Relationship Between Central Arterial Pressure, Exercise and Fitness Level in Stable Coronary Artery Disease

Abstract

Background: Augmentation of central arterial pressure increases cardiovascular risk, and interventions which lower pressure augmentation may reduce risk. It is not known whether greater physical fitness is associated with reduced central pressure augmentation. Methods: In 173 patients (140 males, age 61 ± 9 years) with stable coronary artery disease (CAD), central augmentation pressure (cAP) and augmentation index (cAI) were measured by Pulsecor R6.5 at rest and after treadmill exercise. Aerobic capacity was determined by measuring maximal oxygen consumption (VO2max) using the Moxus metabolic cart (AEI Technologies). Results: Both cAP and cAI at rest were associated with age (+10 years, cAP 3.1, 95%CI, 1.9 to 4.2 mmHg, p < 0.0001) and height (+10 cm, cAP −2.9, CI −4.4 to −1.5 mmHg, p < 0.0001). There was no association between cAI or cAP at rest and VO2max after adjusting for age and height (for VO2max + 1 mL/kg/m2, cAP 0.1, CI −0.08 to 0.28 mmHg, p = 0.26; cAI 0.3%, CI −0.03 to 0.6%, p = 0.08). Mean cAP decreased from 10.2 ± SD 7.7 at rest to 8.4 ± 6.5 immediately after exercise, 6.4 ± 6.0 five minutes, and 5.2 ± 3.7 mmHg ten minutes after exercise (p < 0.0001). Mean cAI decreased from 27 ± 13% at rest to 18 ± 10% immediately after exercise, 20 ± 11% five minutes, and 19 ± 10% after ten minutes (p < 0.0001). Both cAP and cAI decreased more during recovery in patients who exercised to a higher level as indicated by VO2max (p < 0.001). Conclusion: In CAD patients, increased physical fitness was not associated with central pressure augmentation at rest but was associated with a larger reduction in pressure augmentation after exercise.