Exaggerated Exercise Blood Pressure as a Marker of Baroreflex Dysfunction in Normotensive Metabolic Syndrome Patients

IntroductionExaggerated blood pressure response to exercise (EEBP = SBP ≥ 190 mmHg for women and ≥210 mmHg for men) during cardiopulmonary exercise test (CPET) is a predictor of cardiovascular risk. Sympathetic hyperactivation and decreased baroreflex sensitivity (BRS) seem to be involved in the progression of metabolic syndrome (MetS) to cardiovascular disease.ObjectiveTo test the hypotheses: (1) MetS patients within normal clinical blood pressure (BP) may present EEBP response to maximal exercise and (2) increased muscle sympathetic nerve activity (MSNA) and reduced BRS are associated with this impairment.MethodsWe selected MetS (ATP III) patients with normal BP (MetS_NT, n = 27, 59.3% males, 46.1 ± 7.2 years) and a control group without MetS (C, n = 19, 48.4 ± 7.4 years). We evaluated BRS for increases (BRS+) and decreases (BRS−) in spontaneous BP and HR fluctuations, MSNA (microneurography), BP from ambulatory blood pressure monitoring (ABPM), and auscultatory BP during CPET.ResultsNormotensive MetS (MetS_NT) had higher body mass index and impairment in all MetS risk factors when compared to the C group. MetS_NT had higher peak systolic BP (SBP) (195 ± 17 vs. 177 ± 24 mmHg, P = 0.007) and diastolic BP (91 ± 11 vs. 79 ± 10 mmHg, P = 0.001) during CPET than C. Additionally, we found that MetS patients with normal BP had lower spontaneous BRS− (9.6 ± 3.3 vs. 12.2 ± 4.9 ms/mmHg, P = 0.044) and higher levels of MSNA (29 ± 6 vs. 18 ± 4 bursts/min, P < 0.001) compared to C. Interestingly, 10 out of 27 MetS_NT (37%) showed EEBP (MetS_NT+), whereas 2 out of 19 C (10.5%) presented (P = 0.044). The subgroup of MetS_NT with EEBP (MetS_NT+, n = 10) had similar MSNA (P = 0.437), but lower BRS+ (P = 0.039) and BRS− (P = 0.039) compared with the subgroup without EEBP (MetS_NT−, n = 17). Either office BP or BP from ABPM was similar between subgroups MetS_NT+ and MetS_NT−, regardless of EEBP response. In the MetS_NT+ subgroup, there was an association of peak SBP with BRS− (R = −0.70; P = 0.02), triglycerides with peak SBP during CPET (R = 0.66; P = 0.039), and of triglycerides with BRS− (R = 0.71; P = 0.022).ConclusionNormotensive MetS patients already presented higher peak systolic and diastolic BP during maximal exercise, in addition to sympathetic hyperactivation and decreased baroreflex sensitivity. The EEBP in MetS_NT with apparent well-controlled BP may indicate a potential depressed neural baroreflex function, predisposing these patients to increased cardiovascular risk

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Search for dark matter particles produced in association with a Higgs boson in proton-proton collisions at √s = 13 TeV

© 2020, The Author(s). A search for dark matter (DM) particles is performed using events with a Higgs boson candidate and large missing transverse momentum. The analysis is based on proton- proton collision data at a center-of-mass energy of 13 TeV collected by the CMS experiment at the LHC in 2016, corresponding to an integrated luminosity of 35.9 fb−1. The search is performed in five Higgs boson decay channels: h → b b ¯ , γγ, τ+τ−, W+W−, and ZZ. The results from the individual channels are combined to maximize the sensitivity of the analysis. No significant excess over the expected standard model background is observed in any of the five channels or in their combination. Limits are set on DM production in the context of two simplified models. The results are also interpreted in terms of a spin-independent DM-nucleon scattering cross section and compared to those from direct-detection DM experiments. This is the first search for DM particles produced in association with a Higgs boson decaying to a pair of W or Z bosons, and the first statistical combination based on five Higgs boson decay channels. [Figure not available: see fulltext.].SCOAP

Abstract 17296: Autonomic Dysfunction in Metabolic Syndrome With Normal Blood Pressure is Associated With Exacerbate Response of Blood Pressure During Maximal Exercise

Introduction: Hypertensive patients presented impairment in the blood pressure (BP) response during maximal exercise test. Sympathetic hyperactivation and decreased baroreflex sensitivity (BRS) are involved in the progression of metabolic syndrome (MetS) in cardiovascular disease. Hypothesis: (1) MetS patients with normal level of clinical BP show exaggerate peak and recovery systolic BP in response to maximal exercise; (2) Muscle sympathetic nerve activity (MSNA) and BRS are associated with these impairments. Methods: We selected MetS (ATP III) patients with normal BP (ASH/ISH criteria; MetS= 27, 46±1 y) and a healthy control group without MetS (C= 19, 48±2 y). We evaluated MSNA(microneurography), BRS (spontaneous BP and HR fluctuations) and auscultatory BP measures at pretest, peak, 1 st , 2 nd , 4 th min of recovery during cardiopulmonary exercise test. Results: Compared to C, MetS had higher BMI and impairment in all MetS risk factors. MetS had higher BP at pretest, peak, 1 st , 2 nd , 4 th min of recovery (P&lt;0.05). Interestingly, we found that even MetS patients with normal BP had lower spontaneous BRS for decreases (9.38 + 0.7 vs. 12.33 + 1.25 msec/mmHg, P=0.03) and higher levels of MSNA (27 + 1 vs. 18 + 1 bursts/min, P&lt;0.001) compared to C. Further analyses showed association between BRS for decreases with peak BP (r=-.32; P=0.04). Moreover, the MSNA had association with peak BP (r=.40; P=0.03) and BP at 1 st min of recovery (r=.48; P=0.01). Fascinatingly, a subgroup of MetS patients with normal BP but exaggerate peak BP (systolic BP &gt;190 mmHg for women and &gt;210 mmHg for men) showed strong association between BRS for decreases with peak BP (r=-.70; P&lt;0.02) and BRS for decreases with BP at 1 st min of recovery (r=-.73; P&lt;0.04). Conclusion: MetS patients even with normal BP, already show sympathetic hyperactivity and decreased baroreflex sensitivity which could explain, at least in part, the exacerbated BP response during maximal exercise. </jats:p