Greater Exercise Pressor Response Is Associated With Impaired Claudication Outcomes in Symptomatic Peripheral Artery Disease

Abstract

We determined whether a greater exercise pressor response during a constant-load treadmill test was associated with lower peak walking time (PWT) and claudication onset time (COT) measured during a graded maximal treadmill test in 304 patients with symptomatic peripheral artery disease (PAD). The exercise pressor response was assessed by measuring heart rate and blood pressure (BP) at rest and during a constant-load treadmill test (speed = 2 mph, grade = 0%). After only 2 minutes of walking, mean heart rate increased by 26 beats/min from rest and mean systolic BP increased by 16 mm Hg. In adjusted analyses, increases in systolic BP ( P = .021), heart rate ( P = .002), mean arterial pressure ( P = .034), and rate–pressure product ( P < .001) from rest to 2 minutes of constant-load exercise were negatively associated with COT. Similarly, increases in heart rate ( P = .012) and rate–pressure product ( P = .018) from rest to 2 minutes of constant-load exercise were negatively associated with PWT. A greater exercise pressor response observed after only 2 minutes of walking at no incline was independently associated with impaired claudication outcomes in patients with symptomatic PAD. The implication is that the exercise pressor response is an important and easily obtained clinical measurement that partially explains differences in PWT and COT.

Patients With Peripheral Arterial Disease With Exaggerated Pressor Response Have Greater Ambulatory Dysfunction Than Patients With Lower Pressor Response

“…Previously, we have shown that the exaggerated BP response to exercise is associated with worse functional outcomes such as shorter COT and PWT. 19 Findings from the current report support this association and extend our previous results by showing that the association between exaggerated exercise pressor response and shorter COT and PWT is not due to differences in comorbid burden.…”

“…The changes in BP and HR values from rest to the completion of the first 2 minutes of exercise were calculated and used to quantify the exercise pressor response, as previously reported. 19 Determining the exercise pressor response after only 2 minutes of the treadmill test was done because walking for this duration at this work stage (2 mph speed, 0% incline) was more predictive of the clinically relevant outcomes of COT and PWT than when the exercise pressor response was determined at later exercise time points. 19…”

“…This exaggerated BP response to exercise has been shown to be negatively associated with functional outcomes such as claudication onset time (COT) and peak walking time (PWT). 19 Furthermore, we have observed that a subset of patients experience a decrease in BP during the initial minutes of exercise similar to patients with coronary artery diseases or cardiomyopathy, 20 –22 which is strongly associated with adverse events such as cardiac arrhythmia. 23 However, it has not been elucidated whether an exaggerated or a negative pressor response within patients with PAD is associated with functional outcomes independent of comorbid conditions.…”

Nutritional Considerations for Peripheral Arterial Disease: A Narrative Review

“…The timing and composition of nutritional support, in particular supplementary protein, is critical in achieving optimal outcomes for exercise interventions [50,51]. Nutrients with anti-oxidant and anti-inflammatory properties are also essential, not only to treat the underlying atherosclerotic systemic disease state, but also in light of recent work in patients with IC demonstrating a negative association between walking performance and markers of endothelial cell inflammation and a positive association with ambulatory ability and circulating anti-oxidant capacity [52].…”

Vascular Inflammation, Calf Muscle Oxygen Saturation, and Blood Glucose are Associated With Exercise Pressor Response in Symptomatic Peripheral Artery Disease

“…15 Furthermore, we recently found that a greater exercise pressor response is independently associated with impaired treadmill claudication outcomes. 16 Finally, a greater exercise pressor response in patients with PAD indicates a greater increase in their blood pressure and heart rate at a given exercise intensity, 17 thereby increasing the work of the heart and possibly the risk of an adverse event during an exercise session, such as acute myocardial infarction or sudden cardiac death. 18 Based on the previous findings, there are a few possible mechanisms for an exaggerated exercise pressor response in PAD.…”