Cardiovascular and hepatic effects of exercise in hypertensive adults

运动对成人高血压患者心血管和肝脏的影响

• 批准号: 7750621
• 负责人: JEANNE M CLARK
• 金额: $ 20.5万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-01 至 2010-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7750621
• 关键词: Address; Adult; Aerobic; Affect; Arts; Biological Markers; Blood Pressure; Blood Vessels; Body Composition; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Cessation of life; Clinical; Clinical Research; Clinical Trials; Computer software; Conduct Clinical Trials; Data; Data Analyses; Data Set; Detection; Disease Marker; Educational Intervention; Effectiveness; Enrollment; Event; Exercise; Exercise stress test; Fatty Liver; Fatty acid glycerol esters; Freezing; Functional disorder; Funding; Future; Goals; Grant; Guidelines; Health; Health Planning; Health Policy; Hepatic; Hypertension; Image; Image Analysis; Insulin Resistance; Interdisciplinary Study; Intervention; Investigation; Knowledge; Left; Left Ventricular Function; Left Ventricular Mass; Left ventricular structure; Life Style; Light; Lipids; Magnetic Resonance; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Measures; Mediating; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Observational Study; Participant; Patients; Persons; Physical activity; Physiological; Population; Population Study; Process; Public Health; Randomized; Randomized Controlled Clinical Trials; Recommendation; Research; Research Design; Risk Factors; Risk Reduction; Sampling; Serological; Serum; Serum Markers; Shapes; Structure; Thick; Time; Training; Translational Research; Ultrasonography; United States; United States National Institutes of Health; Vasodilator Agents; Ventricular; Vision; brachial artery; cardiovascular disorder risk; cardiovascular risk factor; clinical practice; comparative; control trial; cost; design; fitness; improved; innovation; insulin sensitivity; intrahepatic; modifiable risk; non-diabetic; novel; population based; prevent; programs; public health relevance; randomized trial; research study; respiratory; sedentary; strength training; treatment as usual

DESCRIPTION (provided by applicant): Sedentary lifestyle is a prevalent, modifiable risk factor for cardiovascular disease (CVD), which is the number one cause of death in the United States. Exercise training is known to decrease cardiovascular risk through decreasing blood pressure, improving lipids, and decreasing adiposity, but additional risk reduction is observed beyond these mechanisms. Understanding how exercise improves cardiovascular health as well as the effectiveness of structured exercised program for cardiovascular risk reduction for different populations would be helpful for clinical guidelines and public health planning. We seek to address these questions using two clinical trials conducted at the Johns Hopkins General Clinical Research Center. Both research studies randomized sedentary adults to either an identical 6-month aerobic and strength training intervention or usual care. The first study population (SHAPE) included persons with mild hypertension and the second study (SHAPE2) included persons with mild hypertension and type 2 diabetes (T2DM). We propose to use the two studies and benefit from the excellent study design and premium measures of traditional cardiovascular risk factors as well as exercise and fitness to answer this important public health question. In the proposed grant, we plan to: 1. Examine the impact of structured exercise on endothelial function. To carry out this aim we will reanalyze data from brachial artery ultrasound obtained from SHAPE using edge detection software. We will also measure novel biomarkers of endothelial function using frozen serum samples from SHAPE2. 2. Determine whether exercise improves left ventricular diastolic function by analyzing tagged cardiac magnetic resonance imaging from SHAPE and SHAPE2 to estimate left ventricular (LV) diastolic function. 3. Using data from maximal exercise stress tests, determine the importance of changes in fitness for predicting changes in markers of CVD. 4. Analyze data from hepatic magnetic resonance spectroscopy estimating the level of hepatic steatosis in SHAPE2 to examine the relationship between hepatic fat to parameters of cardiac function, CVD risk factors and measures of body composition and fitness. Using these unique datasets we can answer questions that go beyond the original aims of SHAPE and SHAPE2. We will study the impact of exercise and changes in cardio-respiratory fitness on several CVD markers and hepatic fat in mildly hypertensive persons with and without T2DM. These analyses will advance our knowledge of the cardiovascular effects of exercise training and could affect national recommendations on exercise and fitness. PUBLIC HEALTH RELEVANCE: The proposed research will further describe and quantify the effects of exercise on markers of cardiovascular disease in sedentary adults with cardiovascular risk factors. We will take advantage of two preexisting NIH- funded randomized controlled clinical trials with structured exercise interventions in patients with mild hypertension and type 2 diabetes and measure the impact of exercise and changes in fitness on state-of-the-art serologic and physiologic measures of cardiovascular disease. The results will be used to improve our knowledge of the direct effect of exercise on the cardiovascular system and could inform clinical guidelines on exercise. 1

描述（由申请人提供）：久坐的生活方式是心血管疾病（CVD）的普遍，可修改的风险因素，这是美国死亡的第一大原因。已知运动训练可以通过降低血压，改善脂质和肥胖降低，从而降低心血管风险，但除了这些机制之外，还可以观察到额外的风险降低。了解运动如何改善心血管健康以及结构化锻炼计划以减少不同人群的心血管风险的有效性将有助于临床准则和公共卫生计划。我们试图使用约翰·霍普金斯一般临床研究中心进行的两项临床试验来解决这些问题。两项研究都将久坐的成年人随机分配为相同的6个月有氧和力量训练干预措施或通常的护理。第一个研究人群（形状）包括患有轻度高血压的人，第二项研究（Shape2）包括患有轻度高血压和2型糖尿病（T2DM）的人。我们建议使用两项研究，并从传统的心血管危险因素的出色研究设计和高级度量中受益，以及锻炼和健身，以回答这一重要的公共卫生问题。在拟议的赠款中，我们计划：1。检查结构化运动对内皮功能的影响。为了执行此目标，我们将使用边缘检测软件从形状获得的臂动脉超声重新分析数据。我们还将使用Shape2的冷冻血清样品测量内皮功能的新生物标志物。 2。通过分析从形状和Shape2到估计左心室（LV）舒张功能的标记的心脏磁共振成像来确定运动是否改善左心室舒张功能。 3。使用最大运动压力测试的数据，确定适应性变化在预测CVD标记变化方面的重要性。 4。分析来自肝磁共振光谱的数据估计Shape2中肝脂肪变性的水平，以检查肝脂肪与心脏功能参数，CVD风险因素以及身体组成和适应性的测量之间的关系。使用这些独特的数据集，我们可以回答超出形状和Shape2的原始目标的问题。我们将研究运动和心脏呼吸适应性的变化对有和没有T2DM的轻度高血压患者的几种CVD标记和肝脂肪的影响。这些分析将提高我们对运动训练的心血管影响的了解，并可能影响国家对运动和健身的建议。 公共卫生相关性：拟议的研究将进一步描述和量化运动对患有心血管危险因素的久坐成年人心血管疾病标志的影响。我们将利用两种先前存在的NIH资助的随机对照临床试验，在轻度高血压和2型糖尿病患者中进行结构化运动干预，并测量运动和适应性对心血管疾病的先进血清学和生理学测量的影响。结果将用于提高我们对运动对心血管系统的直接影响的了解，并可以为锻炼的临床指南提供信息。 1