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Exercise central (aortic) blood pressure is predominantly driven by forward traveling waves, not wave reflection

Citation

Schultz, MG and Davies, JE and Roberts-Thomson, P and Black, JA and Hughes, AD and Sharman, JE, Exercise central (aortic) blood pressure is predominantly driven by forward traveling waves, not wave reflection, Hypertension, 62, (1) pp. 175-182. ISSN 0194-911X (2013) [Refereed Article]

Copyright Statement

Copyright 2013 American Heart Association, Inc.

DOI: doi:10.1161/HYPERTENSIONAHA.111.00584

Abstract

Exercise hypertension independently predicts cardiovascular mortality, although little is known about exercise central hemodynamics. This study aimed to determine the contribution of arterial wave travel and aortic reservoir characteristics to central blood pressure (BP) during exercise. We hypothesized that exercise central BP would be principally related to forward wave travel and aortic reservoir function. After routine diagnostic coronary angiography, invasive pressure and flow velocity were recorded in the ascending aorta via sensor-tipped intra-arterial wires in 10 participants (age, 10 years; 70% men) free of coronary artery disease with normal left ventricular function. Measures were recorded at baseline and during supine cycle ergometry. Using wave intensity analysis, dominant wave types throughout the cardiac cycle were identified (forward and backward, compression, and decompression), and aortic reservoir and excess pressure were calculated. Central systolic BP increased significantly with exercise (Δ=1912 mm Hg; P<0.001). This was associated with increases in systolic forward compression waves (Δ=12x10617x106 Wm-2s-1; P=0.045) and forward decompression waves in late systole (Δ=9x1066x106 Wm-2s-1; P<0.001). Despite significant augmentation in BP (Δ=96 mm Hg; P=0.002), reflected waves did not increase in magnitude (Δ=-1x1063x106 Wm-2s-1; P=0.2). Excess pressure rose significantly with exercise (Δ=169 mm Hg; P<0.001), and reservoir pressure integral fell (Δ=-5x1055x105 Pas; P=0.010). Change in reflection coefficient negatively correlated with change in central systolic BP (r=-0.68; P=0.03). We conclude that elevation of exercise central BP is principally because of increases in aortic forward traveling waves generated by left ventricular ejection. These findings have relevance to understanding central BP waveform morphology and pathophysiology of exercise hypertension.

Item Details

Item Type:Refereed Article
Keywords:aorta, blood pressure, exercise, pulse wave analysis, venous reservoirs, wave intensity, wave reflection
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Schultz, MG (Dr Martin Schultz)
Author:Sharman, JE (Professor James Sharman)
ID Code:85241
Year Published:2013
Web of Science® Times Cited:31
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-06-20
Last Modified:2017-09-05
Downloads:0

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