Digital Blood Pressure in Normal Subjects and Patients with Peripheral Arterial Disease Effect of Change in Temperature

Background/Aims Peripheral arterial disease is common among those aged 60 years or above and can cause debilitating intermittent claudication. This impacts quality of life and is a marker for increased morbidity and mortality, mainly from cardiovascular disease. Access to recommended exercise programmes for people with symptomatic peripheral arterial disease is poor in most areas of the UK. This study aimed to evaluate the benefits of expanding an established cardiac rehabilitation service to accommodate supervised exercise for people with peripheral arterial disease Methods The study evaluated 11 participants peripheral arterial disease and intermittent claudication who were referred by the Manchester leg circulation service. Participants underwent the programme involving eight weekly 1.5 hour sessions of supervised exercise and cardiovascular education with support, reassurance and motivation. The participants' blood pressure, walking impairment, quality of life, anxiety and depression were monitored and reviewed. Results Overall, the participants' walking distance, intermittent claudication, quality of life and blood pressure had improved. The participants' overall satisfaction with the programme was excellent. The programme also demonstrated clinical and cost-effectiveness. Conclusions A structured, supervised exercise programme can have considerable benefits for people with peripheral arterial disease, improving their symptoms and quality of life. It may also help to reduce the morbidity and mortality risks associated with inactivity in this patient group.

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Heat therapy vs. supervised exercise therapy for peripheral arterial disease: a 12-wk randomized, controlled trial

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00151.2019 ◽

2019 ◽

Vol 316 (6) ◽

pp. H1495-H1506 ◽

Cited By ~ 10

Author(s):

Ashley P. Akerman ◽

Kate N. Thomas ◽

Andre M. van Rij ◽

E. Dianne Body ◽

Mesfer Alfadhel ◽

...

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Water Immersion ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Hot Water ◽

Walking Distance ◽

Supervised Exercise ◽

Heat Therapy ◽

Peripheral Arterial

Peripheral arterial disease (PAD) is characterized by lower limb atherosclerosis impairing blood supply and causing walking-induced leg pain or claudication. Adherence to traditional exercise training programs is poor due to these symptoms despite exercise being a mainstay of conservative treatment. Heat therapy improves many cardiovascular health outcomes, so this study tested if this was a viable alternative cardiovascular therapy for PAD patients. Volunteers with PAD were randomized to 12 wk of heat ( n = 11; mean age 76 ± 8 yr, BMI 28.7 ± 3.5 kg/m2, 4 females) or exercise ( n = 11; 74 ± 10 yr, 28.5 ± 6.8 kg/m2, 3 females). Heat involved spa bathing at ∼39°C, 3–5 days/wk for ≤30 min, followed by ≤30 min of callisthenics. Exercise involved ≤90 min of supervised walking and gym-based exercise, 1–2 days/wk. Following the interventions, total walking distance during a 6-min walk test increased (from ∼350 m) by 41 m (95% CI: [13, 69], P = 0.006) regardless of group, and pain-free walking distance increased (from ∼170 m) by 43 m ([22, 63], P < 0.001). Systolic blood pressure was reduced more following heat (−7 mmHg, [−4, −10], P < 0.001) than following exercise (−3 mmHg, [0, −6], P = 0.078), and diastolic and mean arterial pressure decreased by 4 mmHg in both groups ( P = 0.002). There were no significant changes in blood volume, ankle-brachial index, or measures of vascular health. There were no differences in the improvement in functional or blood pressure outcomes between heat and exercise in individuals with PAD. NEW & NOTEWORTHY Heat therapy via hot-water immersion and supervised exercise both improved walking distance and resting blood pressure in peripheral arterial disease (PAD) patients over 12 wk. Adherence to heat therapy was excellent, and the heat intervention was well tolerated. The results of the current study indicate that heat therapy can improve functional ability and has potential as an effective cardiovascular conditioning tool for individuals with PAD. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/heat-therapy-vs-exercise-in-peripheral-arterial-disease/ .

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Response by Itoga et al to Letter Regarding Article, “Association of Blood Pressure Measurements With Peripheral Arterial Disease Events”

Circulation ◽

10.1161/circulationaha.119.039293 ◽

2019 ◽

Vol 139 (15) ◽

pp. 1855-1856

Author(s):

Nathan K. Itoga ◽

Daniel S. Tawfik ◽

Nicholas J. Leeper ◽

Tara I. Chang

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Pressure Measurements ◽

Peripheral Arterial

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Ankle Brachial Pressure Index: An update for the vascular specialist and general practitioner

Vascular ◽

10.1177/1708538119842395 ◽

2019 ◽

Vol 27 (5) ◽

pp. 560-570 ◽

Cited By ~ 1

Author(s):

Benjamin Thurston ◽

Joseph Dawson

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Cardiac Risk Factor ◽

Diabetic Patients ◽

Ankle Brachial Pressure Index ◽

Pressure Index ◽

Clinical Scenarios ◽

Invaluable Tool ◽

Peripheral Arterial

Objectives Ankle brachial pressure index (ABPI) is an invaluable tool for assessing the severity of peripheral arterial disease. In addition, it can be used as an independent marker of cardiovascular risk, with a predictive ability similar to the Framingham criteria. Identification of an abnormal ABPI should therefore trigger aggressive cardiac risk factor modulation for a patient. Unfortunately, the significance of abnormal ABPIs is poorly understood within the general medical community. This is compounded by the influence of various comorbidities on accurate measurement of ABPI, potentially leading to a wide variability in readings that need to be considered before interpretation in these patient populations. We aim to address these issues by revealing several common misunderstandings and pitfalls in ABPI measurement, describing accurate methodology, and highlighting patient cohorts in whom additional or alternative approaches may be required. Methods We present a narrative review of the role of ABPI in both the community and hospital setting. We have performed a literature review, exploring the validity and reproducibility of methodology for obtaining ABPI, alongside the utility of ABPI in different clinical scenarios. Results The measurement of ABPI is often performed incorrectly. Common pitfalls include inadequate patient preparation, failure to obtain the blood pressure from the correct lower limb artery in patients with tibial disease, failure to account for differences in brachial blood pressure between the arms, inappropriately chosen equipment and patient factors such as highly calcified arteries. Standardisation of methodology greatly improves reliability of the test. Exercise ABPI can identify significant peripheral arterial disease in patients with normal resting ABPI. In addition to its role in peripheral arterial disease, ABPI measurement has a role in assessing venous ulcers, entrapment syndromes and injured extremities; conversely, it has a more limited utility in the diabetic population. Conclusions A thorough understanding of the correct technique and associated limitations of ABPI measurement is essential in accurately generating and interpreting the data it provides. With this knowledge, the ABPI is an invaluable tool to help manage patients with peripheral arterial disease. Perhaps more importantly, ABPI can be used to identify and risk stratify patients with asymptomatic peripheral arterial disease, itself a major indicator of significant underlying cardiovascular disease. With the emergence of best medical therapy, targeted pharmacotherapy and lifestyle changes can reduce the risk of major cardiovascular events in high-risk patients by approximately 30%, particularly in diabetic patients. Therefore, the utility of ABPI transgresses vascular surgery, with an essential role in general practice and public health.

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Toe-brachial index and toe systolic blood pressure for the diagnosis of peripheral arterial disease

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd013783 ◽

2020 ◽

Author(s):

Peta E Tehan ◽

Joseph L Mills ◽

Mathew Sebastian ◽

Christopher Oldmeadow ◽

Vivienne Chuter

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Systolic Blood Pressure ◽

Arterial Disease ◽

Toe Brachial Index ◽

Peripheral Arterial

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Skeletal muscle carnitine metabolism in patients with unilateral peripheral arterial disease

Journal of Applied Physiology ◽

10.1152/jappl.1992.73.1.346 ◽

1992 ◽

Vol 73 (1) ◽

pp. 346-353 ◽

Cited By ~ 94

Author(s):

W. R. Hiatt ◽

E. E. Wolfel ◽

J. G. Regensteiner ◽

E. P. Brass

Keyword(s):

Peripheral Arterial Disease ◽

Lactate Threshold ◽

Normal Subjects ◽

Arterial Disease ◽

Short Chain ◽

Peak Exercise ◽

Muscle Lactate ◽

Control Subjects ◽

Carnitine Metabolism ◽

Peripheral Arterial

Patients with peripheral arterial disease (PAD) have abnormalities of carnitine metabolism that may contribute to their functional impairment. To test the hypothesis that muscle acylcarnitine generation (intermediates in oxidative metabolism) in patients with PAD provides a marker of the muscle dysfunction, 10 patients with unilateral PAD and 6 age-matched control subjects were studied at rest, and the patients were studied during exercise. At rest, biopsies of the gastrocnemius muscle in the patients' nonsymptomatic leg revealed a normal carnitine pool and lactate content compared with control subjects. In contrast, the patients' diseased leg had higher contents of lactate and long-chain acylcarnitines than controls. The muscle short-chain acylcarnitine content in the patients' diseased leg at rest was inversely correlated with peak exercise performance (r = -0.75, P less than 0.05). With graded treadmill exercise, only patients who exceeded their individual lactate threshold had an increase in muscle short-chain acylcarnitine content in the nonsymptomatic leg, which was identical to the muscle carnitine response in normal subjects. In the patients' diseased leg, muscle short-chain acylcarnitine content increased with exercise from 440 +/- 130 to 900 +/- 200 (SE) nmol/g (P less than 0.05). In contrast to the nonsymptomatic leg, there was no increase in muscle lactate content in the diseased leg with exercise, and the change in muscle carnitine metabolism was correlated with exercise duration (r = 0.82, P less than 0.01) and not with the lactate threshold. We conclude that energy metabolism in ischemic muscle of patients with PAD is characterized by the accumulation of acylcarnitines.(ABSTRACT TRUNCATED AT 250 WORDS)

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