Evidências epidemiológicas tem sugerido que a desnutrição intra-uterina pode ter papel importante no desenvolvimento de hipertensão arterial na fase adulta. No presente trabalho, foi estudada a influência da desnutrição intra-uterina na reatividade vascular e na pressão arterial de animais Wistar e SHR (ambos os sexos). Para tanto, ratas prenhes foram submetidas à restrição alimentar equivalente a 50% da dieta normal, durante toda a gestação. Curvas concentração-efeito à noradrenalina (NA), acetilcolina (ACh) e ao nitroprussiato de sódio (NPS) foram realizadas em anéis de aorta de ratos Wistar e SHR nutridos e desnutridos (ambos os sexos). A desnutrição intra-uterina elevou a pressão arterial em animais Wistar, machos e fêmeas, até níveis considerados de hipertensão. Além disso, acarretou alterações da reatividade à NA e à ACh, mas não ao NPS. Em animais SHR, de ambos os sexos, os efeitos deletérios da desnutrição intra-uterina foram capazes de exacerbar a hipertensão e a disfunção endotelial já existentes nesses animais. / Epidemiological studies suggest that intrauterine undernutrition can play an important role in the development of arterial hypertension in adulthood (FERRARI et al., 2000). Furthermore, maternal malnutrition during organ developmental stage impairs fetal growth and is believed to alter permanently the metabolism and physiology of the developing tissues. The aim of the present study was to examine the effects of intrauterine undernutrition in the arterial blood and vascular reactivity pressure of male and female normotensive (Wistar) and spontaneously hypertensive (SHR) rats offspring. Female pregnant rats (Wistar and SHR) were fed either normal or 50% of the normal intake diets, during the whole gestational period. Arterial blood pressure and the norepinephrine (NE), acetylcholine (ACh) and sodium nitroprusside (SNP) dose-response curves in isolated aortic rings of their offspring (male and female – when they reached adulthood) were determined. In Wistar rats, the intrauterine undernutrition induced an increase in the arterial blood pressure, leading to hypertension. Dietary restriction during pregnancy of Wistar rats altered the vascular reactivity to NE and ACh, whereas the response to SNP remained unaltered in the offspring. In the SHR offspring (male and female) the intrauterine undernutrition exacerbates the already existing hypertension and endothelial dysfunction. In summary, this study has shown that intrauterine undernutrition increased the arterial blood pressure and altered the vascular reactivity of male and female normotensive and SHR offspring.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In this paper, we propose a technological solution integrated to a wearable device that allows measuring some physiological variables such as body mass index (BMI), steps walked in a determined day, burned calories, blood pressure and other risk factors associated with the Framingham´s score. The objective of this article is to identify the evolutionary pattern of the Framingham’s score each day in order to determine a presumptive diagnosis of high blood pressure. The technological solution was validated in the social insurance of a public hospital in Lima, Perú. The preliminary results obtained in a diagnostic test show a sensitivity level of 83.33%, a level of precision better than a traditional Framingham´s score for presumptive diagnosis of high blood pressure. Our proposal contributes to the patient’s awareness about the bad routine habits related to lifestyle and promotes the empowerment of data in order to make some changes that influence on the reduction of cardiovascular disease risk. / Revisión por pares

The aim of this diploma thesis was to get familiar with methods to generate surrogates and how to apply them on cardiovascular signals. The first part of this diploma thesis describes the basic theory of baroreflex function and methods to generate surrogate data. Surrogate data were generated from data, acquired from the database, by using three different methods. In the next part of this diploma thesis, coherence significance between blood pressure and heart intervals was calculated by using surrogates. In the end two hypotheses were defined and tested by which it was detected whether the orthostatic change of the measurement position has effect on the causal coherence change and baroreflex function.

An educational module, based on evidence-based practice (EBP) guidelines by the 8th Joint National Committee (JNC 8) and the American College of Cardiology (ACC), was created and implemented to determine if its implementation would impact the knowledge of clinic staff regarding current EBP guidelines about self-management of hypertension (HTN). The module has the potential to contribute to the resolution of patient noncompliance on HTN treatment and management by increasing nursing staff proficiency in knowledge transfer to patients on effective self-management of their health condition. The creation of the module was guided by the concept of need or asset assessment and the theory of planned behavior. The module was composed of 2 short lecture presentations on HTN, current EBP guidelines on lifestyle modifications, and proper blood pressure measurement. The module also included pre- and postlecture surveys to evaluate knowledge and practices of staff, and reiterated the current guidelines and approaches presented in the lectures. Survey data were analyzed using McNemar’s test for paired and binary data. Results showed the agreement of all the staff in recognizing the utility of the module in standardizing their knowledge of current EBP guidelines on lifestyle modifications and blood pressure measurement procedures. The results also showed the enhancement of staff proficiency which might lead to efficient education of patients on effective HTN treatment and management protocol. This pathway has the potential to bring about social change by decreasing the incidence of patient noncompliance and improving patient health.

MPH / Department of Public Health / High blood pressure is a global public health problem. High blood pressure shows no signs or symptoms and it can only be detected through BP measurements by a health professionals. It’s a chronic condition which requires long term management. Poor control of high blood pressure can lead to complications and even death. The aim of the study was to determine the prevalence of high blood pressure among University of Venda academic staff. UNIVEN is situated in Thohoyandou, Vhembe District in Limpopo. A cross-sectional design was used. A modified WHO stepwise questionnaire for non-communicable diseases version 3.1 was used to collect data regarding demographic characteristics, BP status, and stress and lifestyle characteristics. Charts and graphs were used to present the results of the study. The Statistical Package of Social Sciences was used to analyse data. The Chi-square test was used to determine the association between blood pressure and risk factors. A total of 179 respondents were selected, their ages of were ranged from 22 to 68 years. Their blood pressure, weight and height of the participants were also measured. The prevalence of high blood pressure was 20%, while 46% were on prehypertension stage and about 34% had a normal BP. About 23% had been previously diagnosed with HBP, while about 90% were on treatment for high blood pressure. Only 13% had their BP under control. The prevalence of high blood pressure was associated with gender, family history, vegetable intake and diabetes. Department of Sports need to introduce sports among academic staff as a way of prevention and management of high blood pressure.

<p>Obesity has ascended to become the primary modifiable cause of death in the United States. New evidence has called into question the utility of BMI – the typical index of obesity – in predicting cardiometabolic disturbances. The distribution of body fatness may be just as important as the total quantity. Intermuscular adipose tissue (IMAT) has emerged as a distinct subset of adipose in skeletal muscle that may be particularly metabolically deleterious. Typically, sections of either the calf or thigh are used as proxy measurements for whole-body IMAT in investigations. However, IMAT dispersion may not be consistent across tissues, instead infiltrating specific muscle or muscle compartments, and these have may have different metabolic consequences. The study described in Chapter 2 was designed to address this possibility and investigate and compare associations among thigh and calf IMAT stores with indices of cardiometabolic health. The strength of the relationship between IMAT and glucose control-related indices of cardiometabolic health was dependent upon anatomic location. Specifically, thigh IMAT is a better predictor of cardiometabolic risk that calf IMAT. </p> <p>Skeletal muscle has gained increased recognition in recent years for its importance in promotion of health and wellness throughout the life course. While treatment models addressing issues of declining muscle mass and strength with age previously focused on older adults, the importance of utilizing a life course model to promote skeletal muscle health at all ages was more recently recognized. There is consistent evidence that higher-protein diets modestly improve body composition. However, women are at greater risk for not meeting protein requirements and seem to be less willing to adopt strategies to achieve greater protein intake, such as protein supplementation, for fear that it may cause ‘bulkiness’. Therefore, the study described in Chapter 3 was designed to critically evaluate the effect of whey protein supplementation on body composition changes in women via a systematic review & meta-analysis of published randomized controlled trials. It was hypothesized that whey protein supplementation would moderately improve body composition but would not cause excessive muscle hypertrophy. Consistent with our hypothesis, whey protein supplementation improved body composition by modestly (<1%) increasing lean mass, without influencing fat mass.</p> <p>Dietary protein and skeletal muscle are conceptually inseparable; protein is often only considered in terms of how it impacts skeletal muscle-related outcomes. However, it is of interest to determine if the proposed beneficial effects of increased dietary protein consumption extend beyond skeletal muscle. Consumption of higher protein diets result in lower resting blood pressure, but the potential for protein to attenuate acute exercise blood pressure responses is unclear. The study described in Chapter 4 was designed to investigate the effects of meals with different amounts of protein on blood pressure responses to exercise in a randomized, cross-over trial. We hypothesized that consuming the higher-protein meal would attenuate the blood pressure responses to exercise and result in a more robust post-exercise hypotensive response. Contrary to our hypothesis, a higher-protein meal does not attenuate exercise-induced blood pressure responses compared to a lower-protein meal. These findings build upon previous research suggesting that the beneficial effect of chronically elevated protein intake on blood pressure is typically not observed in an acute setting by extending these findings to encompass blood pressure responses to acute responses to exercise.</p> <p>The three studies packaged herein utilize different techniques and report on different outcomes, but conceptual threads unite these works which augment the collective findings. Future researchers investigating the effects of protein on skeletal muscle anabolism can: 1) learn of the importance of proper reflection on surrogate measures and potential for anatomic-specific effects from the IMAT findings (Chapter 2), 2) appreciate the relevance of energy and training states in modulating responses from the WP meta-analysis (Chapter 3), and 3) recognize the importance of holistic approaches and employing challenges to reveal heterogeneity from the protein and BP trial (Chapter 4). Taken together, the research presented in this dissertation forwards our understanding of the relations and effects of dietary protein with different components of body composition on cardiometabolic health. </p>

Traumatic damage to the cervical spinal cord has a dramatic impact on determinants affecting cardiovascular fitness. In tetraplegia, in addition to diminished skeletal muscle function, impaired sympathetic cardiovascular innervation together with a dysfunction of catecholamine release is typically present. Individuals with tetraplegia are at a high risk of long-term inactivity, which increasingly contributes to the development of common civilization diseases. The aim of the current dissertation project is to investigate the cardiovascular fitness in males with cervical spinal cord injury (n=20) as compared to able- bodied males (n=27). Both groups completed exercise testing on an arm-crank ergometer. Arterial blood pressure response to exercise, peak oxygen consumption and peak heart rate were the primary outcome variables. In the first part of the study, a graded maximal arm- crank ergometer test to the subjective exhaustion was performed for the inter-group peak exercise comparison. The peak power dramatically differs between the groups and could be an important confounding factor limiting the evaluation of a physiologic response related to the equivalent physical loading. Therefore, in the second part of the study, individuals of the control group completed a second graded arm-crank ergometer...

Introduction: L’hypothèse de l’architecture génétique commune de phénotypes d’adiposité et de pression artérielle a été testée chez les adolescents par Melka et al. (Journal of Clinical Endocrinology & Metabolism, 2012) qui ont identifié cinq variants associés à l’indice de masse corporelle, rs16933812 (PAX5), rs7638110 (MRPS22), rs9930333 (FTO), rs7120548 (MTCH2) et rs17773430 (MC4R), dont trois (PAX5, MRPS22 et FTO) l’était aussi avec la pression artérielle systolique. Objectif : Investiguer si les associations entre les cinq variants et l’adiposité et la pression artérielle sont répliquées dans une population d’âge et de situation géographique similaire. Méthodes: Les données proviennent de l’étude Nicotine Dependence In Teens, une étude longitudinale d’adolescents suivis à partir de 12 ans. L’ADN de 713 adolescents d’ascendance européenne a été génotypé et des mesures anthropométriques et de pression artérielle ont été effectuées lorsqu’ils avaient en moyenne 13, 15, 17 et 24 ans. Les associations entre les cinq variants avec l’indice de masse corporelle et la pression artérielle systolique ont été estimées à l’aide de modèles linéaires mixtes. Résultats: Les associations des variants sur les gènes FTO et MTCH2 avec l’indice de masse corporelle ont été répliquées, mais pas celles correspondantes aux variants sur MRPS22, PAX5 et MC4R. Aucune des associations avec la pression artérielle systolique n’a été répliquée. Conclusion: Les facteurs proposés pour expliquer la réplication partielle des résultats comprennent une différence de structure génétique entre les populations étudiées, une définition différente du phénotype de pression artérielle et la surestimation de certains effets estimés dans Melka et al. / Introduction : Melka et al. (Journal of Clinical Endocrinology & Metabolism, 2012) tested the hypothesis that adiposity and blood pressure share a common genetic architecture in adolescents. They identified five single nucleotide variants, rs16933812 (PAX5), rs7638110 (MRPS22), rs9930333 (FTO), rs7120548 (MTCH2) and rs17773430 (MC4R), associated with body mass index, three of which (MRPS22, PAX and FTO) were also associated with systolic blood pressure. Objective: To investigate if the reported associations between the five variants and adiposity and blood pressure can be replicated in a population similar in age and geographical situation. Methods: Data were drawn from the Nicotine Dependence In Teens study, a longitudinal study of adolescents followed-up from 12 years old. The DNA of 713 adolescents of European ancestry was genotyped and anthropometric and systolic blood pressure measurements were taken at age 13, 15, 17 and 24 on average. The associations between the five variants and both body mass index and systolic blood pressure were estimated using linear mixed models. Results: We replicated the associations of variants at genes FTO and MTCH2 with body mass index, but not those corresponding to MRPS22, PAX or MC4R. Further, none of the associations with systolic blood pressure were replicated. Conclusion: Explanations for the partial replication of results include differences in genetic structures across study populations, different definitions of the blood pressure phenotype and the overestimation of specific effects initially estimated by Melka et al.

The purpose of this study was to investigate the effect of hand-weights and exaggerated arm swing on heart rate, blood pressure, and ratings of perceived exertion during submaximal walking. Twenty middle-aged (40- 59 years) female volunteers were given four submaximal treadmill tests at 3.0 mph and 0 grade. The four treatment conditions were as follows: 1) walking with unexaggerated arm swing (AS); 2) walking with unexaggerated arm swing with hand-held weights (ASHW); 3) walking with exaggerated arm swing (EAS), and 4) walking with exaggerated arm swing with hand-held weights (EASHW). The testing sequence was randomized and a minimum of 48 hr was given between tests.

The present study evaluated the utility of heart rhythm coherence (HRC) feedback to reduce the reported pain intensity of patients enrolled in a multimodal pain management program. Participants were recruited and assigned to a usual treatment group (UT) or a heart rhythm coherence feedback group (UT+HRC). It was hypothesized that UT+HRC participants who achieved heart rhythm coherence would report a reduction of pain intensity, as measured by the McGill Pain Inventory. For those whose pain intensity decreased, it was also expected that their self reported levels of depression as measured by the Beck Depression Inventory-Second Edition and state anger as measured by the State Trait Anger Inventory would decrease. It is also hypothesized that with a reduction in pain levels, anger, and depression, blood pressure would also decrease among those who had high blood pressure prior to the intervention. Multivariate analyses of variance (MANOVA) were used to investigate the relationship between treatment condition, coherence status and pain levels. A series of independent t-tests were utilized to investigate the change in pain, depression, and state anger from baseline to posttest, followed by Pearson product moment correlation coefficients on difference scores to understand the relationship between the outcome variables for Hypothesis 2. Standard multiple regression analyses were computed using difference scores to determine if the outcome measures were significant predictors of systolic blood pressure and diastolic blood pressure. Results indicated a failure to reject the null with regard to hypothesis one. No relationship between treatment assignment, coherence status or pain levels were found. Hypothesis 2 was partially supported. Although there was a positive significant relationship between depression and anger when utilizing difference scores, these affective measures were not related to difference scores on either pain measure. In regard to Hypothesis 3, there was also a failure to reject the null. None of the outcome measures utilized in this study emerged as being significantly related to changes in systolic or diastolic blood pressure. Limitations of the study and implications for future research are offered.