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The effect of 2 behavioral programs, aerobic exercise training and stress management training, with routine medical care on psychosocial functioning and markers of cardiovascular risk is determined. Results revealed that for patients with stable ischemic heart disease (IHD), exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.

Background: Impaired cerebrovascular reactivity (CVR) and blunted cerebral hemodynamic recruitment are thought to be important mechanisms linking hypertension to cerebrovascular and cognitive outcomes. Few studies have examined cardiovascular or dietary correlates of CVR among hypertensives.Objective: To delineate associations between cardiometabolic risk, diet, and cerebrovascular functioning among individuals with resistant hypertension from the TRIUMPH trial (n = 140).Methods: CVR was assessed by examining changes in tissue oxygenation (tissue oxygenation index [TOI] and oxygenated hemoglobin [HBO2]) using functional near-infrared spectroscopy (fNIRS) during a breath holding test, a standardized CVR assessment to elicit a hypercapnic response. Participants also underwent fNIRS during three cognitive challenge tasks. Vascular function was assessed by measurement of brachial artery flow-mediated dilation and hyperemic flow response. Cardiometabolic fitness was assessed from peak VO2 on an exercise treadmill test and body mass index. Dietary patterns were quantified using the DASH eating score. Cognitive function was assessed using a 45-minute test battery assessing Executive Function, Processing Speed, and Memory.Results: Greater levels fitness (B = 0.30, p = 0.011), DASH compliance (B = 0.19, p = 0.045), and lower obesity (B = -0.30, p = 0.004), associated with greater changes in TOI, whereas greater flow-mediated dilation (B = 0.19, p = 0.031) and lower stroke risk (B = -0.19, p = 0.049) associated with greater HBO2. Similar associations were found for cerebral hemodynamic recruitment, and associations between CVR and cognition were moderated by duration of hypertension.Conclusion: Impaired CVR elevated cardiometabolic risk, obesity, vascular function, and fitness among hypertensives. [ABSTRACT FROM AUTHOR]

Importance: Anxiety is common among patients with coronary heart disease (CHD) and is associated with worse health outcomes; however, effective treatment for anxiety in patients with CHD is uncertain.Objective: To determine whether exercise and escitalopram are better than placebo in reducing symptoms of anxiety as measured by the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) and in improving CHD risk biomarkers.Design, Setting, and Participants: This randomized clinical trial was conducted between January 2016 and May 2020 in a tertiary care teaching hospital in the US and included 128 outpatients with stable CHD and a diagnosed anxiety disorder or a HADS-A score of 8 or higher who were older than 40 years, sedentary, and not currently receiving mental health treatment.Interventions: Twelve weeks of aerobic exercise 3 times per week at an intensity of 70% to 85% heart rate reserve, escitalopram (up to 20 mg per day), or placebo pill equivalent.Main Outcomes and Measures: The primary outcome was HADS-A score. CHD biomarkers included heart rate variability, baroreflex sensitivity, and flow-mediated dilation, along with 24-hour urinary catecholamines.Results: The study included 128 participants. The mean (SD) age was 64.6 (9.6) years, and 37 participants (29%) were women. Participants randomized to the exercise group and escitalopram group reported greater reductions in HADS-A (exercise, -4.0; 95% CI, -4.7 to -3.2; escitalopram, -5.7; 95% CI, -6.4 to -5.0) compared with those randomized to placebo (-3.5; 95% CI, -4.5 to -2.4; P = .03); participants randomized to escitalopram reported less anxiety compared with those randomized to exercise (-1.67; 95% CI, -2.68 to -0.66; P = .002). Significant postintervention group differences in 24-hour urinary catecholamines were found (exercise z score = 0.05; 95% CI, -0.2 to 0.3; escitalopram z score = -0.24; 95% CI, -0.4 to 0; placebo z score = 0.36; 95% CI, 0 to 0.7), with greater reductions in the exercise group and escitalopram group compared with the placebo group (F1,127 = 4.93; P = .01) and greater reductions in the escitalopram group compared with the exercise group (F1,127 = 4.37; P = .04). All groups achieved comparable but small changes in CHD biomarkers, with no differences between treatment groups.Conclusions and Relevance: Treatment of anxiety with escitalopram was safe and effective for reducing anxiety in patients with CHD. However, the beneficial effects of exercise on anxiety symptoms were less consistent. Exercise and escitalopram did not improve CHD biomarkers of risk, which should prompt further investigation of these interventions on clinical outcomes in patients with anxiety and CHD.Trial Registration: ClinicalTrials.gov Identifier: NCT02516332. [ABSTRACT FROM AUTHOR]

BACKGROUND Masked hypertension (nonhypertensive in the clinic setting but hypertensive outside the clinic during wakefulness) is characterized by increased blood pressure in response to physical and emotional stressors that activate the sympathetic nervous system (SNS). However, no studies have assessed vascular reactivity to a pharmacological SNS challenge in individuals with masked hypertension. METHODS We analyzed data from 161 adults aged 25 to 45 years (mean ± standard deviation age 33 ± 6 years; 48% were African American and 43% were female). Participants completed ambulatory blood pressure monitoring, and a standardized α 1-adrenergic agonist phenylephrine test that determines the dose of phenylephrine required to increase a participant's mean arterial pressure by 25 mm Hg (PD25). RESULTS Twenty-one participants were considered to have masked hypertension (clinic systolic blood pressure (SBP) <140 and diastolic blood pressure (DBP) <90 mm Hg but awake SBP ≥135 or DBP ≥85 mm Hg), 28 had sustained hypertension (clinic SBP ≥140 or DBP ≥90 mm Hg and awake SBP ≥135 or DBP ≥85 mm Hg), and 106 had sustained normotension (clinic SBP <140 and DBP <90 mm Hg and awake SBP <135 and DBP <85 mm Hg). After multivariable adjustment, the mean (±SE) PD25 was less in participants with masked hypertension compared with their counterparts with sustained normotension (222.1 ± 33.2 vs. 328.7 ± 15.0; P = 0.012), but similar to that observed in subjects with sustained hypertension (254.8 ± 31.0; P =0.12). CONCLUSIONS Among young and middle-aged adults, masked hypertension is associated with increased vascular reactivity to a SNS challenge, which may contribute to elevated awake BPs as well as to increased cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

New Findings What is the central question of this study? Decreased heart rate variability (HRV) is associated with increased cardiovascular disease (CVD) risk, including greater left ventricular mass (LVM). Despite their enhanced CVD risk profile, African Americans have been shown to exhibit higher HRV, relative to Whites; however, it is unclear whether this pattern extends to the association between HRV and LVM., What is the main finding and its importance? Using ECG and echocardiographic data, HRV was positively associated with LVM in a non-clinical sample of African Americans. These findings suggest that current assumptions regarding the meaning of higher HRV might not be universal, which might have implications for HRV as a risk marker among African Americans., Increased left ventricular mass (LVM) is an early precursor of target organ damage attributable to hypertension. Diminished parasympathetic cardiac control has been linked to both hypertension onset and left ventricular impairment; however, emerging evidence suggests that this pattern might be different in African Americans. The present study sought to determine whether race impacts the relationship between parasympathetic cardiac control and LVM. The LVM was assessed via echocardiography in a sample ( n = 148) of African American and White adults (mean age 33.20 ± 5.71 years) with normal or mildly elevated blood pressure. Parasympathetic cardiac control was assessed by a measure of high-frequency heart rate variability (HF-HRV) determined from ECG recordings during 5 min of rest. In regression analysis, greater HF-HRV was associated with greater LVM among African Americans ( P = 0.002) but was not related to LVM in Whites ( P = 0.919). These are the first data to demonstrate that race moderates the relationship between HRV and LVM and further suggest that race might be an important factor in the association between parasympathetic cardiac control and other cardiovascular disease risk factors. [ABSTRACT FROM AUTHOR]

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Background: Anxiety is highly prevalent among patients with coronary heart disease (CHD), and there is growing evidence that high levels of anxiety are associated with worse prognosis. However, few studies have evaluated the efficacy of treating anxiety in CHD patients for reducing symptoms and improving clinical outcomes. Exercise and selective serotonin reuptake inhibitors have been shown to be effective in treating patients with depression, but have not been studied in cardiac patients with high anxiety.Methods: The UNWIND trial is a randomized clinical trial of patients with CHD who are at increased risk for adverse events because of comorbid anxiety. One hundred fifty participants with CHD and elevated anxiety symptoms and/or with a diagnosed anxiety disorder will be randomly assigned to 12 weeks of aerobic exercise (3×/wk, 35 min, 70%-85% VO2peak), escitalopram (5-20 mg qd), or placebo. Before and after 12 weeks of treatment, participants will undergo assessments of anxiety symptoms and CHD biomarkers of risk, including measures of inflammation, lipids, hemoglobin A1c, heart rate variability, and vascular endothelial function. Primary outcomes include post-intervention effects on symptoms of anxiety and CHD biomarkers. Secondary outcomes include clinical outcomes (cardiovascular hospitalizations and all-cause death) and measures of quality of life.Conclusions: The UNWIND trial (ClinicalTrials.gov NCT02516332) will evaluate the efficacy of aerobic exercise and escitalopram for improving anxiety symptoms and reducing risk for adverse clinical events in anxious CHD patients. [ABSTRACT FROM AUTHOR]

This study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on insulin sensitivity and lipids. In a randomized control trial, 144 overweight (body mass index: 25 to 40) men (n=47) and women (n=97) with high blood pressure (130 to 159/85 to 99 mm Hg) were randomly assigned to one of the following groups: (1) DASH diet alone; (2) DASH diet with aerobic exercise and caloric restriction; or (3) usual diet controls (UC). Body composition, fitness, insulin sensitivity, and fasting lipids were measured before and after 4 months of treatment. Insulin sensitivity was estimated on the basis of glucose and insulin levels in the fasting state and after an oral glucose load. Participants in the DASH diet with aerobic exercise and caloric restriction condition lost weight (-8.7 kg [95% CI: -2.0 to -9.7 kg]) and exhibited a significant increase in aerobic capacity, whereas the DASH diet alone and UC participants maintained their weight (-0.3 kg [95% CI: -1.2 to 0.5 kg] and +0.9 kg [95% CI: 0.0 to 1.7 kg], respectively) and had no improvement in exercise capacity. DASH diet with aerobic exercise and caloric restriction demonstrated lower glucose levels after the oral glucose load, improved insulin sensitivity, and lower total cholesterol and triglycerides compared with both DASH diet alone and UC, as well as lower fasting glucose and low-density lipoprotein cholesterol compared with UC. DASH diet alone participants generally did not differ from UC in these measures. Combining the DASH diet with exercise and weight loss resulted in significant improvements in insulin sensitivity and lipids. Despite clinically significant reductions in blood pressure, the DASH diet alone, without caloric restriction or exercise, resulted in minimal improvements in insulin sensitivity or lipids. [ABSTRACT FROM AUTHOR]

Anxiety disorders are associated with low vagal control of heart rate and increased risk of cardiac mortality and sudden cardiac death. This study examined whether the herbal anxiolytic, kava, produces improvement in vagal control in generalized anxiety disorder. Before and after treatment with placebo (n = 7) or kava (n = 6), two indices of vagal control were measured under supine conditions using power spectral analysis: baroreflex control of heart rate (BRC) and respiratory sinus arrhythmia (RSA). Significantly more patients treated with kava showed improved BRC compared to the placebo group (p < 0.05). Furthermore, the magnitude of improvement in BRC was significantly correlated with the degree of clinical improvement (p < 0.05). RSA did not respond to treatment. These preliminary findings suggest that kava might exert a favourable effect on reflex vagal control of heart rate in generalized anxiety disorder patients. The parallel clinical and BRC responses may reflect an underlying common effect of this herbal anxiolytic. [ABSTRACT FROM AUTHOR]

Objective: Although depression and anxiety predict risk of cardiac mortality, the contributions of depression and anxiety to vagal cardiac control have not been systematically evaluated. The goal of this study was to examine the relationship between state anxiety and vagal control of heart rate in older adults with major depressive disorder (MDD). Older adults (50-70 years old) were selected for this study because of the greater cardiac risk associated with low vagal cardiac control across this age range.Methods: Fifty-six men and women with MDD were evaluated. MDD was diagnosed using the Diagnostic Interview Schedule, and severity of depression was measured using the Beck Depression Inventory and the Hamilton Rating Scale for depression. State anxiety was measured using the Spielberger State Anxiety Inventory. Power spectral analysis was used to measure two indices of vagal control: baroreflex control of heart rate (BRC(SPEC)) and respiratory sinus arrhythmia (RSA).Results: State anxiety was negatively correlated with levels of BRC(SPEC) (r = -0.32, p < .05), whereas depression severity was not related to either RSA or BRC(SPEC). Furthermore, BRC(SPEC) was reduced by approximately 33% in MDD patients with state anxiety scores (ST-ANX) in the highest quartile (ST-ANX > 41, N = 13), compared with patients with ST-ANX scores in the lowest quartile (ST-ANX < 25, N = 14; p < .05).Conclusions: Anxiety, but not depression severity, is associated with reduced BRC(SPEC) in older men and women. Future studies are needed to determine whether comorbid anxiety contributes to the increased cardiovascular risk associated with MDD. [ABSTRACT FROM AUTHOR]