC) total foi maior no SMet NT comparado ao C. Na MAPA de 24h, SMet NT apresentou menor PAD no sono que C. Além disso, SMet NT apresentou menor SBR+ e SBR- e maior ANSM comparado ao C. Interessantemente, no subgrupo de pacientes com SMet NT (n=10, 37%) que apresentou PAS pico exagerada a SBR- se correlacionou fortemente com a PAS pico (r=-0,70, P=0,02) e com a PAS no 1º min de recuperação (r=-0,73, P=0,04). Conclusão: Pacientes com SMet, mesmo normotensos, já apresentam resposta exacerbada da PAS e da PAD durante o TECP, dos quais 40% com PAS pico exagerada. A disfunção autonômica pode explicar, pelo menos em parte, esta reposta exacerbada / Introduction. The progression of the metabolic syndrome (MetS) to cardiovascular disease is complex, multifactorial and may be associated in part with sympathetic hyperactivation and reduced baroreflex sensitivity (BRS), mechanisms strongly associated with arterial hypertension (AH). Additionally, in hypertension, the BP response during the maximal cardiopulmonary exercise test (CPET) and 24h BP (ABPM) is impaired. It is not known whether patients with MetS but without hypertension present those damages. Hypotheses. Patients with MetS with normal clinical BP level present: (1) Increased response of peak BP and recovery BP in response to maximal exercise; (2) Impaired 24 hour BP. In addition, we analyzed if those changes are associated with muscle sympathetic nerve activity (MSNA) and BRS. Methods. We selected 72 newly diagnosed patients with MetS (ATP III), subdivided in 3 groups according to the BP classification (according to the ESH/ESC Guidelines): hypertensive MetS (HT, n=16, 51±9 years, 33±4 kg/m2), pre-hypertensive MetS (PHT, n=29, 47± 10 years, 31±3 kg/m2) and normotensive MetS (NT, n= 27, 46±7 years, 32±4 kg/m2). A control group (C, n=19, 48±2 years, 25±2 kg/m2) paired by gender and age was involved in the study. The following were evaluated: the MSNA (microneurography); BRS (analysis of spontaneous fluctuations of systolic BP and HR) for increases to BP (SBR+) and for decreases to BP (SBR-); BP auscultatory measurements in the pre-test, peak, 1st, 2nd and 4th min of recovery (CPET); and SBP and DBP of 24 hours, wakefulness, sleep and awakening (24-hour ABPM). The study was divided into two parts: Part 1. All groups with MetS (HT, PHT and NT) were studied; and C group. Part 2. Only the NT MetS group was compared to the C. Results Part 1. The MetS groups (HT, PHT and NT) were similar and were impaired compared to group C in physical characteristics, physical capacity and risk factors of MetS. In the peak SBP reached at CPET, HT MetS group presented higher values when compared to PHT and NT MetS groups and C (217±23 vs. 202±22, 195±17, 177±-24 mmHg, respectively, P=0.03). There was an exaggerated SBP response (SBP > 190 mmHg for women and > 210 mmHg for men) in 81% of the HT group, 55% of the PHT, 37% of the NT and 21% of the C group. In the ABPM, HT MetS had a higher 24-hour BP than the other 3 groups (P < 0.001). The MSNA was higher in HT, PHT and NT MetS groups when compared to C (33±7, 30±7, 29±6, vs. 18±1 burst/min, respectively, P < 0.001). Only the HT MetS group showed lower SBR+ compared to C (6±3, 8±3, 9±3, vs. 11±5 mmHg/ms, P=0.002). The HT and PHT MetS groups presented lower SBR-, while NT MetS was similar to C (7±2; 9 ±4; 10±3, vs. 12±5 mmHg/ms; P < 0.05). There was a correlation between SBR- and peak SBP (r= -0.32, P=0.04) with all subjects from the MetS and C groups. Results Part 2. Except for SBP in the 4th min of recovery, NT MetS presented higher SBP and DBP compared to C at all moments of the CPET. The SBP and DBP responses by AUC analysis were higher in NT MetS compared to C. In 24h ABPM, NT MetS presented lower DBP in the sleep than in C. In addition, NT MetS presented decreased SBR+ and SBR- and increased MSNA compared with C. Interestingly, in the NT MetS subgroup of patients (n=10, 37%) who showed an exaggerated peak SBP, showed a negative correlation between BRS- and peak SBP (r=-.70; P=0.01) and SBP at 1st minute of recovery (r=.73; P=0.04). Conclusion. Patients with MetS, even normotensive, already present an exacerbated SBP and DBP response during CPET, of which 40% with exaggerated peak SBP. Autonomic dysfunction may explain, at least in part, this exacerbated response

INTRODUÇÃO: Os efeitos do consumo de café na frequência e ritmo cardíaco, na pressão arterial e risco cardiovascular permanecem um assunto controverso. O objetivo desse estudo foi avaliar os efeitos do consumo de café filtrado nas torra escura e média na frequência cardíaca (FC), na frequência de extrassístoles, na variabilidade de frequência cardíaca (VFC), na pressão arterial, na tolerância ao exercício e em isquemia e angina em voluntários com doença arterial coronariana (DAC). MÉTODOS: Em um ensaio clínico randomizado e com crossover, comparamos o efeito do consumo de 450 a 600 ml de café nas torras escura e média em 41 voluntários com DAC, com idade média de 64,5 ± 6,7 anos, sendo que 33 eram do sexo masculino (80,5%). Após período de washout (período basal) e após cada período de quatros semanas de consumo de café (em ambas torras), os voluntários foram submetidos a teste ergométrico (TE), monitorização ambulatorial da pressão arterial (MAPA) e eletrocardiografia dinâmica (Holter). RESULTADOS: O consumo contínuo de café não exerceu nenhum efeito deletério na isquemia miocárdica desencadeada por esforço no teste ergométrico. O tempo total de exercício (deltaT Exercício) foi de 566,59 ± 192,40, 599,39 ± 205,60 e 602,22 ± 210,24 segundos (s), respectivamente para o momento basal (após washout), após consumo de café torra escura e após consumo de café torra média (média ± DP, p = 0,002). Na MAPA, as variáveis encontradas após período basal, após consumo de café torra escura e após consumo de café torra média foram, respectivamente: pressão arterial sistólica (PAS) de 110,59 ± 12,05, 111,83 ± 12,89 e 114,32 ± 11,89 mmHg (média ± DP, p = 0,065); e pressão arterial diastólica (PAD) de 64,10 ± 8,99, 64,85 ± 9,31 e 66,27 ± 9,59 mmHg (média ± DP, p = 0,143). Os valores a seguir foram obtidos através do Holter após período basal, após consumo de café torra escura e após consumo de café torra média, respectivamente: FC Média de 67,38 ± 8,44, 66,51 ± 8,11, e 67,44 ± 8,54 (média ± DP, p = 0,59); frequência de extrassístoles supraventriculares (ESV) de 21 (75), 22 (59), e 18 (85) [mediana (intervalo interquartil), p = 0,77]; frequência de extrassístoles ventriculares (EV) de 8 (426), 10 (123), e 8 (36) [mediana (intervalo interquartil), p = 0,17]; e desvio padrão de todos os intervalos RR normais (SDNN) de 129,87 ± 32,82, 134,74 ± 30,90, e 128,31 ± 28,12 (média ± DP, p = 0,16). CONCLUSÕES: Neste estudo, o consumo contínuo de café aumentou a tolerância ao exercício, não afetou de forma significativa a pressão arterial, o ritmo e a frequência cardíaca e não aumentou a frequência de extrassístoles ventriculares e supraventriculares. Com relação a presença de isquemia e/ou angina no TE, não ocorreram modificações relacionadas ao consumo de café em ambas torras / BACKGROUND: The effect of coffee on heart rate (HR), cardiac rhythm, blood pressure (BP) and cardiovascular risk has long been a controversial issue. The aim of this study was to compare the effects of dark roast (DR) and medium-dark roast (MDR) paper-filtered coffee on HR, premature complexes, heart rate variability (HRV), BP, total exercise time (deltaT Exercise) and exercise-induced angina pectoris in volunteers with coronary artery disease (CAD). METHODS: In a randomized crossover trial, we compared the effects of consuming three to four cups (150 mL) of DR and MDR coffee per day for 4 weeks in 41 volunteers with CAD, with 64.5 ± 6.7 years old, 33 men (80.5%). At baseline and after each 4-week period of drinking, the subjects were submitted to treadmill test, ambulatory blood pressure monitoring (24-h ABPM) and 24-hour Holter electrocardiograms (24-h Holter). RESULTS: The continuous coffee consumption had no deleterious effect on exercise-induced angina pectoris on treadmill test. The deltaT Exercise at baseline and after ingesting DR and MDR were 566.59 ± 192.40, 599.39 ± 205.60 and 602.22 ± 210.24 seconds, respectively (mean ± SD, p = 0.002). The analyzed parameters on 24-h ABPM at baseline and after 4 weeks of DR and MDR coffee consumption were, respectively: systolic BP of 110.59 ± 12.05, 111.83 ± 12.89 and 114.32 ± 11.89 mmHg (mean ± SD, p = 0.065); and diastolic BP of 64.10 ± 8.99, 64.85 ± 9.31 e 66.27 ± 9.59 mmHg (mean ± SD, p = 0,143). The following values were obtained on 24-h Holter at baseline and after 4 weeks of DR and MDR coffee consumption, respectively: average HRs of 67.38 ± 8.44, 66.51 ± 8.11, and 67.44 ± 8.54 (mean ± SD, p = 0.59); premature atrial complexes of 21 (75), 22 (59), and 18 (85) [median (IQR), p = 0.77]; premature ventricular complexes of 8 (426), 10 (123), and 8 (36) [median (IQR), p = 0.17]; and standard deviations of normal to normal R-R intervals (SDNNs) of 129.87 ± 32.82, 134.74 ± 30.90, and 128.31 ± 28.12 (mean ± SD, p = 0.16). CONCLUSIONS: In this study, continuous coffee consumption increased total exercise time, did not significantly affect blood pressure, HR or HRV and did not increase the frequency of premature complexes in volunteers with CAD. Furthermore, continuous coffee consumption had no deleterious effect on exercise-induced angina pectoris

INTRODUÇÃO: Os efeitos do consumo de café na frequência e ritmo cardíaco, na pressão arterial e risco cardiovascular permanecem um assunto controverso. O objetivo desse estudo foi avaliar os efeitos do consumo de café filtrado nas torra escura e média na frequência cardíaca (FC), na frequência de extrassístoles, na variabilidade de frequência cardíaca (VFC), na pressão arterial, na tolerância ao exercício e em isquemia e angina em voluntários com doença arterial coronariana (DAC). MÉTODOS: Em um ensaio clínico randomizado e com crossover, comparamos o efeito do consumo de 450 a 600 ml de café nas torras escura e média em 41 voluntários com DAC, com idade média de 64,5 ± 6,7 anos, sendo que 33 eram do sexo masculino (80,5%). Após período de washout (período basal) e após cada período de quatros semanas de consumo de café (em ambas torras), os voluntários foram submetidos a teste ergométrico (TE), monitorização ambulatorial da pressão arterial (MAPA) e eletrocardiografia dinâmica (Holter). RESULTADOS: O consumo contínuo de café não exerceu nenhum efeito deletério na isquemia miocárdica desencadeada por esforço no teste ergométrico. O tempo total de exercício (deltaT Exercício) foi de 566,59 ± 192,40, 599,39 ± 205,60 e 602,22 ± 210,24 segundos (s), respectivamente para o momento basal (após washout), após consumo de café torra escura e após consumo de café torra média (média ± DP, p = 0,002). Na MAPA, as variáveis encontradas após período basal, após consumo de café torra escura e após consumo de café torra média foram, respectivamente: pressão arterial sistólica (PAS) de 110,59 ± 12,05, 111,83 ± 12,89 e 114,32 ± 11,89 mmHg (média ± DP, p = 0,065); e pressão arterial diastólica (PAD) de 64,10 ± 8,99, 64,85 ± 9,31 e 66,27 ± 9,59 mmHg (média ± DP, p = 0,143). Os valores a seguir foram obtidos através do Holter após período basal, após consumo de café torra escura e após consumo de café torra média, respectivamente: FC Média de 67,38 ± 8,44, 66,51 ± 8,11, e 67,44 ± 8,54 (média ± DP, p = 0,59); frequência de extrassístoles supraventriculares (ESV) de 21 (75), 22 (59), e 18 (85) [mediana (intervalo interquartil), p = 0,77]; frequência de extrassístoles ventriculares (EV) de 8 (426), 10 (123), e 8 (36) [mediana (intervalo interquartil), p = 0,17]; e desvio padrão de todos os intervalos RR normais (SDNN) de 129,87 ± 32,82, 134,74 ± 30,90, e 128,31 ± 28,12 (média ± DP, p = 0,16). CONCLUSÕES: Neste estudo, o consumo contínuo de café aumentou a tolerância ao exercício, não afetou de forma significativa a pressão arterial, o ritmo e a frequência cardíaca e não aumentou a frequência de extrassístoles ventriculares e supraventriculares. Com relação a presença de isquemia e/ou angina no TE, não ocorreram modificações relacionadas ao consumo de café em ambas torras / BACKGROUND: The effect of coffee on heart rate (HR), cardiac rhythm, blood pressure (BP) and cardiovascular risk has long been a controversial issue. The aim of this study was to compare the effects of dark roast (DR) and medium-dark roast (MDR) paper-filtered coffee on HR, premature complexes, heart rate variability (HRV), BP, total exercise time (deltaT Exercise) and exercise-induced angina pectoris in volunteers with coronary artery disease (CAD). METHODS: In a randomized crossover trial, we compared the effects of consuming three to four cups (150 mL) of DR and MDR coffee per day for 4 weeks in 41 volunteers with CAD, with 64.5 ± 6.7 years old, 33 men (80.5%). At baseline and after each 4-week period of drinking, the subjects were submitted to treadmill test, ambulatory blood pressure monitoring (24-h ABPM) and 24-hour Holter electrocardiograms (24-h Holter). RESULTS: The continuous coffee consumption had no deleterious effect on exercise-induced angina pectoris on treadmill test. The deltaT Exercise at baseline and after ingesting DR and MDR were 566.59 ± 192.40, 599.39 ± 205.60 and 602.22 ± 210.24 seconds, respectively (mean ± SD, p = 0.002). The analyzed parameters on 24-h ABPM at baseline and after 4 weeks of DR and MDR coffee consumption were, respectively: systolic BP of 110.59 ± 12.05, 111.83 ± 12.89 and 114.32 ± 11.89 mmHg (mean ± SD, p = 0.065); and diastolic BP of 64.10 ± 8.99, 64.85 ± 9.31 e 66.27 ± 9.59 mmHg (mean ± SD, p = 0,143). The following values were obtained on 24-h Holter at baseline and after 4 weeks of DR and MDR coffee consumption, respectively: average HRs of 67.38 ± 8.44, 66.51 ± 8.11, and 67.44 ± 8.54 (mean ± SD, p = 0.59); premature atrial complexes of 21 (75), 22 (59), and 18 (85) [median (IQR), p = 0.77]; premature ventricular complexes of 8 (426), 10 (123), and 8 (36) [median (IQR), p = 0.17]; and standard deviations of normal to normal R-R intervals (SDNNs) of 129.87 ± 32.82, 134.74 ± 30.90, and 128.31 ± 28.12 (mean ± SD, p = 0.16). CONCLUSIONS: In this study, continuous coffee consumption increased total exercise time, did not significantly affect blood pressure, HR or HRV and did not increase the frequency of premature complexes in volunteers with CAD. Furthermore, continuous coffee consumption had no deleterious effect on exercise-induced angina pectoris

Hypertension is a global disease that many effected people in developing countries is not aware of. Hypertension is linked with cardiovascular disease. Prehypertension is not a disease but if not correctly treated, it could develop into hypertension. The aim of the study was to investigate if there are any differences in circadian blood pressure between two study groups, one group with normal blood pressure and one group with prehypertension. This study was a explorative study and its design is based on measurements of blood pressure values and a questionnaire was used to help get the data collection. 51 students volunteered to have their blood pressure taken from them and out of these 51, 24 where selected into two groups of 12 each for the Ambulatory blood pressure monitoring. hese 24 students would be a part of our study and an ambulatory (Schiller-102 plus) blood pressure monitor was used to collect the data. The prevalence of prehypertension findings in the clinical testing phase was 37% of the population. There was a variation between the groups during the day (systolic) but there was not a significant difference during the night.

Introdução. A progressão da síndrome metabólica (SMet) para a doença cardiovascular é complexa, multifatorial e pode estar associada, em parte, com a hiperativação simpática e com a diminuição da sensibilidade barorreflexa (SBR), mecanismos fortemente associados à hipertensão arterial (HAS). Adicionalmente, na hipertensão a resposta da pressão arterial (PA) durante o teste de esforço cardiopulmonar máximo (TECP) e na pressão arterial de 24h (MAPA) está prejudicada. Não é conhecido se pacientes com SMet mas sem hipertensão, apresentam estes prejuízos. Hipóteses. Pacientes com SMet com nível normal de PA clínica apresentam:(1) Resposta aumentada da PA pico e da PA de recuperação em resposta ao exercício máximo; (2) Prejuízo na PA de 24 horas Além disso, analisamos se estas alterações se correlacionam com a atividade nervosa simpática muscular (ANSM) e com a SBR. Métodos. Foram selecionados 72 pacientes recém-diagnosticados com SMet (ATP III), alocados em 3 grupos conforme a classificação da PA (segundo as Diretrizes 2013 ESH/ESC):, SMet hipertensos (HT, n=16, 51±9 anos, 33±4 kg/m2), SMet pré-hipertensos (PHT, n=29, 47±10 anos, 31±3 kg/m2) e SMet normotensos (NT, n=27, 46±7 anos, 32±4 kg/m2). Um grupo controle (C, n=19, 48±2 anos, 25±2 kg/m2) pareado por gênero e idade foi envolvido no estudo. Foram avaliados: a ANSM (microneurografia); a SBR (análise das flutuações espontâneas da PA sistólica e FC) para aumentos (SBR+) e diminuições da PA (SBR-); medidas auscultatórias da PA no pré-teste, pico, 1°, 2° e 4° min de recuperação (TECP); e PAS e PAD de 24 horas, vigília, sono e despertar (MAPA de 24h). O estudo foi dividido em duas partes: Parte 1 - todos os grupos com SMet (HT, PHT e NT) e C foram estudados; e Parte 2 - somente o grupo SMet NT foi comparado ao C. Resultados - Parte 1. Os grupos SMet (HT, PHT e NT) foram semelhantes entre si e apresentaram prejuízo quando comparado ao grupo C nas características físicas, na capacidade física e nos fatores de risco da SMet. Na PAS pico atingida no TECP, o grupo SMet HT apresentou valores superiores quando comparado com SMet PHT, NT, e C (217±23 vs. 202±22; 195±17; 177±24 mmHg; respectivamente; P=0,03). Apresentaram resposta da PAS exagerada (PAS >190 mmHg para mulheres e > 210 mmHg para homens) 81% no grupo HT, 55% no PHT, 37% no NT e 21% no C. Na MAPA, SMet HT apresentou maior PA de 24h que os outros 3 grupos. (P < 0,001). A ANSM foi maior nos grupos SMet HT, PHT e NT quando comparados ao C (33±7; 30±7; 29±6; vs. 18±1 disparos/min, respectivamente, P < 0,001). Somente o grupo SMet HT apresentou menor SBR+ quando comparado ao grupo C (6±3; 8±3; 9±3; vs. 11±5 mmHg/ms; P=0,002). Os grupos SMet HT e PHT apresentaram menor SBR-, enquanto SMet NT foi semelhante ao C (7±2; 9±4; 10±3; vs. 12±5 mmHg/ms; P < 0,05). Houve correlação entre a SBR- e a PAS pico (r=-0,32, P=0,04) com todos os sujeitos dos grupos da SMet e C. Resultados Parte 2. Exceto na PAS no 4º min de recuperação, o grupo SMet NT apresentou maior PAS e PAD comparado ao C em todos os momentos do TECP. O comportamento da PAS e PAD pela área sob a curva (ASC) total foi maior no SMet NT comparado ao C. Na MAPA de 24h, SMet NT apresentou menor PAD no sono que C. Além disso, SMet NT apresentou menor SBR+ e SBR- e maior ANSM comparado ao C. Interessantemente, no subgrupo de pacientes com SMet NT (n=10, 37%) que apresentou PAS pico exagerada a SBR- se correlacionou fortemente com a PAS pico (r=-0,70, P=0,02) e com a PAS no 1º min de recuperação (r=-0,73, P=0,04). Conclusão: Pacientes com SMet, mesmo normotensos, já apresentam resposta exacerbada da PAS e da PAD durante o TECP, dos quais 40% com PAS pico exagerada. A disfunção autonômica pode explicar, pelo menos em parte, esta reposta exacerbada / Introduction. The progression of the metabolic syndrome (MetS) to cardiovascular disease is complex, multifactorial and may be associated in part with sympathetic hyperactivation and reduced baroreflex sensitivity (BRS), mechanisms strongly associated with arterial hypertension (AH). Additionally, in hypertension, the BP response during the maximal cardiopulmonary exercise test (CPET) and 24h BP (ABPM) is impaired. It is not known whether patients with MetS but without hypertension present those damages. Hypotheses. Patients with MetS with normal clinical BP level present: (1) Increased response of peak BP and recovery BP in response to maximal exercise; (2) Impaired 24 hour BP. In addition, we analyzed if those changes are associated with muscle sympathetic nerve activity (MSNA) and BRS. Methods. We selected 72 newly diagnosed patients with MetS (ATP III), subdivided in 3 groups according to the BP classification (according to the ESH/ESC Guidelines): hypertensive MetS (HT, n=16, 51±9 years, 33±4 kg/m2), pre-hypertensive MetS (PHT, n=29, 47± 10 years, 31±3 kg/m2) and normotensive MetS (NT, n= 27, 46±7 years, 32±4 kg/m2). A control group (C, n=19, 48±2 years, 25±2 kg/m2) paired by gender and age was involved in the study. The following were evaluated: the MSNA (microneurography); BRS (analysis of spontaneous fluctuations of systolic BP and HR) for increases to BP (SBR+) and for decreases to BP (SBR-); BP auscultatory measurements in the pre-test, peak, 1st, 2nd and 4th min of recovery (CPET); and SBP and DBP of 24 hours, wakefulness, sleep and awakening (24-hour ABPM). The study was divided into two parts: Part 1. All groups with MetS (HT, PHT and NT) were studied; and C group. Part 2. Only the NT MetS group was compared to the C. Results Part 1. The MetS groups (HT, PHT and NT) were similar and were impaired compared to group C in physical characteristics, physical capacity and risk factors of MetS. In the peak SBP reached at CPET, HT MetS group presented higher values when compared to PHT and NT MetS groups and C (217±23 vs. 202±22, 195±17, 177±-24 mmHg, respectively, P=0.03). There was an exaggerated SBP response (SBP > 190 mmHg for women and > 210 mmHg for men) in 81% of the HT group, 55% of the PHT, 37% of the NT and 21% of the C group. In the ABPM, HT MetS had a higher 24-hour BP than the other 3 groups (P < 0.001). The MSNA was higher in HT, PHT and NT MetS groups when compared to C (33±7, 30±7, 29±6, vs. 18±1 burst/min, respectively, P < 0.001). Only the HT MetS group showed lower SBR+ compared to C (6±3, 8±3, 9±3, vs. 11±5 mmHg/ms, P=0.002). The HT and PHT MetS groups presented lower SBR-, while NT MetS was similar to C (7±2; 9 ±4; 10±3, vs. 12±5 mmHg/ms; P < 0.05). There was a correlation between SBR- and peak SBP (r= -0.32, P=0.04) with all subjects from the MetS and C groups. Results Part 2. Except for SBP in the 4th min of recovery, NT MetS presented higher SBP and DBP compared to C at all moments of the CPET. The SBP and DBP responses by AUC analysis were higher in NT MetS compared to C. In 24h ABPM, NT MetS presented lower DBP in the sleep than in C. In addition, NT MetS presented decreased SBR+ and SBR- and increased MSNA compared with C. Interestingly, in the NT MetS subgroup of patients (n=10, 37%) who showed an exaggerated peak SBP, showed a negative correlation between BRS- and peak SBP (r=-.70; P=0.01) and SBP at 1st minute of recovery (r=.73; P=0.04). Conclusion. Patients with MetS, even normotensive, already present an exacerbated SBP and DBP response during CPET, of which 40% with exaggerated peak SBP. Autonomic dysfunction may explain, at least in part, this exacerbated response