Document Detail


Exercise pressor response and arterial baroreflex unloading during exercise in chronic kidney disease.
MedLine Citation:
PMID:  23239869     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with chronic kidney disease (CKD) have poor exercise capacity, which contributes to cardiovascular risk. We sought to determine whether patients with stage 2 or stage 3 CKD have an augmented blood pressure (BP) response during exercise, and if so, whether overactivation of the sympathetic nervous system (SNS) during exercise might play a role. In 13 patients with CKD and hypertension and 13 controls with hypertension, we measured hemodynamics and muscle sympathetic nerve activity (MSNA) during the following maneuvers: low-level rhythmic handgrip (RHG 20%), which primarily stimulates mechanoreceptors, and moderate static handgrip exercise (SHG 30%) followed by posthandgrip circulatory arrest (PHGCA), which isolates metaboreceptors. During baseline studies, patients with CKD had significantly greater increases in mean arterial pressure (MAP) during SHG 30% (P = 0.045), RHG 20% (P = 0.031), and PHGCA (P = 0.043); however, the MSNA response was not augmented in patients with CKD compared with controls. We hypothesized that an augmented SNS response during exercise might be revealed in CKD if arterial baroreflex constraint was equalized using nitroprusside (NTP). These exercise maneuvers were repeated in patients with CKD during NTP infusion to equalize the BP response between groups, thereby relieving baroreflex-mediated suppression of SNS activity. With NTP infusion, patients with CKD had significantly increased MSNA responses during SHG 30% (P = 0.0044), and RHG 20% (P = 0.0064), but not during PHGCA (P > 0.05), suggesting increased reflex activation of the SNS during exercise, which may be mediated by mechanoreceptors but not metaboreceptors. Patients with CKD have an exaggerated BP response during rhythmic and static exercise with underlying SNS overactivation that is revealed during arterial baroreflex unloading during exercise.
Authors:
Jeanie Park; Arshed A Quyyumi; Holly R Middlekauff
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2012-12-13
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  114     ISSN:  1522-1601     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2014-01-13     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  538-49     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arteries / metabolism,  physiology
Baroreflex / physiology*
Blood Pressure / physiology
Exercise / physiology*
Hand Strength / physiology
Hemodynamics / physiology
Humans
Hypertension / metabolism,  physiopathology
Mechanoreceptors / metabolism
Middle Aged
Muscle, Skeletal / blood supply,  innervation,  physiology*
Nitroprusside / metabolism
Renal Insufficiency, Chronic / metabolism,  physiopathology*
Sympathetic Nervous System / metabolism,  physiology
Grant Support
ID/Acronym/Agency:
K23 HL098744/HL/NHLBI NIH HHS; K23 HL098744/HL/NHLBI NIH HHS; P20 HL113451/HL/NHLBI NIH HHS; UL1-RR025008/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
169D1260KM/Nitroprusside
Comments/Corrections

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