Patients with coronary artery disease have sustained elevation in blood pressure following exercise

1. Coronary artery disease patients had sustained elevations in central systolic blood pressure (cSBP) during recovery after exercise whereas controls had a hypotensive central response

2. There were no meaningful changes in brachial systolic blood pressure following exercise

3. Post-exercise cSBP response in CAD patients were present regardless of exercise intensity

Evidence Rating Level: 1 (Excellent)

This randomized controlled investigated the divergent post-exercise responses of central (cSBP) and brachial systolic blood pressure (bSBP) in patients with coronary artery disease (CAD). Given that cSBP is more predictive of cardiovascular events than bSBP and that post-exercise hypotension (PEH) is often attenuated in CAD patients, the study aimed to clarify how combined exercise of varying intensities (high vs. moderate) affects both central and peripheral BP. Seventeen patients with stable CAD and 18 age-matched controls underwent two combined exercise sessions, with post-exercise BP and arterial stiffness (cfPWV) measured at 5, 15, and 30 minutes. Linear mixed models were used for group comparisons, and individual BP responsiveness was analyzed via Bayesian methods (ROPE + HDI). There was a significant group-by-time interaction for cSBP (p < 0.001, ω² = 0.16), with CAD patients experiencing sustained elevations in cSBP during recovery (mean increase at 30 minutes: +10 mmHg, 95% CI: 4 to 17 mmHg, p = 0.001). In contrast, controls exhibited a clear central hypotensive response (mean decrease at 30 minutes: -13 mmHg, 95% CI: -19 to -7 mmHg, p = 0.003). Interestingly, bSBP did not show meaningful post-exercise changes in either group, suggesting a disconnect between central and peripheral BP responses. Individual-level analysis supported these trends, with most CAD patients (65% after high-intensity, 53% after moderate-intensity exercise) classified as central hypertensive responders, while 61% of controls demonstrated central hypotension post-exercise. Therefore, post-exercise cSBP responses in CAD patients remain elevated irrespective of exercise intensity, challenging the traditional reliance on bSBP to assess vascular response to exercise. These findings highlight the clinical importance of monitoring central BP in CAD patients, as sustained elevations in cSBP may indicate transient organ damage risk and altered hemodynamic regulation. Further research is warranted to explore whether these central BP patterns predict future cardiovascular events and how exercise interventions might be tailored to mitigate this risk.

Click to read the study in PLOSONE

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