From Rest to Stressed: Adults with Type 2 Diabetes Exhibit a Greater Exercise‐Induced Increase in Arterial Stiffness and Vessel Hemodynamics

Abstract

ObjectiveIndividuals with type 2 diabetes mellitus (T2DM) are known to have a greater blood pressure (BP) response to acute maximal exercise. The nature of this exaggerated response is likely a function of vascular abnormalities; therefore, we aimed to examine the exercise‐induced response of carotid‐femoral pulse wave velocity (cfPWV), the gold‐standard measure of arterial stiffness, and other vessel hemodynamic parameters in adults with and without T2DM.MethodsAdults with T2DM (n=77) and without T2DM (n=105) underwent an exercise test to volitional exhaustion on a treadmill (following a modified Bruce protocol). Using applanation tonometry (SphygmoCor), cfPWV and augmentation index corrected for a heart rate (HR) of 75 beats/min (AIx75) were assessed at rest, and immediately following exercise termination. At the same time points, peripheral BP, and HR were measured with an automated oscillometric BP monitor (BPTru). Linear regression models were used to evaluate between‐group differences in parameters at rest, as well as the absolute change of each parameter in response to exercise, with adjustments for exercise time and the baseline value.ResultsMean age was 59.0±11.0 years and body mass index was 31.5±4.0 kg/m2 (non‐significantly different between groups). All subjects had hypertension and were taking anti‐hypertensive medication (mean BP 130±14/80±9 mmHg). At rest, subjects with T2DM had significantly higher cfPWV (10.2±2.5 vs. 9.3±1.8 m/s), HR (70±12 vs. 66±10 beats/min), and lower diastolic BP (80±9 vs. 83±9 mmHg), but no significant difference in systolic BP (118±14 vs. 121±12 mmHg) or AIx75 (23±9 vs. 23±10%). In response to exercise, subjects with T2DM had a significantly greater increase in cfPWV by 1.3 m/s (95% CI 0.1, 2.4), systolic BP by 11.2 mmHg (95% CI 2.9, 19.5) and pulse pressure (PP) by 5.63 mmHg (95%CI 0.19, 11.08). A greater number of subjects with T2DM had a hypertensive (systolic BP>210 mmHg in men, and >190 mmHg in women) response to exercise (n=31, 30%) compared to subjects without T2DM (n=14, 18%). The increase in AIx75 was significantly lower in subjects with T2DM by 2.6% (95% CI −4.9, −0.2).ConclusionBy incorporating exercise as a vascular stressor, we provide evidence of a greater increase in arterial stiffness, independently of exercise time and resting arterial stiffness. Despite no differences in systolic BP or PP at rest, we observed an exaggerated systolic BP response in subjects with T2DM, and importantly an altered arterial stiffness response to acute exercise. Therefore, evaluating the exercise‐induced response of arterial stiffness and hemodynamic parameters may serve as a useful model for evaluating vascular impairment and CVD risk in adults with T2DM.Support or Funding InformationThis work was funded by the Canadian Institutes of Health Research (CIHR). KD and SSD hold salary awards from the Fonds de recherche du Québec‐Santé. ABC holds a PhD award from CIHR.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.