Impaired Glucose Metabolism and the Exaggerated Blood Pressure Response to Exercise Treadmill Testing in Normotensive Patients

Abstract

The authors aimed to investigate the association between glucose metabolism measures and the exaggerated blood pressure response (EXBPR) to exercise testing in normotensive nondiabetic patients. One hundred and forty‐two consecutive patients underwent office blood pressure (BP) measurements, 24‐hour BP monitoring, echocardiography, and treadmill exercise test according to the Bruce protocol. The population was divided into 2 groups according to EXBPR at a submaximal workload level. Furthermore, blood samples were obtained for fasting glucose (FG), fasting insulin (FI), and lipid profile assessment. Measures of insulin resistance (homeostasis model assessment of insulin resistance [HOMA‐IR], quantitative insulin sensitivity check index [QUICKI], and McAuley index) were also estimated, and a standardized oral glucose tolerance test was performed to evaluate glucose levels at 120 minutes (G120). Patients with EXBPR (n=40; 27 men) compared with those without EXBPR (n=102; 66 men) were older by 4±6 years (P<.001). FG, FI, G120, HOMA‐IR, QUICKI, and McAuley index differed in patients with EXBPR compared with those without EXBPR (P<.001 for all). Logistic multivariable regression models revealed that the studied glucose metabolism measures, duration of exercise, and 24‐hour systolic BP remained determinants of EXBPR (P<.05 for all) after adjustment. Impaired glucose measures are significant determinants of EXBPR to exercise testing in normotensive nondiabetic patients, suggesting that impaired glucose metabolism may contribute to adverse cardiovascular prognosis including new‐onset hypertension.

Increased mean arterial pressure response to dynamic exercise in normotensive subjects with multiple metabolic risk factors

“…Furthermore, multivariate regression analysis revealed that a greater number of MS components was an independent determinant of high MAP during exercise after adjustment for potential confounders, including age and BMI. These findings are in agreement with previous published reports of significant associations with high lipoprotein cholesterol, 10,16 impaired glucose metabolism, 16,19 and MS 18 with exercise BP. In addition, the present results indicate that the accumulation of risk factors is also an important predictor of BP response to exercise.…”

“…Such an effect might have a greater influence on vascular reactivity than on basal tone. [16][17][18][19] Therefore, although resting BP may not necessarily be high when the vascular impairment is not yet very severe, the vascular reactivity may already be abnormal, possibly resulting in excessive BP elevation under stressful conditions, for example, during physical exertion.…”

Cardiovascular disease risk factors and blood pressure response during exercise in healthy children and adolescents: The European Youth Heart Study

“…A positive association has previously been observed between HOMA-IR score and BP response to exercise in nondiabetic adults with (39) and without (37) hypertension. Furthermore, BMI levels have been found to be related to exercise BP response in obese adolescents (8,9).…”

Exaggerated Exercise Blood Pressure Response and Future Cardiovascular Disease

“…We focused on stimulated and basal NO release to assess endothelial function, large artery stiffness, and basal/peak exercise neurohormonal activation. It is possible, however, that other factors such endothelium‐derived hyperpolarizing factor, increased sympathetic outflow, asymmetric dimethyl arginine, and insulin levels may have contributed either collectively or in isolation to ExSBP and certainly this merits further investigation. Additionally, we considered only few of the possible mechanisms affecting both vascular and myocardial responsiveness to exercise.…”