Sex Differences in Aortic Hemodynamics Following Acute Exercise: Wave Separation Analysis

Sang Ouk Wee; Huimin Yan; Abbi Lane-Cordova; Sushant M. Ranadive; Alexander J. Rosenberg; Daniel W. White; Bo Fernhall

doi:10.1055/a-0752-0256

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2019; 40(01): 23-30
DOI: 10.1055/a-0752-0256

Physiology & Biochemistry

Sex Differences in Aortic Hemodynamics Following Acute Exercise: Wave Separation Analysis

Sang Ouk Wee

¹Kinesiology, California State University San Bernardino, San Bernardino, United States

,

Huimin Yan

²Department of Exercise and Health Science, University of Massachusetts, Boston, United States

,

Abbi Lane-Cordova

³Department of Exercise Science, University of South Carolina, Columbia, United States

,

Sushant M. Ranadive

⁴Department of Kinesiology, University of Maryland, College Park, United States

,

Alexander J. Rosenberg

⁵Department of Physiology and Anatomy, University of North Texas, Fort Worth, United States

,

Daniel W. White

⁶School of Arts & Science, University of Houston Victoria, Victoria, United States

,

Bo Fernhall

⁷Kinesiology, Nutrition, and Rehabilitation, University of Illinois Chicago, Chicago, United States

› Author Affiliations

Abstract

The importance of sex differences in the control of blood pressure responses to exercise is controversial. It is unknown whether the potential sex differences are a result of magnitude differences in forward or reflected pressure waves. The purpose of this study was to investigate sex differences in BP following acute exercise using wave separation analysis. Sixty-eight adults (36 females) participated in the study. Aerobic capacity was measured during a graded cycle ergometry test. Central pulse wave analysis was derived from the radial pulse using applanation tonometry and separated into forward and reflected pressure waves before, and 15 min and 30 min after maximum aerobic exercise. Both males and females exhibited significantly decreased brachial SBP (p<0.05) following acute exercise. However, only males exhibited a significant decrease in forward wave pressure (p<0.05). Reflected wave pressure was decreased following exercise in both sex (p<0.05) with no sex difference. Males and females differ in blood pressure control following maximal exercise. Results show that males rely on both central and peripheral hemodynamic modifications, whereas females mostly rely on peripheral modifications. The preferential peripheral adaptations in females may provide insight regarding mechanisms of blood pressure control and the disproportionate development of hypertension in young men compared to women.

Key words

exercise - blood pressure - sex - wave separation

Full Text

References

References
1 Avolio AP, Van Bortel LM, Boutouyrie P, Cockcroft JR, McEniery CM, Protogerou AD, Roman MJ, Safar ME, Segers P, Smulyan H. Role of pulse pressure amplification in arterial hypertension: Experts' opinion and review of the data. Hypertension 2009; 54: 375-383
2 Carter 3rd R, Watenpaugh DE, Smith ML. Gender differences in cardiovascular regulation during recovery from exercise. J Appl Physiol 2001; 91: 1902-1907
3 Cecelja M, Jiang B, McNeill K, Kato B, Ritter J, Spector T, Chowienczyk P. Increased wave reflection rather than central arterial stiffness is the main determinant of raised pulse pressure in women and relates to mismatch in arterial dimensions: A twin study. J Am Coll Cardiol 2009; 54: 695-703
4 Chen CH, Nevo E, Fetics B, Pak PH, Yin FC, Maughan WL, Kass DA. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. Circulation 1997; 95: 1827-1836
5 Chirinos JA, Zambrano JP, Chakko S, Veerani A, Schob A, Willens HJ, Perez G, Mendez AJ. Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease. Hypertension 2005; 45: 980-985
6 Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH. Menopause and the risk of coronary heart disease in women. New Engl J Med 1987; 316: 1105-1110
7 Collier SR, Frechette V, Sandberg K, Schafer P, Ji H, Smulyan H, Fernhall B. Sex differences in resting hemodynamics and arterial stiffness following 4 weeks of resistance versus aerobic exercise training in individuals with pre-hypertension to stage 1 hypertension. Biol Sex Diff 2011; 2: 9
8 Cote AT, Phillips AA, Foulds HJ, Charlesworth SA, Bredin SS, Burr JF, Koehle MS, Warburton DE. Sex differences in cardiac function after prolonged strenuous exercise. Clin J Sport Med 2015; 25: 276-283
9 Halliwill JR, Buck TM, Lacewell AN, Romero SA. Postexercise hypotension and sustained postexercise vasodilatation: What happens after we exercise?. Exp Physiol 2013; 98: 7-18
10 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 update. Int J Sports Med 2017; 38: 1126-1131
11 Hart EC, Charkoudian N. Sympathetic neural regulation of blood pressure: influences of sex and aging. Physiology 2014; 29: 8-15
12 Heffernan KS, Jae SY, Fernhall B. Racial differences in arterial stiffness after exercise in young men. Am J Hypertens 2007; 20: 840-845
13 Heffernan KS, Jae SY, Lee M, Woods JA, Fernhall B. Arterial wave reflection and vascular autonomic modulation in young and older men. Aging Clin Exp Res 2008; 20: 1-7
14 Kenney MJ, Seals DR. Postexercise hypotension. Key features, mechanisms, and clinical significance. Hypertension 1993; 22: 653-664
15 Kips JG, Rietzschel ER, De Buyzere ML, Westerhof BE, Gillebert TC, Van Bortel LM, Segers P. Evaluation of noninvasive methods to assess wave reflection and pulse transit time from the pressure waveform alone. Hypertension 2009; 53: 142-149
16 Kurl S, Laukkanen JA, Rauramaa R, Lakka TA, Sivenius J, Salonen JT. Systolic blood pressure response to exercise stress test and risk of stroke. Stroke 2001; 32: 2036-2041
17 Laukkanen JA, Kurl S, Salonen R, Lakka TA, Rauramaa R, Salonen JT. Systolic blood pressure during recovery from exercise and the risk of acute myocardial infarction in middle-aged men. Hypertension 2004; 44: 820-825
18 Lieber A, Millasseau S, Bourhis L, Blacher J, Protogerou A, Levy BI, Safar ME. Aortic wave reflection in women and men. Am J Physiol Heart Circ Physiol 2010; 299: H236-H242
19 Maruf FA, Ogochukwu UN, Dim PA, Alada AR. Absence of sex differences in systolic blood pressure and heart rate responses to exercise in healthy young adults. Niger J Physiol Sci 2012; 27: 95-100
20 Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. New Engl J Med 1999; 340: 1801-1811
21 Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, Vasan RS, Levy D. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: The Framingham Heart Study. Hypertension 2004; 43: 1239-1245
22 O'Rourke MF, Nichols WW. Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension 2005; 45: 652-658
23 Parker BA, Smithmyer SL, Pelberg JA, Mishkin AD, Herr MD, Proctor DN. Sex differences in leg vasodilation during graded knee extensor exercise in young adults. J Appl Physiol 2007; 103: 1583-1591
24 Pauca AL, O'Rourke MF, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 2001; 38: 932-937
25 Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. American College of Sports M. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 2004; 36: 533-553
26 Pescatello LS, Kulikowich JM. The aftereffects of dynamic exercise on ambulatory blood pressure. Med Sci Sports Exerc 2001; 33: 1855-1861
27 Phan TS, Li JK, Segers P, Chirinos JA. Misinterpretation of the determinants of elevated forward wave amplitude inflates the role of the proximal aorta. J Am Heart Assoc 2016; 5: e003069
28 Queiroz AC, Rezk CC, Teixeira L, Tinucci T, Mion D, Forjaz CL. Gender influence on post-resistance exercise hypotension and hemodynamics. Int J Sports Med 2013; 34: 939-944
29 Rossow L, Yan H, Fahs CA, Ranadive SM, Agiovlasitis S, Wilund KR, Baynard T, Fernhall B. Postexercise hypotension in an endurance-trained population of men and women following high-intensity interval and steady-state cycling. Am J Hypertens 2010; 23: 358-367
30 Rylski B, Desjardins B, Moser W, Bavaria JE, Milewski RK. Gender-related changes in aortic geometry throughout life. Eur J Cardiothorac Surg 2014; 45: 805-811
31 Senitko AN, Charkoudian N, Halliwill JR. Influence of endurance exercise training status and gender on postexercise hypotension. J Appl Physiol 2002; 92: 2368-2374
32 Teixeira AL, Ritti-Dias R, Antonino D, Bottaro M, Millar PJ, Vianna LC. Sex differences in cardiac baroreflex sensitivity after isometric handgrip exercise. Med Sci Sports Exerc 2018; 50: 770-777
33 Torjesen AA, Wang N, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Forward and backward wave morphology and central pressure augmentation in men and women in the Framingham Heart Study. Hypertension 2014; 64: 259-265
34 Waddell TK, Dart AM, Gatzka CD, Cameron JD, Kingwell BA. Women exhibit a greater age-related increase in proximal aortic stiffness than men. J Hypertens 2001; 19: 2205-2212
35 Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Berent R, Eber B. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation 2004; 109: 184-189
36 Westerhof BE, Guelen I, Westerhof N, Karemaker JM, Avolio A. Quantification of wave reflection in the human aorta from pressure alone: A proof of principle. Hypertension 2006; 48: 595-601
37 Wheatley CM, Snyder EM, Johnson BD, Olson TP. Sex differences in cardiovascular function during submaximal exercise in humans. Springerplus 2014; 3: 445
38 Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 2000; 525 Pt 1 263-270
39 Yan H, Ranadive SM, Heffernan KS, Lane AD, Kappus RM, Cook MD, Wu PT, Sun P, Harvey IS, Woods JA, Wilund KR, Fernhall B. Hemodynamic and arterial stiffness differences between African-Americans and Caucasians after maximal exercise. Am J Physiol Heart Circ Physiol 2014; 306: H60-H68
40 Zamani P, Jacobs Jr. DR, Segers P, Duprez DA, Brumback L, Kronmal RA, Lilly SM, Townsend RR, Budoff M, Lima JA, Hannan P, Chirinos JA. Reflection magnitude as a predictor of mortality: The Multi-Ethnic Study of Atherosclerosis. Hypertension 2014; 64: 958-964