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    Blood Pressure Variability: Relationship with Endothelial Health and Effects of an Exercise Training Intervention

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    Genre
    Thesis/Dissertation
    Date
    2012
    Author
    Diaz, Keith M.
    Advisor
    Brown, Michael D.
    Committee member
    Gadegbeku, Crystal
    Komaroff, Eugene
    Kendrick, Zebulon V.
    Crabbe, Deborah
    Department
    Kinesiology
    Subject
    Kinesiology
    Health Sciences
    Public Health
    Blood Pressure Variability
    Endothelial Microparticles
    Endothelium
    Exercise
    Flow Mediated Dilation
    Smooth Muscle
    Permanent link to this record
    http://hdl.handle.net/20.500.12613/1093
    
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    DOI
    http://dx.doi.org/10.34944/dspace/1075
    Abstract
    Purpose: Evidence has accumulated to show that blood pressure variability (BPV) has a striking relationship with cardiovascular (CV) risk. Despite the mounting evidence implicating BPV as a CV risk factor, scant attention has been paid to: (1) the mechanisms by which high BPV confers greater CV risk; and (2) the efficacy of non-pharmacologic treatment modalities in the attenuation of BPV. In order to address these two unresolved questions, the purpose of this dissertation was twofold. The purpose of study #1 was to investigate the association between measures of short-term BPV (24-hour BPV) and long-term BPV (visit-to-visit BPV) with markers of endothelial health in a cohort of African Americans in order to determine if increased BPV may confer greater CV risk by eliciting injury to the endothelium. The purpose of study #2 was to investigate the effects of a 6-month aerobic exercise training (AEXT) intervention on visit-to-visit BPV and 24-hour BPV in the same cohort of African Americans in order to provide the first available data on the efficacy of a non-pharmacologic treatment modality in the lowering of BPV. Methods: We recruited 72 African Americans who were sedentary, non-diabetic, non-smoking, and free of CV and renal disease. Before and after a 6-month AEXT intervention, office blood pressure (BP) was measured at 3 separate visits and 24-hour ambulatory BP monitoring (ABPM) was conducted to measure visit-to-visit BPV and 24-hour BPV, respectively. Right brachial artery diameter was assessed at rest, during flow-mediated dilation (FMD), and after nitroglycerin-mediated dilation (NMD). Peak and area under the curve (AUC) were calculated as measures of FMD and NMD, and the FMD/NMD ratio was calculated as a measure of endothelial function normalized by smooth muscle function. Fasted blood samples were obtained and were analyzed for circulating EMPs expressed as CD31+CD42- and CD62E+ EMPs. Results: In study #1, participants with higher 24-hour diastolic BPV (DBPV) had significantly lower CD31+CD42- EMPs compared to participants with lower 24-hour DBPV. When categorized according to visit-to-visit DBPV, participants with higher visit-to-visit DBPV had a significantly lower FMD/NMD ratio, and significantly higher %NMDpeak and NMDAUCs compared to participants with lower visit-to-visit DBPV. When analyzed as continuous variables, 24-hour mean arterial pressure variability (MAPV) was inversely associated with CD31+CD42- EMPs visit-to-visit DBPV was inversely associated with the FMD/NMD ratio and positively associated with %NMDpeak and NMDAUC; and 24-hour DBPV was positively associated with NMDAUC. All associations were independent of age, gender, BMI, mean BP, and pulse pressure. In study #2 investigating the effects of AEXT in 33 participants who completed the study, 24-hour DBPV and 24-hour MAPV were significantly increased after AEXT. The increase in 24-hour DBPV was independent of changes in BMI, mean BP, and self-reported sleep time. Heart rate variability (HRV) derived from ABPM was associated with the changes in 24-hour DBPV and 24-hour MAPV. There were no significant changes in visit-to-visit BPV after AEXT. Conclusions: The results from study #1 provide evidence that BPV is associated with vascular health as endothelial function was decreased in participants with high visit-to-visit DBPV, while smooth muscle function was increased in participants with higher visit-to-visit and 24-hour DBPV. The findings from study #2 show that 6-months of AEXT do not elicit beneficial changes in BPV. The finding of an association between changes in 24-hour BPV with HRV could indicate, however, that changes in activity levels during ABPM, in part, contributed to the observed changes in 24-hour BPV.
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