Hipotensão pós-exercício é o fenômeno de redução da pressão arterial sistêmica por minutos ou horas após a realização de atividade física, sendo considerado uma resposta fisiológica para o controle pressórico. Fatores como nível pressórico, aptidão física e tipo de exercício físico, contribuem para potencializar a resposta hipotensora pós-exercício, contudo, apesar de ser conhecido que a pressão arterial não possui valor constante ao longo das 24 horas, ainda não foi investigado se existe diferença na resposta hipotensora quando o exercício físico é realizado em diferentes horários do dia. À vista disso, 16 mulheres foram divididas em dois grupos; Adultos Maduros (n=8; 58,7 + 10,9 anos) e Adultos Jovens (n=8; 21 + 4,3 anos). Cada grupo realizou três sessões experimentais; duas compostas de exercício físico resistido de baixa intensidade (dez exercícios a 40% de uma repetição máxima) realizados em diferentes fases do dia, manhã (07:30h) e noite (18:00h), e uma sessão controle - sem a realização de exercício físico. A pressão arterial foi medida por 24 horas após as sessões, a percepção de desconforto avaliada por meio de inventário. Em suma, descrevemos que: (1) Não constatamos redução pressórica no grupo Adultos Jovens em nenhuma das fases avaliadas. Observamos hipotensão pós-exercício no grupo Adultos Maduros de forma intermitente por 5 horas na variável pressão arterial média após o exercício realizado na fase matutina. Com base na análise de Fourier e da própria observação do comportamento pressórico da pressão arterial média, podemos observar que o exercício matutino atenuou o padrão pressórico ultradiano, como consequência, a pressão arterial média manteve-se a níveis abaixo da sessão controle; (2) Na avaliação da percepção de desconforto, o grupo Adultos Jovens quando comparado com o grupo Adultos Maduros, apresentou maior desconforto ao realizar o exercício na fase matutina, já na sessão com exercício noturno, encontramos pouca alteração na percepção de desconforto de adultos jovens e adultos maduros / Post exercise hypotension is a phenomenon of decreased blood pressure by minutes or hours after physical exercise, being considered a physiological response in blood pressure control. Factors such as blood pressure level, physical ability and type of exercise, contribute to potentiate post exercise hypotension, however, despite being known that blood pressure has no constant value over 24 hours, still not been investigated whether there are differences in the hypotensive response when exercise is performed at different times of the day. In view of this, 16 women were divided into two groups; Mature adults (n = 8; 58.7 ± 10.9 years) and Young Adults (n = 8; 21 ± 4.3 years). Each group performed three experimental sessions; two with low intensity resitance exercise (tem exercise at 40% one repetition maximum) was performed at two phases, morning (07: 30h) and night (18: 00h), and a control session without performing physical exercise. Blood pressure was measured during 24 hours after the sessions, perception of discomfort assessed by inventory. We describe that: We did not found blood pressure reduction in Young Adults group for none of the phases. We observed intermittently post-exercise hypotension Mature Adults group for five hours in mean arterial pressure after morning exercise. Based on Fourier Analysis and own observation mean arterial pressure behavior, we can observe that the morning exercise attenuated ultradian pressor pattern, As a result, average blood pressure levels remained below than control session; (2) In assessing the perception of discomfort, Young Adults group compared with Mature Adults group, showed greater discomfort to perform the exercise in the morning phase, during nightly exercise, we found little perception of discomfort change in Young Adults and Mature adults

In this study, we used a cross-sectional study design to examine the relationship between the calcium intake and risk factors for CVD among obese adults by using continuous waves of National Health and Nutrition Examination Survey (NHANES) data 1999-2010. The association between calcium intake and risk factors of CVD (hypertension, total cholesterol, HDL, glycohemoglobin), CRP, albuminuria) is assessed among obese adults in USA. The incidence of Cardiovascular Disease (CVD) is high among obese people. The potential effects of inadequate calcium intake on CVD are receiving increased epidemiologic attention. Understanding the association between risk factors for CVD and calcium intake among obese adults is important for the advancement of CVD, nutrition and obesity research. Data collected from the National Health and Nutrition Examination Survey from 1999-2010 were examined, utilizing a subset of 14,856 obese subjects. Analysis of Variance statistical tests were conducted to determine associations between calcium intake and CVD risk. Simple and multiple linear and logistic regression analyses were conducted to determine the predicted value of calcium intake with CVD. After adjusting for energy intake and other potential risk factors, systolic blood pressure, diastolic blood pressure, C-reactive protein, glycosylated hemoglobin and albuminuria were negatively associated with calcium intake at &alpha = 0.05 level in both linear and logistic regression analyses. In a comparison of calcium intake by quartiles, results reveal that total cholesterol had a weak negative association with calcium intake at &alpha = 0.1 level. The implications of these study results are important as the importance of adequate calcium intake and its potential to decrease CVD among obese adults has incredible preventive value for populations. Additional research that focuses on dietary intake, calcium thresholds and impacts on total cholesterol levels in the body is warranted.

Baroreflex sensitivity (BRS) is often reduced in elderly populations and patients with chronic cardiovascular diseases leading to a concomitant rise in blood pressure variability (BPV) that is associated with increased cardiovascular related morbidity and mortality. Thus, there is a need to better understand the mechanisms by which BPV causes cardiovascular end-organ damage. Animal studies using sinoaortic denervation (SAD) to increase BPV have demonstrated pathologic changes in the structure of the heart and blood vessels; however, there is a paucity of data investigating changes in functional measures of the heart and smaller, resistance type arteries. Furthermore, the pathogenic mechanisms involved in BPV-induced cardiovascular end-organ damage remain unknown. Baroreceptor denervation results in multiple cardiac stressors, many of which are associated with production of reactive oxygen species. Oxidative stress is known to promote cardiovascular end-organ damage but it is unclear if it plays a role in models of increased BPV. Thus, this study was designed to investigate the functional responses of smaller resistance type arteries and the heart to chronic exposure to enhanced BPV. In addition, the role of oxidative stress on these functional responses in a normotensive rat model of increased BPV was also investigated. Rats were subjected to either SAD surgery or a sham procedure and were observed for six weeks. To determine the role of oxidative stress, SAD rats were either treated with the superoxide dismutase mimetic tempol or left untreated. During the observation period, mean blood pressure remained normotensive, whereas baroreflex sensitivity was reduced and BPV increased two to three fold. Weekly in vivo assessment of vascular function of the long posterior ciliary artery (LPCA) demonstrated a significant reduction in endothelial-dependent dilation starting three weeks after SAD surgery compared to the sham group. Endothelial-independent dilation was not affected by SAD. Structural changes were not evident in the LPCA following SAD. However, structural (wall thickness, wall area, and wall area/lumen area ratio) and functional (strain and distensibility) changes were observed in the aorta. Cardiac structural (hypertrophy) and functional (diastolic dysfunction) effects were also evident following six weeks of increased BPV. Antioxidant treatment with tempol did not have any effect on the SAD-induced increase in BPV or decrease in BRS. Nevertheless, chronic tempol treatment prevented or reduced the cardiovascular end-organ damage (endothelial-dependent vascular dysfunction, decreased aortic distensibility, cardiac and vascular hypertrophy, and cardiac dysfunction) observed in the untreated SAD group. These findings suggest that the pathology observed following SAD is at least partly mediated by oxidative stress. Antioxidant treatment in patients with increased BPV (e.g., hypertension, diabetes, heart failure) may prevent or ameliorate cardiovascular end-organ damage and reduce the overall risk for cardiovascular disease events.

<p>Cardiovascular risk in primary hyperparathyroidism (HPT) is controversial, and studies mainly from Europe associate HPT with increased cardiovascular morbidity and mortality. Cardiovascular morphology and function were evaluated prospectively in 31 consecutive HPT patients (mean serum calcium 2.97±0.04) and randomly enrolled controls matched for age and sex. Patients were re-examined at normocalcemia about one year after parathyroidectomy. </p><p>HPT patients showed an operatively reversible disturbance in endothelial vasodilatory function that seemed unrelated to an early sign of atherosclerosis, i.e. thickness of carotid artery intima-media complex. Acute hypercalcemia in healthy subjects induced a similar impairment in endothelial function, which suggests a dependence on biochemical rather than structural vascular changes in HPT. Echocardiography showed left ventricular diastolic dysfunction and supernormal systolic performance being reversed after operation. Left ventricular mass tended to be irreversibly increased. During exercise HPT patients exhibited greater rise in systolic blood pressure compared to controls and an increased number of premature ventricular beats. This indicated increased work load and a propensity for fatal cardiac events. Following surgery, an improvement with less pronounced ST-segment depression was seen. 24-hour ambulatory blood pressure monitoring showed irreversibly increased levels despite maintained diurnal rhythm, while 24-hour heart rate variability analysis displayed blunted nocturnal increase of low and very low frequency bands that was corrected postoperatively. </p><p>Parathyroidectomy seems to alleviate most of the cardiovascular disturbances in HPT, except for hypertension. This is consistent with the normalised longevity in HPT treated with parathyroidectomy and supports active treatment of HPT. </p>

Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2007.

Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

Cardiovascular risk in primary hyperparathyroidism (HPT) is controversial, and studies mainly from Europe associate HPT with increased cardiovascular morbidity and mortality. Cardiovascular morphology and function were evaluated prospectively in 31 consecutive HPT patients (mean serum calcium 2.97±0.04) and randomly enrolled controls matched for age and sex. Patients were re-examined at normocalcemia about one year after parathyroidectomy. HPT patients showed an operatively reversible disturbance in endothelial vasodilatory function that seemed unrelated to an early sign of atherosclerosis, i.e. thickness of carotid artery intima-media complex. Acute hypercalcemia in healthy subjects induced a similar impairment in endothelial function, which suggests a dependence on biochemical rather than structural vascular changes in HPT. Echocardiography showed left ventricular diastolic dysfunction and supernormal systolic performance being reversed after operation. Left ventricular mass tended to be irreversibly increased. During exercise HPT patients exhibited greater rise in systolic blood pressure compared to controls and an increased number of premature ventricular beats. This indicated increased work load and a propensity for fatal cardiac events. Following surgery, an improvement with less pronounced ST-segment depression was seen. 24-hour ambulatory blood pressure monitoring showed irreversibly increased levels despite maintained diurnal rhythm, while 24-hour heart rate variability analysis displayed blunted nocturnal increase of low and very low frequency bands that was corrected postoperatively. Parathyroidectomy seems to alleviate most of the cardiovascular disturbances in HPT, except for hypertension. This is consistent with the normalised longevity in HPT treated with parathyroidectomy and supports active treatment of HPT.

Diabetic long-term complications, despite intensive treatment, cause serious handicaps at relatively young age in diabetic patients. Diabetic nephropathy (DN) develops in up to 30% of patients with type 1 diabetes (T1D). Besides the eventual loss of kidney function, with need for dialysis treatment and transplantation, this complication also increases the risk of early death from cardiovascular disease. In addition to hyperglycaemia, the risk of developing DN is influenced by a number of life-style related factors, such as smoking and diet, but the mechanisms of action of these factors are largely unknown. The incidence of DN is not linearly related to diabetes duration. There is a peak incidence of DN at 15-20 years and this, together with results from family studies, shows that genetic factors are important contributors. Possible candidate genes are those involved in regulation of intraglomerular pressure and blood pressure, oxidative stress and inflammation. The main aims of this thesis were: ● To investigate the risk of DN associated with polymorphisms in; A) the endothelial NO-synthase gene (NOS3) and genes in the renin-angiotensin-system (RAAS) (all involved in the regulation of intraglomerular pressure). B) the manganese superoxide dismutase gene (SOD2) (involved in the regulation of oxidative stress). C) the ICAM1 gene (involved in activation and migration of lymphocytes) ● To investigate gene-smoking interactions ● To investigate the influence of normal diet on risk of microalbuminuria. The aims were addressed in different case-control settings, including 347 T1D patients from Sweden and 1163 patients from Finland, with or without DN, defined as; overt DN – having albumin excretion rate (AER) ≥200 μg/min, incipient DN – AER between 20 and 200 μg/min, non-DN controls – having AER &lt;20 μg/min and at least 20 years of diabetes duration. In one study also non-diabetic healthy individuals were included to asses the risk of T1D associated with the ICAM1 gene. Results: The RAAS genes were investigated in the Swedish sample set and there was an association between a polymorphism in the angiotensin II type 1 receptor (AGTR1) gene and overt DN, when adjusting for age, duration of diabetes, HbA1c, sex and smoking (adjusted OR=3.04, 99% CI=1.02-9.06). Also a synergistic interaction with smoking was indicated. The ICAM1 gene was investigated in the Swedish sample set, but no association with DN was found. There were, however, associations between T1D and two polymorphisms in this gene, rs281432 (OR=1.64, 95% CI=1.14-2.38) and rs5498 (OR=2.46, 95% CI=1.59-3.80). In the combined Swedish/Finnish sample set, the Glu/Glu genotype of the Glu298Asp polymorphism in the NOS3 gene was associated with DN when age at diabetes onset, duration of diabetes, HbA1c, blood pressure, sex and smoking were taken into account (adjusted OR=1.46, 95% CI=1.12-1.91). There was also association between a polymorphism in the MnSOD gene and DN in this sample set. Homozygosity for the valine-allele of the Val16Ala polymorphism was associated with increased risk of DN in a model including age at diabetes onset, duration of diabetes, HbA1c, sex and smoking (adjusted OR=1.32, 95% CI=1.00-1.74). Smoking was associated with DN (OR=2.00, 95% CI=1.60-2.50) and in the Swedish sample set there were indications of interactions between smoking and the NOS3 and SOD2 genes, but these results could not be confirmed in the Finnish sample set. A high protein intake can enhance glomerular filtration rate and accelerate progression to DN, also other dietary components such as fat, fibres, vitamins and the ratio red/white meat have been discussed as important for DN development. In a nested case-control study including young T1D patients, the normal dietary intakes of protein and other nutrients were assessed using a semiquantitative questionnaire. The results showed that T1D patients consuming more than 6.5 g fish protein (&gt;75th percentile) per day were at slightly lower risk to have microalbuminuria in both crude (OR=0.49, 95% CI=0.25-0.97) and adjusted analyses (OR=0.26, 95% CI=0.09-0.76, adjusted for age, duration of diabetes, sex, HbA1c, mean arterial pressure, BMI, region, smoking, energy intake and fish fat intake). Conclusions: The risk of having diabetic nephropathy is influenced by at least two genes controlling blood pressure and one gene protecting against oxidative stress. Smoking also increases the risk of DN and our findings indicate that smoking may accentuate the effect of the AGTR1, NOS3 and SOD2 genes. Normal dietary intake of protein was not associated with risk of having microalbuminuria in young T1D patients, on the other hand, an intake of fish protein above the 75th percentile decreased the risk of microalbuminuria.

The purpose of this investigation was to examine whether a single 10 minute bout of exercise, performed at multiple intervals throughout the day to equal 30 minutes, can effectively elicit post-exercise hypotension (PEH). Secondly, it is important to explore whether a light (40% VO2R) or moderate (70% VO2R) intensity is required to elicit PEH within 10 minutes. Subjects (N=11) completed a VO2max test utilizing the Bruce Treadmill protocol. Each subject returned within 3 – 5 days to complete two separate exercising trials. A counter balanced system was employed so that each subject did not perform the same intensity rotation (Counter Balance 1 = 40% VO2R and 70% VO2R for session 1 and session 2, respectively; Counter Balance 2 = 70% VO2R and 40% VO2R for session 1 and session 2). The first session consisted of 3 sessions (morning, noon, evening) separated by an average of 3.5 hours at one of two intensities (40% VO2R or 70% VO2R). The second group of sessions were performed identical to the first, however, the intensity was altered depending upon counter balance. Baseline BP was measured prior to exercising. After each session, BP was measured at 2 intervals for the morning and noon sessions (immediately following and 20 minutes post-exercise); and at 3 intervals for the evening sessions (60 minutes post-exercise added) for both intensities. At 40% VO2R, BP decreased significantly at the morning (p = 0.007), noon (p = 0.018) and evening (p = 0.010) sessions at the 20 minute post-exercise interval. Although not significantly different, BP was observed to be lower at 60 minutes post-exercise interval. During the 70% VO2R session, BP was significantly lower at the morning 20 minute (p = .029) and evening 60 minute post-exercise measurements (p = .006) when compared to baseline. There was no significant difference noted between 40% and 70% VO2R intensities at eliciting a drop in BP at any interval at any time point. Although not statistically significant, 70% VO2R appeared to produce a further decrease at the 60 minute post-exercise measurement (102 mmHg) than did the 40% session (106 mmHg). The results of this study indicate that PEH may be elicited after a single 10 minute exercise session. Furthermore, multiple bouts of 10 minutes produce an accumulated decrease in BP that can be observed at the completion of the day.

<p>In addition to the adverse effects of high blood pressure (HBP) on cardiovascular disease, HBP is also associated with increased risk of stroke, dementia, and neurocognitive dysfunction. Although aerobic exercise and dietary modifications have been shown to reduce blood pressure, no studies have examined the effects of a combined aerobic exercise and dietary intervention on neurocognition among individuals with HBP, a group at elevated risk for neurocognitive dysfunction. As part of a larger investigation, the ENCORE study, this study examined the effects of dietary modification alone and combined with aerobic exercise on neurocognitive function among individuals with HBP. One hundred twenty five individuals with high normal blood pressure were randomized to an aerobic exercise and dietary modification group (DASH + WM), dietary modification alone (DASH-A), or a usual care control group. Participants completed a battery of neurocognitive tests assessing executive function and vigilance at baseline and again following the four month intervention. Following the intervention, participants in the DASH + WM and DASH-A groups exhibited modest improvements in neurocognitive function relative to controls, and these changes appeared to be mediated by improved cardiovascular fitness and weight loss. A combined aerobic exercise and dietary intervention improves neurocognitive function among individuals with HBP.</p> / Dissertation