Faculty Opinions recommendation of Arterial stiffness, cardiovagal baroreflex sensitivity and postural blood pressure changes in older adults: the Rotterdam Study.

Background High‐resistance inspiratory muscle strength training (IMST) is a novel, time‐efficient physical training modality. Methods and Results We performed a double‐blind, randomized, sham‐controlled trial to investigate whether 6 weeks of IMST (30 breaths/day, 6 days/week) improves blood pressure, endothelial function, and arterial stiffness in midlife/older adults (aged 50–79 years) with systolic blood pressure ≥120 mm Hg, while also investigating potential mechanisms and long‐lasting effects. Thirty‐six participants completed high‐resistance IMST (75% maximal inspiratory pressure, n=18) or low‐resistance sham training (15% maximal inspiratory pressure, n=18). IMST was safe, well tolerated, and had excellent adherence (≈95% of training sessions completed). Casual systolic blood pressure decreased from 135±2 mm Hg to 126±3 mm Hg ( P <0.01) with IMST, which was ≈75% sustained 6 weeks after IMST ( P <0.01), whereas IMST modestly decreased casual diastolic blood pressure (79±2 mm Hg to 77±2 mm Hg, P =0.03); blood pressure was unaffected by sham training (all P >0.05). Twenty‐four hour systolic blood pressure was lower after IMST versus sham training ( P =0.01). Brachial artery flow‐mediated dilation improved ≈45% with IMST ( P <0.01) but was unchanged with sham training ( P =0.73). Human umbilical vein endothelial cells cultured with subject serum sampled after versus before IMST exhibited increased NO bioavailability, greater endothelial NO synthase activation, and lower reactive oxygen species bioactivity ( P <0.05). IMST decreased C‐reactive protein ( P =0.05) and altered select circulating metabolites (targeted plasma metabolomics) associated with cardiovascular function. Neither IMST nor sham training influenced arterial stiffness ( P >0.05). Conclusions High‐resistance IMST is a safe, highly adherable lifestyle intervention for improving blood pressure and endothelial function in midlife/older adults with above‐normal initial systolic blood pressure. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03266510.

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The aortic-femoral arterial stiffness gradient is blood pressure independent in older adults

Journal of Hypertension ◽

10.1097/hjh.0000000000002937 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Keeron Stone ◽

Simon Fryer ◽

James Faulkner ◽

Michelle L. Meyer ◽

Kevin Heffernan ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Arterial Stiffness ◽

Pressure Independent

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DOES GENDER INFLUENCE RISK FOR ORTHOSTATIC HYPOTENSION IN OLDER ADULTS WITH SARCOPENIA?

Innovation in Aging ◽

10.1093/geroni/igz038.2519 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S682-S682

Author(s):

Melissa J Benton ◽

Amy L Silva-Smith ◽

Jefferson M Spicher

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Systolic Blood Pressure ◽

Orthostatic Hypotension ◽

Lean Mass ◽

Bioelectrical Impedance ◽

Early Morning ◽

Postural Changes ◽

Before And After ◽

Pressure Changes

Abstract Older adults with sarcopenia may be at risk for unstable postural blood pressure due to diminished lean mass that plays a role in maintaining fluid volume. Males have greater lean mass, so risk may be mediated by gender. We compared postural blood pressure changes in older men (77.1 ± 2.0 years; n = 15) and women (79.6 ± 2.0 years; n = 13) with sarcopenia before and after an overnight fast. Sarcopenia was defined using the Lean Mass Index (males ≤ 19.0 kg/m2; females ≤ 15.0 kg/m2). Body composition was measured using multi-frequency bioelectrical impedance, and blood pressure was measured lying, sitting, and standing. On Day 1 (normally hydrated) there were significant drops in systolic blood pressure, with an overall decrease of -9.1 ± 2.2 mmHg (p < 0.001) between lying and standing. On Day 2 (overnight fast), postural changes were more profound, with an overall decrease of -14.1 ± 2.8 mmHg (p < 0.001). However, when compared by gender, postural changes between lying and standing remained significant but did not differ between men and women (Day 1: men -8.9 ± 2.5 vs. women -9.3 ± 2.5 mmHg; Day 2: men -14.6 ± 4.6 vs. women -13.6 ± 3.1 mmHg). On both days diastolic blood pressure remained stable. In this group of older adults, significant decreases in postural systolic blood pressure were observed in the early morning fasted condition, increasing the risk for orthostatic hypotension (drop in systolic blood pressure -20.0 mmHg). Interestingly, gender did not influence risk.

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Orthostatic blood pressure changes and arterial baroreflex sensitivity in elderly subjects

Age and Ageing ◽

10.1093/ageing/28.6.522 ◽

1999 ◽

Vol 28 (6) ◽

pp. 522-530 ◽

Cited By ~ 49

Author(s):

M. James

Keyword(s):

Blood Pressure ◽

Baroreflex Sensitivity ◽

Elderly Subjects ◽

Arterial Baroreflex ◽

Orthostatic Blood Pressure ◽

Pressure Changes ◽

Arterial Baroreflex Sensitivity

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Abstract 13: Mineralocorticoid Receptor Blockade does not Result in Arterial Destiffening in Healthy Older Adults

Hypertension ◽

10.1161/hyp.60.suppl_1.a13 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Demetra D Christou ◽

Jeung-Ki Yoo ◽

Moon-Hyon Hwang ◽

Meredith Luttrell ◽

Han-Kyul Kim ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Carotid Artery ◽

Arterial Stiffness ◽

Mineralocorticoid Receptor ◽

Augmentation Index ◽

Stiffness Index ◽

Double Blind ◽

Healthy Older Adults ◽

Carotid Artery Compliance

Arterial stiffness, an independent predictor of cardiovascular disease, is increased in aging, but the underlying mechanisms are not completely understood. We hypothesized that mineralocorticoid receptor (MR) activation is partly responsible for increased arterial stiffness and that MR blockade would lead to arterial destiffening in healthy older adults. To test this hypothesis, we administered in a randomized, double blind, crossover study, 100 mg of Eplerenone (MR blocker) or placebo once per day for one month with one month washout, in 23 healthy older adults (age, 64±1 years; mean±SE) and assessed arterial stiffness (aortic, arm and leg pulse wave velocity (PWV; doppler flowmeter) and carotid artery compliance, distensibility, beta-stiffness index, augmentation index (high resolution ultrasonography and applanation tonometry). Despite reductions in blood pressure in response to Eplerenone (systolic blood pressure: 127±3 vs. 120±2 mmHg, P=0.01; diastolic blood pressure: 74±1 vs.72±1 mmHg, P=0.02; placebo vs. Eplerenone), arterial stiffness did not change (aortic PWV, 9.2±1.2 vs. 8.9±1.2m/sec, P=0.5; arm PWV, 11.4±0.6 vs. 11.7±0.7 m/sec, P=0.7; leg PWV, 13.4±0.4 vs.12.8±0.5 m/sec, P=0.3; carotid artery compliance, 0.17±0.02 vs. 0.16±0.02 mm 2 /mmHg, P=0.6; distensibility, 12.7±1.6 vs.13.6±1.5 10 -3 kPa -1 , P=0.6; beta stiffness index, 3.2±0.3 vs. 3.4±0.3, P=0.5; augmentation index, 24.3±2.9 vs. 22.0±2.9 %, P=0.3, placebo vs. Eplerenone). In conclusion, MR blockade does not result in arterial destiffening in healthy older adults despite reductions in blood pressure.

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