Background:
Patients with type 2 diabetes mellitus (T2DM) have increased large artery stiffness and exaggerated brachial and central systolic blood pressure (SBP) responses to exercise. Elevations in exercise central SBP may be a result of increased arterial wave reflections and this study aimed to test this hypothesis.
Methods:
Maximal exercise stress tests were conducted in 50 T2DM patients (55 ± 8y, 70% males) and 50 controls (56 ± 8y, 70% males) matched by age, gender, maximal exercise brachial SBP and heart rate. Brachial and central BP were measured at rest and immediately post-exercise. Augmentation index (AIx), augmented pressure (AP; markers of wave reflection) and central SBP were recorded by radial tonometry.
Results:
Despite no significant differences between groups in maximal exercise brachial or central SBP, AIx and AP were significantly lower in T2DM patients (Table
). Exercise central SBP was inversely and independently associated with exercise AIx in the T2DM patients (β= -0.32; p=0.05) but not controls (β= -0.10; p=0.49). The presence of T2DM was also identified as a weak but significant independent determinant of exercise AIx (β= -0.19) and central SBP (β= 0.10; p<0.05 both).
Conclusions:
Patients with T2DM have 1) a paradoxical reduction in wave reflection at maximal exercise and 2) a significant inverse association between wave reflection and exercise central SBP that is not observed in controls. The reduced reflected pressure waves may indicate an increase in peripheral vasodilation to offset high exercise central BP.
Exercise hemodynamics in T2DM patients and controls
A COMPARISON OF CLINICAL OUTCOMES IN THE BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION IN TYPE-2 DIABETES MELLITUS (BARI 2D) BY TYPE OF STENT IMPLANTATION
