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

Abstract

We determined whether calf muscle oxygen saturation (StO2) and vascular biomarkers of inflammation and oxidative stress were associated with an exercise pressor response during treadmill walking in 179 patients with symptomatic peripheral artery disease (PAD). The exercise pressor response was measured as the change in blood pressure from rest to the end of the first 2-minute treadmill stage (2 mph, 0% grade). There was a wide range in the change in systolic blood pressure (−46 to 50 mm Hg) and in diastolic blood pressure (−23 to 38 mm Hg), with mean increases of 4.3 and 1.4 mm Hg, respectively. In multiple regression analyses, significant predictors of systolic pressure included glucose ( P < .001) and insulin ( P = .039). Significant predictors of diastolic pressure included cultured endothelial cell apoptosis ( P = .019), the percentage drop in exercise calf muscle (StO2; P = .023), high-sensitivity C-reactive protein ( P = .032), and glucose ( P = .033). Higher levels in pro-inflammatory vascular biomarkers, impaired calf muscle StO2 during exercise, and elevated blood glucose were independently associated with greater exercise pressor response in patients with symptomatic PAD. The clinical implication is that exercise and nutritional interventions designed to improve inflammation, microcirculation, and glucose metabolism may also lower blood pressure during exercise in patients with symptomatic PAD.

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

“…17,18 Other factors that were independent predictors of the exercise pressor response included endothelial cell apoptosis, endothelial cell nuclear factor-κB activity, high-sensitivity C-reactive protein, and plasma glucose and insulin concentrations. 2 Although these could all be potential mechanisms for exaggerated exercise pressor response, data from this investigation suggest that comorbid conditions of patients with PAD do not play a significant role in exaggerated BP response.…”

“…Peripheral arterial disease (PAD) is an atherosclerotic occlusive disease affecting 8 to 12 million people in the United States 1 –3 and 202 million people globally, with a 23.5% increase in prevalence in the first decade of this century. 4 Peripheral arterial disease is highly associated with all-cause and cardiovascular (CV) mortality 1 and has a great economic burden.…”

The hidden side of calf claudication: Hemodynamic and clinical results of treadmill testing in 584 patients complaining of isolated exertional calf pain

“…Aside from ABI determination, the evaluation of limb ischemia can be performed by near infra-red spectroscopy (NIRS) that has gained an increasing interest in vascular medicine [26][27][28][29][30]. This technology could theoretically be used simultaneously in calves, thighs and buttock but, to the best of our knowledge, has never been used this way until now.…”