Publications by year
In Press
McDonagh STJ, Wylie LJ, Morgan P, Vanhatalo A, Jones A (In Press). A randomised controlled trial exploring the effects of different beverages consumed alongside a nitrate-rich meal on systemic blood pressure. Nutrition and Health
McDonagh S, Clark CE (In Press). Inter-arm differences in blood pressure: a brief summary.
Diabetes and Primary Care,
21 Full text.
McDonagh STJ, Mejzner N, Clark CE (In Press). Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis.
Abstract:
Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis
Abstract
. Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care despite these associated risks. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.Methods: a systematic review, meta-analyses and meta-regression were undertaken. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean prevalence of PH were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment of included studies was undertaken using an adapted version of the Newcastle-Ottawa Scale.Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%) in the community, 19% (15-25%) in primary care and 31% (15-50%) in residential care or nursing homes (P=0.16 between groups). By condition, prevalences were 20% (16-24%) with hypertension, 21% (16-26%) with diabetes, 25% (18-33%) with Parkinson’s disease and 29% (25-33%) with dementia, compared to 14% (12-17%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04).Conclusions: the prevalence of PH in populations relevant to primary care is substantial. The definition used is important when testing for PH. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of postural hypotension.PROSPERO: CRD42017075423.
Abstract.
McDonagh STJ, Mejzner N, Clark CE (In Press). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis.
Abstract:
Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis
Abstract
. Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.
Methods: Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale.
Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I2=99%) for community cohorts, 19% (15-25%; I2=98%) for 23 primary care cohorts and 31% (15-50%; I2=0%) for 3 residential care or nursing homes cohorts (P=0.16 between groups). By condition, prevalences were 20% (16-23%; I2=98%) with hypertension (20 cohorts), 21% (16-26%; I2=92%) with diabetes (4 cohorts), 25% (18-33%; I2=88%) with Parkinson’s disease (7 cohorts) and 29% (25-33%; I2=0%) with dementia (3 cohorts), compared to 14% (12-17%; I2=99%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04).
Conclusions: PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH.
PROSPERO:CRD42017075423.
Abstract.
2021
Mcdonagh S, Sheppard J, Warren F, Boddy K, Fordham J, Farmer L, Lewis P, Baumber R, Martin U, Clark C, et al (2021). ARM BASED ON LEG BLOOD PRESSURES (ABLE-BP): CAN LEG BLOOD PRESSURE MEASUREMENTS PREDICT BRACHIAL BLOOD PRESSURE? INDIVIDUAL PARTICIPANT DATA META-ANALYSIS FROM THE INTERPRESS-IPD.
Author URL.
McDonagh STJ, Sheppard JP, Warren FC, Boddy K, Farmer L, Shore H, Williams P, Lewis PS, Baumber R, Fordham J, et al (2021). Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration.
BMJ Open,
11(3), e040481-e040481.
Abstract:
Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration
IntroductionBlood pressure (BP) is normally measured on the upper arm, and guidelines for the diagnosis and treatment of high BP are based on such measurements. Leg BP measurement can be an alternative when brachial BP measurement is impractical, due to injury or disability. Limited data exist to guide interpretation of leg BP values for hypertension management; study-level systematic review findings suggest that systolic BP (SBP) is 17 mm Hg higher in the leg than the arm. However, uncertainty remains about the applicability of this figure in clinical practice due to substantial heterogeneity.AimsTo examine the relationship between arm and leg SBP, develop and validate a multivariable model predicting arm SBP from leg SBP and investigate the prognostic association between leg SBP and cardiovascular disease and mortality.Methods and analysisIndividual participant data (IPD) meta-analyses using arm and leg SBP measurements for 33 710 individuals from 14 studies within the Inter-arm blood pressure difference IPD (INTERPRESS-IPD) Collaboration. We will explore cross-sectional relationships between arm and leg SBP using hierarchical linear regression with participants nested by study, in multivariable models. Prognostic models will be derived for all-cause and cardiovascular mortality and cardiovascular events.Ethics and disseminationData originate from studies with prior ethical approval and consent, and data sharing agreements are in place—no further approvals are required to undertake the secondary analyses proposed in this protocol. Findings will be published in peer-reviewed journal articles and presented at conferences. A comprehensive dissemination strategy is in place, integrated with patient and public involvement.PROSPERO registration numberCRD42015031227.
Abstract.
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Clark CE, McDonagh STJ, McManus RJ, Martin U (2021). COVID-19 and hypertension: risks and management. A scientific statement on behalf of the British and Irish Hypertension Society.
J Hum Hypertens,
35(4), 304-307.
Author URL.
Full text.
McDonagh STJ, Mejzner N, Clark CE (2021). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis.
BMC Family Practice,
22(1).
Abstract:
Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis
Abstract
. Background
. Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.
.
. Methods
. Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale.
.
. Results
. One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14–20%; I2 = 99%) for 34 community cohorts, 19% (15–25%; I2 = 98%) for 23 primary care cohorts and 31% (15–50%; I2 = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16–23%; I2 = 98%) with hypertension (20 cohorts), 21% (16–26%; I2 = 92%) with diabetes (4 cohorts), 25% (18–33%; I2 = 88%) with Parkinson’s disease (7 cohorts) and 29% (25–33%, I2 = 0%) with dementia (3 cohorts), compared to 14% (12–17%, I2 = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R2 = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04).
.
. Conclusions
. PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH.
. PROSPERO:CRD42017075423.
.
Abstract.
Full text.
Abu-Alghayth M, Vanhatalo A, Wylie LJ, McDonagh STJ, Thompson C, Kadach S, Kerr P, Smallwood MJ, Jones AM, Winyard PG, et al (2021). S-nitrosothiols, and other products of nitrate metabolism, are increased in multiple human blood compartments following ingestion of beetroot juice.
Redox Biology,
43, 101974-101974.
Full text.
Clark C, Boddy K, Warren F, Mcdonagh S, Moore S, Aboyans V, Cloutier L, McManus R, Shore A, Taylor R, et al (2021). SYSTOLIC INTER-ARM BLOOD PRESSURE DIFFERENCE AND COGNITIVE DECLINE: FINDINGS FROM THE INTERPRESS-IPD COLLABORATION.
Author URL.
Taylor RS, Dalal HM, McDonagh STJ (2021). The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology
Schwartz CL, Edwards K, Gamble W, Kirkham A, Lacy P, Lewis P, McDonagh STJ, Peers C, Sheppard JP, Swales P, et al (2021). Validation of the Kinetik Blood Pressure Monitor-Series 1 for use in adults at home and in clinical settings, according to the 2002 European Society of Hypertension International Protocol on the validation of blood pressure devices.
J Hum Hypertens,
35(11), 1046-1050.
Abstract:
Validation of the Kinetik Blood Pressure Monitor-Series 1 for use in adults at home and in clinical settings, according to the 2002 European Society of Hypertension International Protocol on the validation of blood pressure devices.
The aim of this study was to assess the blood pressure (BP) measurement accuracy of the Kinetik Blood Pressure Monitor-Series 1 (BPM-1) for use in home or clinical settings according to the 2002 European Society of Hypertension International Protocol (ESH-IP). Forty-two participants were recruited to fulfil the required number of systolic and diastolic BP measurements according to the ESH-IP. Nine sequential same-arm BP readings were measured and analysed for each participant using the test device and observer mercury standard readings according to the 2002 ESH-IP. Forty one participants were used to obtain 33 sets of systolic and diastolic BP readings and were included in the analysis. Mean difference between the device measurements and the observer (mercury standard) measurements was 1.1 ± 7.2/1.1 ± 6.8 mmHg (mean ± standard deviation; systolic/diastolic). The number of systolic BP differences between the test and observer measurements that fell within 5, 10 and 15 mmHg was 65, 86 and 92. For diastolic readings, the number of test-observer measurement differences within 5, 10 and 15 mmHg was 77, 91 and 94. The number of participants with at least two out of three differences within 5 mmHg was 28 for systolic and 40 for diastolic BP readings. Three participants had no differences between the test and observer measurements within 5 mmHg in both the systolic and diastolic measurement categories. The Kinetik BPM-1 device fulfilled the requirements of the ESH-IP validation procedure and can be recommended for clinical use and self-measurement within the home.
Abstract.
Author URL.
Dalal HM, Doherty P, McDonagh ST, Paul K, Taylor RS (2021). Virtual and in-person cardiac rehabilitation.
BMJ,
373 Author URL.
2020
Clark C, Warren F, Boddy K, McDonagh S, Moore S, Goddard J, Reed N, Turner M, Alzamora MT, Ramos Blanes R, et al (2020). Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: the INTERPRESS-IPD Collaboration.
Hypertension,
n/a, 1-12.
Full text.
Dalal H, Taylor RS, Greaves C, Doherty PJ, McDonagh ST, van Beurden SB, Purcell C (2020). Correspondence to the EJPC in response to position paper by Ambrosetti M et al. 2020.
Eur J Prev Cardiol Author URL.
Dalal H, Taylor RS, Greaves C, Doherty PJ, McDonagh ST, van Beurden SB, Purcell C, REACH-HF Study Group (2020). Correspondence to the EJPC in response to position paper by Ambrosetti M et al. 2020: Cardiovascular rehabilitation and COVID-19: the need to maintain access to evidence-based services from the safety of home.
Eur J Prev Cardiol Author URL.
Albasri A, Clark C, Omboni S, McDonagh S, McManus RJ, Sheppard JO (2020). Effective detection and management of hypertension through community pharmacy in England.
Pharmaceutical Journal Full text.
Daw P, van Beurden SB, Greaves C, Veldhuijzen van Zanten JJCS, Harrison A, Dalal H, McDonagh STJ, Doherty PJ, Taylor RS (2020). Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure.
BMJ Open,
10(6), e036137-e036137.
Abstract:
Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure
IntroductionCardiac rehabilitation (CR) improves health-related quality of life and reduces hospital admissions. However, patients with heart failure (HF) often fail to attend centre-based CR programmes. Novel ways of delivering healthcare, such as home-based CR programmes, may improve uptake of CR. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a new, effective and cost-effective home-based CR programme for people with HF. The aim of this prospective mixed-method implementation evaluation study is to assess the implementation of the REACH-HF CR programme in the UK National Health Service (NHS). The specific objectives are to (1) explore NHS staff perceptions of the barriers and facilitators to the implementation of REACH-HF, (2) assess the quality of delivery of the programme in real-life clinical settings, (3) consider the nature of any adaptation(s) made and how they might impact on intervention effectiveness and (4) compare real-world patient outcomes to those seen in a prior clinical trial.Methods and analysisREACH-HF will be rolled out in four NHS CR centres across the UK. Three healthcare professionals from each site will be trained to deliver the 12-week programme. In-depth qualitative interviews and focus groups will be conducted with approximately 24 NHS professionals involved in delivering or commissioning the programme. Consultations for 48 patients (12 per site) will be audio recorded and scored using an intervention fidelity checklist. Outcomes routinely recorded in the National Audit of Cardiac Rehabilitation will be analysed and compared with outcomes from a recent randomised controlled trial: the Minnesota Living with HF Questionnaire and exercise capacity (Incremental Shuttle Walk Test). Qualitative research findings will be mapped onto the Normalisation Process Theory framework and presented in the form of a narrative synthesis. Results of the study will inform national roll-out of REACH-HF.Ethics and disseminationThe study (IRAS 261723) has received ethics approval from the South Central (Hampshire B) Research Ethics Committee (19/SC/0304). Written informed consent will be obtained from all health professionals and patients participating in the study. The research team will ensure that the study is conducted in accordance with the Declaration of Helsinki, the Data Protection Act 2018, General Data Protection Regulations and in accordance with the Research Governance Framework for Health and Social Care (2005). Findings will be published in scientific peer-reviewed journals and presented at local, national and international meetings to publicise and explain the research methods and findings to key audiences to facilitate the further uptake of the REACH-HF intervention.
Abstract.
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Butterworth JE, Hays R, McDonagh STJ, Bower P, Pitchforth E, Richards SH, Campbell JL (2020). Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).
Patient Educ Couns,
103(10), 2078-2094.
Abstract:
Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).
OBJECTIVE: to assess the effects of interventions aimed at involving older people with multimorbidity in decision-making about their healthcare during primary care consultations. METHODS: Cochrane methodological procedures were applied. Searches covered all relevant trial registries and databases. Randomised controlled trials were identified where interventions had been compared with usual care/ control/ another intervention. A narrative synthesis is presented; meta-analysis was not appropriate. RESULTS: 8160 abstracts and 54 full-text articles were screened. Three studies were included, involving 1879 patient participants. Interventions utilised behaviour change theory; cognitive-behavioural therapy and motivational interviewing; multidisciplinary, holistic patient review and organisational changes. No studies reported the primary outcome 'patient involvement in decision-making about their healthcare'. Patient involvement was evident in the theory underpinning interventions. Certainty of evidence (assessed using GRADE) was limited by small studies and inconsistency in secondary outcomes measured. CONCLUSION: the evidence base is currently too limited to interpret with certainty. Transparency in design and consistency in evaluation, using validated measures, is required for future interventions involving older patients with multimorbidity in decisions about their healthcare. PRACTICE IMPLICATIONS: There is a large gap between clinical guidelines for multimorbidity and an evidence base for implementation of their recommendations during primary care consultations with older people.
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Author URL.
Clark CE, McDonagh STJ, McManus RJ, Worki BPM (2020). Measurement of blood pressure in people with atrial fibrillation (vol 33, pg 763, 2019).
JOURNAL OF HUMAN HYPERTENSION,
34(6), 476-476.
Author URL.
Sheppard JP, Lacy P, Lewis PS, Martin U (2020). Measurement of blood pressure in the leg—a statement on behalf of the British and Irish Hypertension Society.
Journal of Human Hypertension,
34(6), 418-419.
Full text.
Daw P, van Zanten JV, Harrison A, Dalal H, Taylor RS, Doherty PJ, McDonagh STJ, Greaves CJ (2020). Pragmatic parallel mixed methods investigation into implementation of home-based cardiac rehabilitation for heart failure patients: methodological discussion.
Author URL.
Bawab N, Moullin JC, Bugnon O, Perraudin C, Morrow A, Chan P, Hogden E, Taylor N, Pearson M, Carrieri D, et al (2020). Proceedings of the Virtual 3rd UK Implementation Science Research Conference. Implementation Science, 15(S4).
Wise J (2020). The BMJ Awards 2020: Stroke and cardiovascular team of the year.
BMJ-BRITISH MEDICAL JOURNAL,
368 Author URL.
Limb M (2020). The BMJ Awards 2020: showcase of this year’s winning teams. BMJ, m4341-m4341.
2019
Clark CE, McDonagh STJ, McManus RJ (2019). Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis.
J Hum Hypertens,
33(5), 352-364.
Abstract:
Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis.
Atrial fibrillation (AF) affects ~3% of the general population and is twice as common with hypertension. Validation protocols for automated sphygmomanometers exclude people with AF, raising concerns over accuracy of hypertension diagnosis or management, using out-of-office blood pressure (BP) monitoring, in the presence of AF. Some devices include algorithms to detect AF; a feature open to misinterpretation as offering accurate BP measurement with AF. We undertook this review to explore accuracy of automated devices, with or without AF detection, for measuring BP. We searched Medline and Embase to October 2018 for studies comparing automated BP measurement devices to a standard mercury sphygmomanometer contemporaneously. Data were extracted by two reviewers. Mean BP differences between devices and mercury were calculated, where not reported and compared; meta-analyses were undertaken where possible. We included 13 studies reporting 14 devices. Mean systolic and diastolic BP differences from mercury ranged from -3.1 to + 6.1/-4.6 to +9.0 mmHg. Considerable heterogeneity existed between devices (I2: 80 to 90%). Devices with AF detection algorithms appeared no more accurate for BP measurement with AF than other devices. A previous review concluded that oscillometric devices are accurate for systolic but not diastolic BP measurement in AF. The present findings do not support that conclusion. Due to heterogeneity between devices, they should be evaluated on individual performance. We found no evidence that devices with AF detection measure BP more accurately in AF than other devices. More home or ambulatory automated BP monitors require validation in populations with AF.
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McDonagh S, Clark C (2019). CVD risk factors: new evidence, new approaches?. Primary Care Cardiovascular Journal
Mcdonagh S, Norris B, Fordham AJ, Greenwood M, Richards SH, Campbell JL, Clark CE (2019). IMPACT OF INTER-ARM BLOOD PRESSURE DIFFERENCE ON CARDIOVASCULAR RISK ESTIMATION IN PRIMARY CARE.
Author URL.
Clark C, Warren F, Boddy K, McDonagh S, Moore S, Cloutier L, Taylor R, Shore A, McManus R, Aboyans V, et al (2019). INTER-ARM BLOOD PRESSURE DIFFERENCE: INSIGHTS INTO AETIOLOGY FROM THE INTERPRESS-IPD COLLABORATION.
Author URL.
Butterworth JE, Hays R, McDonagh STJ, Richards SH, Bower P, Campbell J (2019). Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations.
Cochrane Database of Systematic Reviews Full text.
Clark CE, McDonagh STJ, McManus RJ, Blood Pressure Measurement Working Party of the British and Irish Hypertension Society (2019). Measurement of blood pressure in people with atrial fibrillation.
J Hum Hypertens,
33(11), 763-765.
Author URL.
McDonagh STJ, Wylie LJ, Thompson C, Vanhatalo A, Jones AM (2019). Potential benefits of dietary nitrate ingestion in healthy and clinical populations: a brief review.
Eur J Sport Sci,
19(1), 15-29.
Abstract:
Potential benefits of dietary nitrate ingestion in healthy and clinical populations: a brief review.
This article provides an overview of the current literature relating to the efficacy of dietary nitrate (NO3-) ingestion in altering aspects of cardiovascular and metabolic health and exercise capacity in healthy and diseased individuals. The consumption of NO3--rich vegetables, such as spinach and beetroot, have been variously shown to promote nitric oxide bioavailability, reduce systemic blood pressure, enhance tissue blood flow, modulate muscle O2 utilisation and improve exercise tolerance both in normoxia and in hypoxia, as is commonly observed in a number of disease states. NO3- ingestion may, therefore, act as a natural means for augmenting performance and attenuating complications associated with limited O2 availability or transport, hypertension and the metabolic syndrome. Recent studies indicate that dietary NO3- might also augment intrinsic skeletal muscle contractility and improve the speed and power of muscle contraction. Moreover, several investigations suggest that NO3- supplementation may improve aspects of cognitive performance both at rest and during exercise. Collectively, these observations position NO3- as more than a putative ergogenic aid and suggest that increasing natural dietary NO3- intake may act as a prophylactic in countering the predations of senescence and certain cardiovascular-metabolic diseases.
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Clark IE, Goulding RP, DiMenna FJ, Bailey SJ, Jones MI, Fulford J, McDonagh STJ, Jones AM, Vanhatalo A (2019). Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task.
Eur J Appl Physiol,
119(1), 149-161.
Abstract:
Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task.
It has been reported that mental fatigue decreases exercise performance during high-intensity constant-work-rate exercise (CWR) and self-paced time trials (TT) in recreationally-trained individuals. The purpose of this study was to determine whether performance is impaired following a prolonged cognitive task in individuals trained for competitive sport. Ten trained competitive athletes (ATH) and ten untrained healthy men (UNT) completed a 6-min severe-intensity CWR followed by a 6-min cycling TT immediately following cognitive tasks designed to either perturb (Stroop colour-word task and N-back task; PCT) or maintain a neutral (documentary watching; CON) mental state. UNT had a higher heart rate (75 ± 9 v. 69 ± 7 bpm; P = 0.002) and a lower positive affect PANAS score (19.9 ± 7.5 v. 24.3 ± 4.6; P = 0.036) for PCT compared to CON. ATH showed no difference in heart rate, but had a higher negative affect score for PCT compared to CON (15.1 ± 3.7 v. 12.2 ± 2.7; P = 0.029). Pulmonary O2 uptake during CWR was not different between PCT and CON for ATH or UNT. Work completed during TT was not different between PCT and CON for ATH (PCT 103 ± 12 kJ; CON 102 ± 12 kJ; P > 0.05) or UNT (PCT 75 ± 11 kJ; CON 74 ± 12 kJ; P > 0.05). Compared to CON, during PCT, UNT showed unchanged psychological stress responses, whereas ATH demonstrated increased psychological stress responses. However, regardless of this distinction, exercise performance was not affected by PCT in either competitive athletes or untrained individuals.
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2018
McDonagh STJ (2018). Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure.
Abstract:
Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure
Ingestion of nitrate (NO3-) from natural sources can improve indices of cardiovascular health and exercise tolerance. The aim of this thesis was to determine the impact of dietary NO3- as a therapeutic aid when consumed amongst factors that might affect its efficacy such as antibacterial mouthwash, blood donation, different food forms and co-ingestion with alcoholic beverages. Young, healthy, normotensive individuals volunteered to participate in each experiment and undergo an array of physiological assessments. Chapter 4: Mouth rinsing with chlorhexidine and non-chlorhexidine mouthwash prior to consumption of concentrated NO3--rich beetroot juice (BR), over 6 days, blunted the rise in plasma nitrite concentration ([NO2-]) by 53 % and 29 % respectively, compared with control. Chlorhexidine mouthwash also elevated systolic (SBP) and mean arterial (MAP) blood pressure (BP) during treadmill walking. Chapter 5: Short-term BR ingestion lowered the oxygen (O2) cost of moderate-intensity exercise (by ~ 4 %), better preserved muscle oxygenation and attenuated the decline in incremental exercise tolerance (by 5 %) following whole blood donation. Chapter 6: an array of different NO3--rich vehicles, including BR, beetroot flapjack (BF), non-concentrated beetroot juice (BL) and beetroot crystals (BC), elevated salivary, plasma and urinary NO3- concentration ([NO3-]) and [NO2-] when compared with baseline and control, with the largest increases in plasma [NO2-] occurring in BF and BR. BR also reduced SBP (~5 mmHg) and MAP (~ 3-4 mmHg), and BF reduced diastolic BP (DBP; ~ 4 mmHg). Chapter 7: a high NO3- salad, accompanied by polyphenol-rich (NIT-RW) and -low (NIT-A) alcoholic beverages and a water control (NIT-CON) elevated salivary, plasma and urinary [NO3-] and [NO2-] compared with control (CON). SBP was reduced 2 h post consumption of NIT-RW (-4 mmHg), NIT-A (-3 mmHg) and NIT-CON (-2 mmHg) compared with CON. DBP and MAP were also lower in NIT-A, and more so in NIT-RW, compared with NIT-CON.
Overall, the findings in this thesis demonstrate the efficacy of naturally derived NO3- on NO metabolites, BP and exercise tolerance. The potential for such benefits to arise may be maximised if antibacterial mouthwash is avoided during supplementation and if NO3- is consumed as BR, BF or as a green leafy salad with or without an alcoholic beverage. It may also be suggested that NO3- ingestion can offset decrements in exercise tolerance following blood donation.
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Clark C, Boddy K, Warren F, McDonagh S, Taylor R, Aboyans V, Cloutier L, McManus R, Shore A, Campbell J, et al (2018). INTER-ARM DIFFERENCES IN BLOOD PRESSURE AND MORTALITY: INDIVIDUAL PATIENT DATA META-ANALYSIS AND DEVELOPMENT OF a PROGNOSTIC ALGORITHM (INTERPRESS-IPD COLLABORATION). Canadian Journal of Cardiology, 34(10).
Clark C, Boddy K, Warren F, Mcdonagh S, Taylor R, Aboyans V, Cloutier L, McManus R, Shore A, Campbell J, et al (2018). INTER-ARM DIFFERENCES IN BLOOD PRESSURE AND MORTALITY: INDIVIDUAL PATIENT DATA META-ANALYSIS AND DEVELOPMENT OF a PROGNOSTIC ALGORITHM (INTERPRESSIPD COLLABORATION).
Author URL.
Clark C, Smith L, Cloutier L, Konya J, Todkar S, Mcdonagh S, Clark O, Glynn L, Taylor R, Campbell J, et al (2018). INTERVENTIONS TO IMPROVE CONTROL OF HYPERTENSION; WHAT WORKS (AND WHAT DOESN'T)?.
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Clark C, Smith L, Cloutier L, Konya J, Todkar S, McDonagh S, Clark O, Glynn L, Taylor R, Campbell J, et al (2018). INTERVENTIONS TO IMPROVE CONTROL OF HYPERTENSION; WHAT WORKS (AND WHAT DOESN’T): SYSTEMATIC REVIEW AND META-REGRESSION. Canadian Journal of Cardiology, 34(10), s130-s131.
McDonagh STJ, Wylie LJ, Webster JMA, Vanhatalo A, Jones AM (2018). Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults.
Nitric Oxide,
72, 66-74.
Abstract:
Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults.
Inorganic nitrate (NO3-) supplementation has been shown to improve cardiovascular health indices in healthy adults. The purpose of this study was to investigate how the vehicle of NO3- administration can influence NO3- metabolism and the subsequent blood pressure response. Ten healthy males consumed an acute equimolar dose of NO3- (∼5.76 mmol) in the form of a concentrated beetroot juice drink (BR; 55 mL), a non-concentrated beetroot juice drink (BL; 456 mL) and a solid beetroot flapjack (BF; 60 g). A drink containing soluble beetroot crystals (BC; ∼1.40 mmol NO3-) and a control drink (CON; 70 mL deionised water) were also ingested. BP and plasma, salivary and urinary [NO3-] and [NO2-] were determined before and up to 24 h after ingestion. All NO3--rich vehicles elevated plasma, salivary and urinary nitric oxide metabolites compared with baseline and CON (P
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2017
Thompson C, Wylie LJ, Blackwell JR, Fulford J, Black MI, Kelly J, McDonagh STJ, Carter J, Bailey SJ, Vanhatalo A, et al (2017). Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training.
J Appl Physiol (1985),
122(3), 642-652.
Abstract:
Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training.
We hypothesized that 4 wk of dietary nitrate supplementation would enhance exercise performance and muscle metabolic adaptations to sprint interval training (SIT). Thirty-six recreationally active subjects, matched on key variables at baseline, completed a series of exercise tests before and following a 4-wk period in which they were allocated to one of the following groups: 1) SIT and [Formula: see text]-depleted beetroot juice as a placebo (SIT+PL); 2) SIT and [Formula: see text]-rich beetroot juice (~13 mmol [Formula: see text]/day; SIT+BR); or 3) no training and [Formula: see text]-rich beetroot juice (NT+BR). During moderate-intensity exercise, pulmonary oxygen uptake was reduced by 4% following 4 wk of SIT+BR and NT+BR (P < 0.05) but not SIT+PL. The peak work rate attained during incremental exercise increased more in SIT+BR than in SIT+PL (P < 0.05) or NT+BR (P < 0.001). The reduction in muscle and blood [lactate] and the increase in muscle pH from preintervention to postintervention were greater at 3 min of severe-intensity exercise in SIT+BR compared with SIT+PL and NT+BR (P < 0.05). However, the change in severe-intensity exercise performance was not different between SIT+BR and SIT+PL (P > 0.05). The relative proportion of type IIx muscle fibers in the vastus lateralis muscle was reduced in SIT+BR only (P < 0.05). These findings suggest that BR supplementation may enhance some aspects of the physiological adaptations to SIT.NEW & NOTEWORTHY We investigated the influence of nitrate-rich and nitrate-depleted beetroot juice on the muscle metabolic and physiological adaptations to 4 wk of sprint interval training. Compared with placebo, dietary nitrate supplementation reduced the O2 cost of submaximal exercise, resulted in greater improvement in incremental (but not severe-intensity) exercise performance, and augmented some muscle metabolic adaptations to training. Nitrate supplementation may facilitate some of the physiological responses to sprint interval training.
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Black MI, Jones AM, Blackwell JR, Bailey SJ, Wylie LJ, McDonagh STJ, Thompson C, Kelly J, Sumners P, Mileva KN, et al (2017). Muscle metabolic and neuromuscular determinants of fatigue during cycling in different exercise intensity domains.
J Appl Physiol (1985),
122(3), 446-459.
Abstract:
Muscle metabolic and neuromuscular determinants of fatigue during cycling in different exercise intensity domains.
Lactate or gas exchange threshold (GET) and critical power (CP) are closely associated with human exercise performance. We tested the hypothesis that the limit of tolerance (Tlim) during cycle exercise performed within the exercise intensity domains demarcated by GET and CP is linked to discrete muscle metabolic and neuromuscular responses. Eleven men performed a ramp incremental exercise test, 4-5 severe-intensity (SEV; >CP) constant-work-rate (CWR) tests until Tlim, a heavy-intensity (HVY; GET) CWR test until Tlim, and a moderate-intensity (MOD;. 0.05) muscle metabolic milieu (i.e. low pH and [PCr] and high [lactate]) was attained at Tlim (approximately 2-14 min) for all SEV exercise bouts. The muscle metabolic perturbation was greater at Tlim following SEV compared with HVY, and also following SEV and HVY compared with MOD (all P < 0.05). The normalized M-wave amplitude for the vastus lateralis (VL) muscle decreased to a similar extent following SEV (-38 ± 15%), HVY (-68 ± 24%), and MOD (-53 ± 29%), (P > 0.05). Neural drive to the VL increased during SEV (4 ± 4%; P < 0.05) but did not change during HVY or MOD (P > 0.05). During SEV and HVY, but not MOD, the rates of change in M-wave amplitude and neural drive were correlated with changes in muscle metabolic ([PCr], [lactate]) and blood ionic/acid-base status ([lactate], [K+]) (P < 0.05). The results of this study indicate that the metabolic and neuromuscular determinants of fatigue development differ according to the intensity domain in which the exercise is performed.NEW & NOTEWORTHY the gas exchange threshold and the critical power demarcate discrete exercise intensity domains. For the first time, we show that the limit of tolerance during whole-body exercise within these domains is characterized by distinct metabolic and neuromuscular responses. Fatigue development during exercise greater than critical power is associated with the attainment of consistent "limiting" values of muscle metabolites, whereas substrate availability and limitations to muscle activation may constrain performance at lower intensities.
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2016
McDonagh STJ, Vanhatalo A, Fulford J, Wylie LJ, Bailey SJ, Jones AM (2016). Dietary nitrate supplementation attenuates the reduction in exercise tolerance following blood donation.
Am J Physiol Heart Circ Physiol,
311(6), H1520-H1529.
Abstract:
Dietary nitrate supplementation attenuates the reduction in exercise tolerance following blood donation.
We tested the hypothesis that dietary nitrate (NO3-)-rich beetroot juice (BR) supplementation could partially offset deteriorations in O2 transport and utilization and exercise tolerance after blood donation. Twenty-two healthy volunteers performed moderate-intensity and ramp incremental cycle exercise tests prior to and following withdrawal of ∼450 ml of whole blood. Before donation, all subjects consumed seven 70-ml shots of NO3--depleted BR [placebo (PL)] in the 48 h preceding the exercise tests. During the 48 h after blood donation, subjects consumed seven shots of BR (each containing 6.2 mmol of NO3-, n = 11) or PL (n = 11) before repeating the exercise tests. Hemoglobin concentration and hematocrit were reduced by ∼8-9% following blood donation (P < 0.05), with no difference between the BR and PL groups. Steady-state O2 uptake during moderate-intensity exercise was ∼4% lower after than before donation in the BR group (P < 0.05) but was unchanged in the PL group. The ramp test peak power decreased from predonation (341 ± 70 and 331 ± 68 W in PL and BR, respectively) to postdonation (324 ± 69 and 322 ± 66 W in PL and BR, respectively) in both groups (P < 0.05). However, the decrement in performance was significantly less in the BR than PL group (2.7% vs. 5.0%, P < 0.05). NO3- supplementation reduced the O2 cost of moderate-intensity exercise and attenuated the decline in ramp incremental exercise performance following blood donation. These results have implications for improving functional capacity following blood loss.
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2015
Thompson C, Wylie LJ, Fulford J, Kelly J, Black MI, McDonagh STJ, Jeukendrup AE, Vanhatalo A, Jones AM (2015). Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise.
Eur J Appl Physiol,
115(9), 1825-1834.
Abstract:
Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise.
UNLABELLED: it is possible that dietary nitrate (NO3 (-)) supplementation may improve both physical and cognitive performance via its influence on blood flow and cellular energetics. PURPOSE: to investigate the effects of dietary NO3 (-) supplementation on exercise performance and cognitive function during a prolonged intermittent sprint test (IST) protocol, which was designed to reflect typical work patterns during team sports. METHODS: in a double-blind randomised crossover study, 16 male team-sport players received NO3 (-)-rich (BR; 140 mL day(-1); 12.8 mmol of NO3 (-)), and NO3 (-)-depleted (PL; 140 mL day(-1); 0.08 mmol NO3 (-)) beetroot juice for 7 days. On day 7 of supplementation, subjects completed the IST (two 40-min "halves" of repeated 2-min blocks consisting of a 6-s "all-out" sprint, 100-s active recovery and 20 s of rest), on a cycle ergometer during which cognitive tasks were simultaneously performed. RESULTS: Total work done during the sprints of the IST was greater in BR (123 ± 19 kJ) compared to PL (119 ± 17 kJ; P < 0.05). Reaction time of response to the cognitive tasks in the second half of the IST was improved in BR compared to PL (BR first half: 820 ± 96 vs. second half: 817 ± 86 ms; PL first half: 824 ± 114 vs. second half: 847 ± 118 ms; P < 0.05). There was no difference in response accuracy. CONCLUSIONS: These findings suggest that dietary NO3 (-) enhances repeated sprint performance and may attenuate the decline in cognitive function (and specifically reaction time) that may occur during prolonged intermittent exercise.
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McDonagh STJ, Wylie LJ, Winyard PG, Vanhatalo A, Jones AM (2015). The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure.
Int J Sports Med,
36(14), 1177-1185.
Abstract:
The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure.
Chlorhexidine-containing mouthwash (STRONG), which disturbs oral microflora, has been shown to diminish the rise in plasma nitrite concentration ([NO2-]) and attenuate the reduction in resting blood pressure (BP) typically seen after acute nitrate (NO3-) ingestion. We aimed to determine whether STRONG and weaker antiseptic agents attenuate the physiological effects of chronic NO3- supplementation using beetroot juice (BR). 12 healthy volunteers mouth-rinsed with STRONG, non-chlorhexidine mouthwash (WEAK) and deionised water (CON) 3 times a day, and ingested 70 mL BR (6.2 mmol NO3-), twice a day, for 6 days. BP (at rest and during 10 min of treadmill walking) and plasma and salivary [NO3-] and [NO2-] were measured prior to and on day 6 of supplementation. The change in salivary [NO3-] 4 h post final ingestion was higher (P
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