Blood Pressure Response To Isometric Handgrip Exercise In Diabetic Patients Without Established Cvd: The Role Of Arterial Stiffness

Objective: a.Purpose/Background/Objectives Type 2 diabetes (T2DM) has been associated with hypertension and an increased risk for CVD. BP responses (BPR) to exercise are predictive of CVD, arterial stiffness, endothelial dysfunction, and cardiac remodeling. Previous studies have shown an exaggerated BPR in high CVD risk patients. However, studies examining exercise responses in diabetic patients are limited and most of them assessed responses during dynamic exercise. This study aimed to examine the BPR during isometric handgrip (HG) exercise between T2DM patients and a group of non-diabetic participants with similar CVD factors. A a secondary aim was to evaluate the parameters (demographic, anthropometric or arterial stiffness indices) that better predict the BPR to HG exercise in T2DM. Design and method: b.Methods Blood pressure was assessed in the office, during 24 hours, and by applanation tonometry (central BP). Arterial stiffness was further evaluated as pulse wave velocity (PWV) and Augmentation Index (Sphygmocor). Participants performed a submaximal 3-min HG exercise (30% MVC) with continuous beat-by-beat hemodynamic assessment (Finapress). None of the participants was receiving antihypertensive treatment. Results: c.Results Fifty-two individuals (aged 54.5 ± 8.1 years), 28 T2DM (HbA1c 6.7/IQ: 6.3–7.9% and disease duration 5/IQ:0.5–10 years) and 24 matched non-diabetics with similar baseline and BP characteristics participated. Groups were matched for age, BMI, gender, office and ambulatory BP; therefore, no differences were found. Although patients with T2DM had increased PWV vs. non-diabetics (9.0+1.6 vs 7.7+1.2m/s, p = 0.002), average exercise-BPR were similar between groups. Among the different BP assessment methods, central BP exhibited the strongest correlation (r = 0.534- to 0.704, p < 0.001) with BPR during the 1st min of HG. The multivariate analysis showed that in the T2DM group, PWV and office BP were significant predictors of the 1stmin exercise BP response; whereas in the non-diabetic group, only baseline office BP remained a statistically significant predictor of exercise BPR. Conclusions: d.Conclusions Our findings suggest that adequately controlled diabetic patients (without established CVD) exert similar exercise BPR with non-diabetic individuals with similar CVD factors and baseline BP. Increased arterial stiffness characterizing these patients, seems to be an important vascular factor predicting the BPR during handgrip exercise.