Impaired glucose metabolism and the exaggerated blood pressure response to exercise treadmill testing in normotensive patients

Abstract

The authors aimed to investigate the association between glucose metabolism measures and the exaggerated blood pressure response (EXBPR) to exercise testing in normotensive nondiabetic patients. One hundred and forty-two consecutive patients underwent office blood pressure (BP) measurements, 24-hour BP monitoring, echocardiography, and treadmill exercise test according to the Bruce protocol. The population was divided into 2 groups according to EXBPR at a submaximal workload level. Furthermore, blood samples were obtained for fasting glucose (FG), fasting insulin (FI), and lipid profile assessment. Measures of insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR], quantitative insulin sensitivity check index [QUICKI], and McAuley index) were also estimated, and a standardized oral glucose tolerance test was performed to evaluate glucose levels at 120 minutes (G120). Patients with EXBPR (n=40; 27 men) compared with those without EXBPR (n=102; 66 men) were older by 4+/-6 years (P<.001). FG, FI, G120, HOMA-IR, QUICKI, and McAuley index differed in patients with EXBPR compared with those without EXBPR (P<.001 for all). Logistic multivariable regression models revealed that the studied glucose metabolism measures, duration of exercise, and 24-hour systolic BP remained determinants of EXBPR (P<.05 for all) after adjustment. Impaired glucose measures are significant determinants of EXBPR to exercise testing in normotensive nondiabetic patients, suggesting that impaired glucose metabolism may contribute to adverse cardiovascular prognosis including new-onset hypertension.

Figure

 Comparative per magnitude associations (z scores) of glucose metabolism measures with exaggerated blood pressure response to exercise treadmill testing after adjustment for significant confounders entered in the logistic regression models. FG indicates fasting glucose; G120, glucose at 120 minutes after standardized oral glucose tolerance test; FI, fasting insulin; HOMA‐IR, homeostasis model assessment insulin resistance; McAuley index, insulin sensitivity index corrected for fatty free mass; QUICKI, quantitative insulin sensitivity index. The statistical significance of the associations of glucose metabolism measures with exaggerated blood pressure response to exercise treadmill testing is presented in Table IV .