Effect of a Physiological Insulin Infusion on the Cardiovascular Responses to a High Fat Meal: Evidence Supporting a Role for Insulin in Modulating Postprandial Cardiovascular Homoeostasis in Man

1996 ◽  
Vol 91 (4) ◽  
pp. 415-423 ◽  
Author(s):  
M. T. Kearney ◽  
A. J. Cowley ◽  
T. A. Stubbs ◽  
I. A. MacDonald
Keyword(s):  
Blood Pressure ◽  
Skeletal Muscle ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Mesenteric Artery ◽  
Insulin Infusion ◽  
High Fat ◽  
High Carbohydrate ◽  
Meal Ingestion ◽  
Fat Meal

1. While the haemodynamic adjustments occurring after meal ingestion and the different effects of meals of different composition on these changes are well established, the mechanisms underlying these changes are less clear. Insulin, which has been shown to be both a positive inotrope and to stimulate vasodilatation in the skeletal muscle vascular bed, may account for the different cardiac and regional haemodynamic responses to high fat and high carbohydrate meals. 2. This study assessed the effect of an insulin infusion reproducing the plasma insulin profile seen after a high carbohydrate meal on the cardiovascular and regional haemodynamic response to a high fat meal. All measurements were carried out non-invasively in nine healthy lean subjects (mean age 24.5 ± 1.3 years). 3. The high fat meal resulted in increases in cardiac output (0.7 ± 0.321/min, P < 0.001), heart rate (7.8 ± 2.1 beats/min, P < 0.001) and insulin (25.1 ± 4.2 m-units/l, P < 0.001), and a decline in systemic vascular resistance (−1.9 ± 0.9 units, P < 0.05) and superior mesenteric artery vascular resistance (− 45 ± 9 units, P < 0.01). After the high fat meal alone, calf vascular resistance and blood pressure did not change. After the high fat meal accompanied by insulin (peak insulin 86.1 ± 10.1 m-units/l) there were greater cardiac responses [(P < 0.001); cardiac output, 1.17 ± 0.361/min, and heart rate, 13.4 ± 2.1 beats-/min], and a larger fall in systemic vascular resistance and superior mesenteric artery vascular resistance. Unlike the high fat meal alone, the high fat meal with insulin was accompanied by a fall in calf vascular resistance (8.3 ± 3.3 units) and blood pressure (3.8 ± 1.6 mmHg). 4. The results of this study support a role for insulin in modulating postprandial cardiovascular homoeostasis; in particular, by its depressor action on skeletal muscle vasculature, insulin may in part contribute to the fall in blood pressure seen in the elderly, who have an inadequate cardiac response to the fall in systemic vascular resistance occurring after meal ingestion.

Blood Pressure, Heart Rate and Neuroendocrine Responses to a High Carbohydrate and a High Fat Meal in Healthy Young Subjects

1990 ◽  
Vol 79 (5) ◽  
pp. 517-522 ◽  
Author(s):  
D. Heseltine ◽  
J. F. Potter ◽  
G. Hartley ◽  
I. A. MacDonald ◽  
O. F. W. James
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Plasma Insulin ◽  
The Elderly ◽  
High Fat ◽  
High Carbohydrate ◽  
Neuroendocrine Responses ◽  
Young Subjects ◽  
Fat Meal ◽  
Carbohydrate Meal

1. The responses of blood pressure, heart rate, autonomic function and plasma insulin to a high carbohydrate and a high fat meal of equivalent energy value were studied in nine young volunteers. 2. Neither meal produced a significant change in supine or erect blood pressure. The high carbohydrate meal, however, resulted in an overall rise in both supine (6 beats/min) and erect (6 beats/min; P < 0.05) heart rate, no such changes being seen after the high fat meal. 3. Plasma noradrenaline levels increased by a maximum of 126% at 90 min (0.98 to 2.22 nmol/l) after the high carbohydrate meal but were virtually unchanged after the high fat meal (P < 0.01). Parasympathetic function showed no between-meal differences. Plasma insulin and glucose levels were significantly higher after the high carbohydrate meal than after the high fat meal. No postprandial difference in packed cell volume was found between meal types. 4. We conclude that, in young subjects, the postprandial blood pressure after a high carbohydrate meal is maintained by an increase in heart rate associated with increased sympathetic nervous system activity. These changes are at variance with the blood pressure and heart rate responses seen in the elderly after a high carbohydrate meal. A high fat meal has no significant cardiovascular or neuroendocrine effects in the young or old. The nutrient composition of meals has to be taken into account when studying the postprandial cardiovascular and neuroendocrine responses in the young.

Cardiovascular responses to a high-fat and a high-carbohydrate meal in healthy elderly subjects

1993 ◽  
Vol 84 (3) ◽  
pp. 263-270 ◽  
Author(s):  
M. B. Sidery ◽  
A. J. Cowley ◽  
I. A. MacDonald
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cardiac Output ◽  
Confidence Interval ◽  
Elderly Subjects ◽  
High Fat ◽  
High Carbohydrate ◽  
Fat Meal ◽  
Carbohydrate Meal

1. The cardiovascular responses to high-fat and high-carbohydrate meals (2.5 MJ) were compared in healthy, non-obese elderly subjects (mean age 68 years, range 63–74 years). 2. Measurements of cardiac output, blood pressure, heart rate, calf blood flow and superior mesenteric artery blood flow were made before and for 60 min after the two meals. 3. Systolic blood pressure only fell after the high-carbohydrate meal, reaching a nadir 13 mmHg below baseline values (95% confidence interval of the change, −2 to −25 mmHg). Diastolic blood pressure fell by 8 mmHg at 30 min after the high-carbohydrate meal (95% confidence interval of the change, −1 to −15 mmHg) and by 5 mmHg 45 min after the high-fat meal (95% confidence interval of the change, −1 to −8 mmHg). 4. Superior mesenteric artery blood flow rose by 70% after the high-carbohydrate meal (95% confidence interval of the change, +105 to +297 ml/min) and by 42% after the high-fat meal (95% confidence interval of the change, +35 to +256 ml/min, P <0.0001, analysis of variance). Calf blood flow reached a nadir 30 min after the high-carbohydrate meal (95% confidence interval of the change, −0.14 to −0.96ml min−1 100 ml−1) and 15min after the high-fat meal (95% confidence interval of the change, −0.1 to −0.92ml min−1 100ml−1P <0.01). There was no significant change in heart rate or cardiac output over the experimental period. 5. In elderly subjects the gut hyperaemia associated with food ingestion is not accompanied by concomitant increases in cardiac output and heart rate. This failure of cardiovascular adjustment to the vascular demands by the gut is likely to contribute to the fall in blood pressure seen in these healthy elderly subjects.

Central and Peripheral Haemodynamic Responses to High Carbohydrate and High Fat Meals in Human Cardiac Transplant Recipients

1996 ◽  
Vol 90 (6) ◽  
pp. 473-483 ◽  
Author(s):  
M. T. Kearney ◽  
A. J. Cowley ◽  
T. A. Stubbs ◽  
A. J. Perry ◽  
I. A. MacDonald
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Cardiac Transplant ◽  
Transplant Recipients ◽  
High Fat ◽  
Maximal Increase ◽  
Cardiac Denervation ◽  
Output Response ◽  
High Carbohydrate ◽  
Fat Meal

1. Patients with autonomic dysfunction and elderly people with an age-related decline in autonomic function can suffer from a fall in blood pressure after eating. While the cardiovascular changes after eating and the effect of meal composition on these changes are well established, the underlying mechanisms are less clear. 2. This study assessed the cardiac, circulatory and humoral responses to ingestion of isoenergetic (2.5 MJ) high carbohydrate and high fat meals in nine orthotopic cardiac transplant recipients, who before transplantation had significant circulatory, metabolic and autonomic abnormalities and after transplantation had complete or partial extrinsic cardiac denervation, and compared them to the responses seen in nine healthy age-matched control subjects. 3. All variables were measured non-invasively. Cardiac transplant recipients, despite cardiac denervation, showed a normal heart rate response to high carbohydrate and high fat meals (maximal increase at 30 min postprandially +7.8 ± 1.1 and +6.3 ± 1.4 beats/min respectively), a normal cardiac output response to the high carbohydrate meal (maximal increase at 30 min +1.16 ± 0.25 l/min), but a significantly attenuated cardiac output response to the high fat meal. Cardiac transplant recipients had attenuated superior mesenteric artery blood flow responses after both meals (P < 0.05) and an attenuated calf vascular resistance response after the high fat meal (P < 0.01). Throughout the study after both meals, cardiac transplant recipients maintained blood pressure. 4. This study demonstrates that cardiac transplant recipients, despite partial or complete cardiac denervation, have a normal chronotropic response to food and a normal cardiac output response to a high carbohydrate meal. The attenuated cardiac output response to a high fat meal did not compromise blood pressure, due at least in part to decreased splanchnic vasodilatation.

Hypotensive and Regional Haemodynamic Effects of Exercise, Fasted and after Food, in Human Sympathetic Denervation

1998 ◽  
Vol 94 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Sharmini Puvi-Rajasingham ◽  
Gareth D. P. Smith ◽  
Adeola Akinola ◽  
Christopher J. Mathias
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Superior Mesenteric Artery ◽  
Vascular Resistance ◽  
Mesenteric Artery ◽  
Autonomic Failure ◽  
Sympathetic Denervation ◽  
Stroke Distance

1. In human sympathetic denervation due to primary autonomic failure, food and exercise in combination may produce a cumulative blood pressure lowering effect due to simultaneous splanchnic and skeletal muscle dilatation unopposed by corrective cardiovascular reflexes. We studied 12 patients with autonomic failure during and after 9 min of supine exercise, when fasted and after a liquid meal. Standing blood pressure was also measured before and after exercise. 2. When fasted, blood pressure fell during exercise from 162 ± 7/92 ± 4 to 129 ± 9/70 ± 5 mmHg (mean arterial pressure by 22 ± 5%), P < 0.0005. After the meal, blood pressure fell from 159 ± 8/88 ± 6 to 129 ± 6/70 ± 4 mmHg (mean arterial pressure by 22 ± 3%), P < 0.0001, and further during exercise to 123 ± 6/61 ± 3 mmHg (mean arterial pressure by 9 ± 3%), P < 0.01. The stroke distance—heart rate product, an index of cardiac output, did not change after the meal. During exercise, changes in the stroke distance—heart rate product were greater when fasted. 3. Resting forearm and calf vascular resistance were higher when fasted. Calf vascular resistance fell further after exercise when fasted. Resting superior mesenteric artery vascular resistance was lower when fed; 0.19 ± 0.02 compared with 032 ± 0.06, P < 0.05. After exercise, superior mesenteric artery vascular resistance had risen by 82%, to 0.53 ± 0.12, P < 0.05 (fasted) and by 47%, to 0.29 ± 0.05, P < 0.05 (fed). 4. On standing, absolute levels of blood pressure were higher when fasted [83 ± 7/52 ± 7 compared with 71 ± 2/41 ± 3 (fed), each P < 0.05]. Subjects were more symptomatic on standing post-exercise when fed. 5. In human sympathetic denervation, exercise in the fed state lowered blood pressure further than when fasted and worsened symptoms of postural hypotension.

Post Prandial Blood Pressure Changes Following High Fat and High Carbohydrate Meals in Young and Elderly Persons

1989 ◽  
Vol 77 (s21) ◽  
pp. 12P-12P
Author(s):  
JF Potter ◽  
D Heseltine ◽  
OFW James
Keyword(s):  
Blood Pressure ◽  
Elderly Persons ◽  
High Fat ◽  
High Carbohydrate ◽  
Pressure Changes

scholarly journals Hemodynamic abnormalities during muscle metaboreflex activation in patients with type 2 diabetes mellitus

2019 ◽  
Vol 126 (2) ◽  
pp. 444-453 ◽  
Author(s):  
Silvana Roberto ◽  
Raffaele Milia ◽  
Azzurra Doneddu ◽  
Virginia Pinna ◽  
Girolamo Palazzolo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiac Output ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Blood Pressure Response ◽  
Pressure Response

Metaboreflex is a reflex triggered during exercise or postexercise muscle ischemia (PEMI) by metaboreceptor stimulation. Typical features of metaboreflex are increased cardiac output (CO) and blood pressure. Patients suffering from metabolic syndrome display hemodynamic abnormalities, with an exaggerated systemic vascular resistance (SVR) and reduced CO response during PEMI-induced metaboreflex. Whether patients with type 2 diabetes mellitus (DM2) have similar hemodynamic abnormalities is unknown. Here we contrast the hemodynamic response to PEMI in 14 patients suffering from DM2 (age 62.7 ± 8.3 yr) and in 15 age-matched controls (CTLs). All participants underwent a control exercise recovery reference test and a PEMI test to obtain the metaboreflex response. Central hemodynamics were evaluated by unbiased operator-independent impedance cardiography. Although the blood pressure response to PEMI was not significantly different between the groups, we found that the SVR and CO responses were reversed in patients with DM2 as compared with the CTLs (SVR: 392.5 ± 549.6 and −14.8 ± 258.9 dyn·s−1·cm−5; CO: −0.25 ± 0.63 and 0.46 ± 0.50 l/m, respectively, in DM2 and in CTL groups, respectively; P < 0.05 for both). Of note, stroke volume (SV) increased during PEMI in the CTL group only. Failure to increase SV and CO was the consequence of reduced venous return, impaired cardiac performance, and augmented afterload in patients with DM2. We conclude that patients with DM2 have an exaggerated vasoconstriction in response to metaboreflex activation not accompanied by a concomitant increase in heart performance. Therefore, in these patients, blood pressure response to the metaboreflex relies more on SVR increases rather than on increases in SV and CO. NEW & NOTEWORTHY The main new finding of the present investigation is that subjects with type 2 diabetes mellitus have an exaggerated vasoconstriction in response to metaboreflex activation. In these patients, blood pressure response to the metaboreflex relies more on systemic vascular resistance than on cardiac output increments.

The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study

1994 ◽  
Vol 3 (5) ◽  
pp. 382-386 ◽  
Author(s):  
CL Ostrow ◽  
E Hupp ◽  
D Topjian
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Critically Ill ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Critically Ill Patients ◽  
Hemodynamic Parameters ◽  
Trendelenburg Position ◽  
Dependent Variables ◽  
Preliminary Study

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.

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