Motivation Hypertension is a pertinent health problem for urban black African men (hereafter referred to as African). Sympathetic hyperactivity and a dominant α-adrenergic response pattern have both been implicated as contributing factors to their poor cardiovascular health. In addition to the deleterious effect of neurogenic hypertension on target organs, sympathetic hyperactivity may promote the accelerated progression of left ventricular hypertrophy and structural vascular disease. Aim The overarching aim of this study is to scrutinize autonomic control of the cardiovascular system in a cohort of urban African and Caucasian men during a mental challenge. Associations were investigated between potential sympatho-vagal imbalance, blood pressure and target organ damage markers to determine cardiovascular risk in ethnic male groups. Methodology The SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study involved the participation of 200 male teachers (99 African and 101 Caucasian) in the Kenneth Kaunda Education District of the North-West Province, South Africa. Of the participant group, HIV-infected (13 African) and clinically confirmed diabetics (1 Caucasian and 6 African men) were excluded from further analyses. Stratification was based on ethnicity and further as indicated through statistical interaction effects. Cardiovascular and autonomic responses were assessed during rest and on stressor exposure (cold pressor test and Stroop colour-word conflict test). Autonomic measures included baroreceptor sensitivity (BRS), 3-methoxy-4-hydroxy-phenylglycol (MHPG) and nitric oxide metabolite (NOx) levels. Cardiovascular variables consisted of blood pressure, cardiac output, stroke volume, total peripheral resistance, heart rate, arterial compliance and ST-segment from the 12-lead electrocardiogram. Markers of target organ damage included the Cornell product (indication of left ventricular hypertrophy) and carotid intima-media thickness as indication of structural vascular disease. Means and proportions were compared by means of standard t-test and Chi-square test, respectively. Significant differences of mean cardiovascular and autonomic measures between ethnic male groups were also determined through analysis of covariance. Uni- and multivariate regression analyses were employed to demonstrate associations between target organ damage, cardiovascular and autonomic markers. Results and conclusion of each manuscript To assess autonomic nervous system and cardiovascular function as well as target organ damage, we clearly focussed on responses where our participants were challenged. Markers of autonomic responses assessed were baroreceptor sensitivity, 3-methoxy-4-hydroxyphenylglycol and nitric oxide metabolites.  The first manuscript (Chapter 2) focused on left ventricular hypertrophy as marker of target organ damage, blood pressure and baroreceptor sensitivity as marker of autonomic function. The objective was to determine whether BRS was significantly lower in African men than in the Caucasian men. Furthermore, the possible association between attenuation of BRS and increased levels of ambulatory blood pressure as well as left ventricular hypertrophy was investigated in these population groups. Results revealed that the African men had significantly lower BRS stress responses. This attenuated BRS profile was coupled with dominant α-adrenergic response patterns, which was associated with an elevation of ambulatory blood pressure. BRS attenuation (rest and stress response) was not associated with left ventricular hypertrophy. It was concluded that lower BRS, especially during stress, may pose a significant health threat for urban African men regarding the development or promotion of α-adrenergic-driven hypertension and higher cardiovascular disease risk.  The aim of the second sub-study (Chapter 3) was to investigate possible associations between structural vascular disease (carotid intima-media thickness as marker), autonomic function (MHPG as marker) and nocturnal blood pressure in the African and Caucasian men. Results showed a higher prevalence of nocturnal hypertension in the African men, with night-time blood pressure significantly higher compared to the Caucasian men. In the African and Caucasian men, carotid intima-media thickness was linearly predicted by nocturnal systolic and diastolic blood pressure respectively. In conclusion, no associations were demonstrated between MHPG and carotid intimamedia thickness or between MHPG and nocturnal blood pressure. Elevated nocturnal blood pressure evidently seems to promote structural vascular disease in this cohort of urban African and Caucasian men.  The aim of the third manuscript presented in Chapter 4, was to investigate bioavailability of NO during mental challenge (autonomic function marker) and the possible association with structural vascular disease (carotid intima-media thickness as marker). In the African men, an attenuated NOx response was demonstrated to the Stroop colour-word conflict test. After stratification into high and low NOx response groups, in the African men with a low NOx response enhanced α-adrenergic with significant STsegment depression responses was demonstrated indicating reduced myocardial oxygen supply during mental stressor exposure. Only in the African men, a ST-segment depression was significantly associated with structural vascular disease. It was concluded that the African men demonstrated a vulnerable cardiovascular profile. In this cohort of African men, the significant association between structural vascular disease and myocardial ischemia may particularly indicate a possible higher risk for future cardiovascular events. General conclusion Through the assessment of autonomic and cardiovascular responses a possible higher cardiovascular risk was demonstrated in the African men. In this cohort sympathetic hyperactivity was evident, coupled with dominant vascular response patterns and reduced myocardial oxygen supply during mental stress exposure. Based on these findings, this population group’s risk for accelerated target organ damage, as well as for future cardiovascular events, appear significantly higher than those of the Caucasian male cohort. / Thesis (PhD (Physiology))--North-West University, Potchefstroom Campus, 2013.

Motivation Hypertension is a pertinent health problem for urban black African men (hereafter referred to as African). Sympathetic hyperactivity and a dominant α-adrenergic response pattern have both been implicated as contributing factors to their poor cardiovascular health. In addition to the deleterious effect of neurogenic hypertension on target organs, sympathetic hyperactivity may promote the accelerated progression of left ventricular hypertrophy and structural vascular disease. Aim The overarching aim of this study is to scrutinize autonomic control of the cardiovascular system in a cohort of urban African and Caucasian men during a mental challenge. Associations were investigated between potential sympatho-vagal imbalance, blood pressure and target organ damage markers to determine cardiovascular risk in ethnic male groups. Methodology The SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study involved the participation of 200 male teachers (99 African and 101 Caucasian) in the Kenneth Kaunda Education District of the North-West Province, South Africa. Of the participant group, HIV-infected (13 African) and clinically confirmed diabetics (1 Caucasian and 6 African men) were excluded from further analyses. Stratification was based on ethnicity and further as indicated through statistical interaction effects. Cardiovascular and autonomic responses were assessed during rest and on stressor exposure (cold pressor test and Stroop colour-word conflict test). Autonomic measures included baroreceptor sensitivity (BRS), 3-methoxy-4-hydroxy-phenylglycol (MHPG) and nitric oxide metabolite (NOx) levels. Cardiovascular variables consisted of blood pressure, cardiac output, stroke volume, total peripheral resistance, heart rate, arterial compliance and ST-segment from the 12-lead electrocardiogram. Markers of target organ damage included the Cornell product (indication of left ventricular hypertrophy) and carotid intima-media thickness as indication of structural vascular disease. Means and proportions were compared by means of standard t-test and Chi-square test, respectively. Significant differences of mean cardiovascular and autonomic measures between ethnic male groups were also determined through analysis of covariance. Uni- and multivariate regression analyses were employed to demonstrate associations between target organ damage, cardiovascular and autonomic markers. Results and conclusion of each manuscript To assess autonomic nervous system and cardiovascular function as well as target organ damage, we clearly focussed on responses where our participants were challenged. Markers of autonomic responses assessed were baroreceptor sensitivity, 3-methoxy-4-hydroxyphenylglycol and nitric oxide metabolites.  The first manuscript (Chapter 2) focused on left ventricular hypertrophy as marker of target organ damage, blood pressure and baroreceptor sensitivity as marker of autonomic function. The objective was to determine whether BRS was significantly lower in African men than in the Caucasian men. Furthermore, the possible association between attenuation of BRS and increased levels of ambulatory blood pressure as well as left ventricular hypertrophy was investigated in these population groups. Results revealed that the African men had significantly lower BRS stress responses. This attenuated BRS profile was coupled with dominant α-adrenergic response patterns, which was associated with an elevation of ambulatory blood pressure. BRS attenuation (rest and stress response) was not associated with left ventricular hypertrophy. It was concluded that lower BRS, especially during stress, may pose a significant health threat for urban African men regarding the development or promotion of α-adrenergic-driven hypertension and higher cardiovascular disease risk.  The aim of the second sub-study (Chapter 3) was to investigate possible associations between structural vascular disease (carotid intima-media thickness as marker), autonomic function (MHPG as marker) and nocturnal blood pressure in the African and Caucasian men. Results showed a higher prevalence of nocturnal hypertension in the African men, with night-time blood pressure significantly higher compared to the Caucasian men. In the African and Caucasian men, carotid intima-media thickness was linearly predicted by nocturnal systolic and diastolic blood pressure respectively. In conclusion, no associations were demonstrated between MHPG and carotid intimamedia thickness or between MHPG and nocturnal blood pressure. Elevated nocturnal blood pressure evidently seems to promote structural vascular disease in this cohort of urban African and Caucasian men.  The aim of the third manuscript presented in Chapter 4, was to investigate bioavailability of NO during mental challenge (autonomic function marker) and the possible association with structural vascular disease (carotid intima-media thickness as marker). In the African men, an attenuated NOx response was demonstrated to the Stroop colour-word conflict test. After stratification into high and low NOx response groups, in the African men with a low NOx response enhanced α-adrenergic with significant STsegment depression responses was demonstrated indicating reduced myocardial oxygen supply during mental stressor exposure. Only in the African men, a ST-segment depression was significantly associated with structural vascular disease. It was concluded that the African men demonstrated a vulnerable cardiovascular profile. In this cohort of African men, the significant association between structural vascular disease and myocardial ischemia may particularly indicate a possible higher risk for future cardiovascular events. General conclusion Through the assessment of autonomic and cardiovascular responses a possible higher cardiovascular risk was demonstrated in the African men. In this cohort sympathetic hyperactivity was evident, coupled with dominant vascular response patterns and reduced myocardial oxygen supply during mental stress exposure. Based on these findings, this population group’s risk for accelerated target organ damage, as well as for future cardiovascular events, appear significantly higher than those of the Caucasian male cohort. / Thesis (PhD (Physiology))--North-West University, Potchefstroom Campus, 2013.

The potential to track changes in training status and fitness levels of especially team sport participants by making use of more time efficient and accessible methods such as heart rate variability (HRV) and heart rate recovery (HRR) cannot be overlooked and needs to be considered. However, studies that have investigated this aspect in team sport participants are scarce. It is against this background that the main objectives of this study were firstly, to determine the relationships between HRV and HRR as well as the fitness levels of a cohort of university-level rugby players. The second objective was to determine the validity of the BioForce Heart Rate Variability System to determine the HRV of a cohort of university-level rugby players. Twenty-four university-level rugby players (age: 20.1 ± 0.41 years; body stature: 182.7 ± 6.2 cm; body mass: 89.7 ± 12.7 kg) of a South African university’s Rugby Institute participated in the first part of the study. During the test day players’ fasting baseline HRV (baseline HRV) values were taken. This was followed by the measurement of the post-breakfast HRV (Pre-Yo-Yo IR1 HRV). Players were then required to perform the Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IR1) while they were fitted with a portable Cosmed K4b2 gas analyser apparatus and a Fix Polar Heart Rate Transmitter Belt. After completion of the test, HRR was taken on 1 and 3 minutes and followed by the measurement of HRV (Post-Yo-Yo IR1 HRV). For the second part of the study a group of twenty u/21 university-level rugby players (age: 20.06 ± 0.40 years; body stature: 181.8 ± 5.5 cm; body mass: 91.1 ± 10.7 kg) of a South African university’s Rugby Institute were recruited to participate in this study. HRV was measured simultaneously by the Actiheart monitor system as well as the BioForce Heart Rate Variability System over three times periods: during the morning in a fasting state just after players had woken up (baseline); in the morning just after the players ate breakfast (pre-anaerobic); after completion of a high-intensity anaerobic training session (post-anaerobic) and after completion of a 20 min recovery session (post-recovery). Significant correlations (p ≤ 0.05) were found between Pre-Yo-Yo IR1 HRV and heart rate (HR) at the respiratory compensation point (RCP-HR (bpm)) (r = -0.468) as well as oxygen uptake at the RCP (RCP- 2max VO (% of 2max VO )) (r = 0.476), respectively. A forward stepwise regression analysis showed that HR at ventilatory threshold 1 (VT1-HR (bpm)) contributed significantly (p ≤ 0.05) to the post-Yo-Yo IR1 HRV with a variance of 39.8%. Final Yo-Yo IR1 level also contributed significantly (p ≤ 0.05) to 3 minute post-Yo-Yo IR1 HRR with a variance of 16.5%. For the second part of the study the majority of significant relationships (p < 0.05) between the Actiheart and Bioforce obtained HRV results were observed for the post-recovery period (Mean RR, SDNN, RMSSD and Peak LF power), followed by the pre-anaerobic period (Mean R-R and SDNN) and the baseline period (LF:HF ratio). No significant relationships were observed between the HRV results of the two apparatuses during the post-anaerobic period. In conclusion, HRV and HRR may have the potential to act as affordable and easy measurement tools of team sport participants’ fitness levels. However, the study results suggested that the BioForce Heart Rate Variability System that is used to obtain team sport participants’ HRV is especially valid to determine HRV after recovery periods that follow hard training sessions. The results do however cast a shadow of doubt over the accuracy of this apparatus when used directly after hard training sessions. / MSc (Sport Science), North-West University, Potchefstroom Campus, 2014

The potential to track changes in training status and fitness levels of especially team sport participants by making use of more time efficient and accessible methods such as heart rate variability (HRV) and heart rate recovery (HRR) cannot be overlooked and needs to be considered. However, studies that have investigated this aspect in team sport participants are scarce. It is against this background that the main objectives of this study were firstly, to determine the relationships between HRV and HRR as well as the fitness levels of a cohort of university-level rugby players. The second objective was to determine the validity of the BioForce Heart Rate Variability System to determine the HRV of a cohort of university-level rugby players. Twenty-four university-level rugby players (age: 20.1 ± 0.41 years; body stature: 182.7 ± 6.2 cm; body mass: 89.7 ± 12.7 kg) of a South African university’s Rugby Institute participated in the first part of the study. During the test day players’ fasting baseline HRV (baseline HRV) values were taken. This was followed by the measurement of the post-breakfast HRV (Pre-Yo-Yo IR1 HRV). Players were then required to perform the Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IR1) while they were fitted with a portable Cosmed K4b2 gas analyser apparatus and a Fix Polar Heart Rate Transmitter Belt. After completion of the test, HRR was taken on 1 and 3 minutes and followed by the measurement of HRV (Post-Yo-Yo IR1 HRV). For the second part of the study a group of twenty u/21 university-level rugby players (age: 20.06 ± 0.40 years; body stature: 181.8 ± 5.5 cm; body mass: 91.1 ± 10.7 kg) of a South African university’s Rugby Institute were recruited to participate in this study. HRV was measured simultaneously by the Actiheart monitor system as well as the BioForce Heart Rate Variability System over three times periods: during the morning in a fasting state just after players had woken up (baseline); in the morning just after the players ate breakfast (pre-anaerobic); after completion of a high-intensity anaerobic training session (post-anaerobic) and after completion of a 20 min recovery session (post-recovery). Significant correlations (p ≤ 0.05) were found between Pre-Yo-Yo IR1 HRV and heart rate (HR) at the respiratory compensation point (RCP-HR (bpm)) (r = -0.468) as well as oxygen uptake at the RCP (RCP- 2max VO (% of 2max VO )) (r = 0.476), respectively. A forward stepwise regression analysis showed that HR at ventilatory threshold 1 (VT1-HR (bpm)) contributed significantly (p ≤ 0.05) to the post-Yo-Yo IR1 HRV with a variance of 39.8%. Final Yo-Yo IR1 level also contributed significantly (p ≤ 0.05) to 3 minute post-Yo-Yo IR1 HRR with a variance of 16.5%. For the second part of the study the majority of significant relationships (p < 0.05) between the Actiheart and Bioforce obtained HRV results were observed for the post-recovery period (Mean RR, SDNN, RMSSD and Peak LF power), followed by the pre-anaerobic period (Mean R-R and SDNN) and the baseline period (LF:HF ratio). No significant relationships were observed between the HRV results of the two apparatuses during the post-anaerobic period. In conclusion, HRV and HRR may have the potential to act as affordable and easy measurement tools of team sport participants’ fitness levels. However, the study results suggested that the BioForce Heart Rate Variability System that is used to obtain team sport participants’ HRV is especially valid to determine HRV after recovery periods that follow hard training sessions. The results do however cast a shadow of doubt over the accuracy of this apparatus when used directly after hard training sessions. / MSc (Sport Science), North-West University, Potchefstroom Campus, 2014