Blood pressure response to exercise is exaggerated in normotensive diabetic patients

Figures & data

Table I. Baseline characteristics.

	Group 1 (Diabetes mellitus) n = 67	Group 2 (Healthy volunteers) n = 68	p-value
Age (years)	51.8 ± 9	50.7 ± 7	0.424
Gender (male/female)	28/39	29/39	0.835
Body mass index (kg/m^2)	28.9 ± 4.3	27.2 ± 3.5	0.011
Fasting plasma glucose (mg/dl)	98.5 ± 28.0	90.9 ± 7.8	0.143
Glycosylated hemoglobin A1c (%)	6.0 ± 2.4	5.7 ± 0.3	0.211
Low density lipoprotein (mg/dl)	127.5 ± 39.2	125.6 ± 34.8	0.772
High density lipoprotein (mg/dl)	43.8 ± 10.1	44.2 ± 9.3	0.817
Triglycerides (mg/dl)	174.6 ± 80.7	188.9 ± 85.8	0.321
Total cholesterol (mg/dl)	207.6 ± 43.4	208.8 ± 42.1	0.868
Thyroid stimulating hormone (mIU/L)	2.1 ± 1	2.1 ± 0.9	0.938
Office systolic BP (mmHg)	120.7 ± 15.2	118.8 ± 11.3	0.435
Office diastolic BP (mmHg)	73.7 ± 10.3	73.3 ± 8.4	0.724
Office heart rate (beats/min)	85.5 ± 13.4	86.2 ± 14.5	0.523
Ambulatory BP monitoring results
Daytime systolic BP (mmHg)	120.8 ± 8.9	119.5 ± 7.6	0.255
Daytime diastolic BP (mmHg)	75.3 ± 7.4	74.8 ± 3.6	0.324
Night-time systolic BP (mmHg)	110.4 ± 10.7	107.5 ± 9.6	0.145
Night-time diastolic BP (mmHg)	67.5 ± 11.2	66.8 ± 10.5	0.512
24-h systolic BP (mmHg)	116.2 ± 10.2	115.1 ± 12.4	0.432
24-h diastolic BP (mmHg)	73.8 ± 7.9	72.2 ± 6.6	0.336
24-h heart rate (beats/min)	75.6 ± 11.9	77.3 ± 12.3	0.576

Data are expressed as mean ± standard deviation for normally distributed data and percentage (%) for categorical variables. BP, blood pressure.

Table II. Exercise test results of groups.

	Group 1 (Diabetes mellitus) n = 67	Group 2 (Healthy volunteers) n = 68	p-value
Rest systolic BP (mmHg)	121.9 ± 13.1	120.2 ± 10	0.377
Rest diastolic BP (mmHg)	75.5 ± 8.7	76.5 ± 5.7	0.412
Rest heart rate (beats/min)	93.2 ± 15.4	91 ± 11.7	0.350
1st-stage systolic BP (mmHg)	154.5 ± 20.6	138.6 ± 13.5	0.001
1st-stage diastolic BP (mmHg)	82.4 ± 13.4	79.9 ± 8.1	0.190
1st-stage heart rate (beats/min)	119.9 ± 15.2	117.7 ± 16.5	0.413
2nd-stage systolic BP (mmHg)	176 ± 20.9	152.4 ± 14.6	0.001
2nd-stage diastolic BP (mmHg)	80.2 ± 13.7	80.3 ± 10.2	0.970
2nd-stage heart rate (beats/min)	135.8 ± 15.7	134.8 ± 16.4	0.715
3rd-stage systolic BP (mmHg)	197.2 ± 18.1	166.1 ± 18.4	0.001
3rd-stage diastolic BP (mmHg)	81.2 ± 15.5	84.4 ± 10.6	0.167
3rd-stage heart rate (beats/min)	157.4 ± 19.4	160.3 ± 14.1	0.329
Recovery 1st-min systolic BP (mmHg)	161.3 ± 30.4	147.1 ± 12.1	0.001
Recovery 1st-min diastolic BP (mmHg)	75.9 ± 12.1	78 ± 8.3	0.238
Recovery 1st-min heart rate (beats/min)	134.2 ± 21.7	133 ± 19	0.730
Recovery 3rd-min systolic BP (mmHg)	129.1 ± 17.1	127.6 ± 13.1	0.565
Recovery 3rd-min diastolic BP (mmHg)	74.4 ± 9.4	76.6 ± 7.4	0.345
Recovery 3rd-min heart rate (beats/min)	105.9 ± 13.9	102.8 ± 13.1	0.184
Peak exercise systolic BP (mmHg)	196.9 ± 18	165.9 ± 18.6	0.001
Peak exercise diastolic BP (mmHg)	88.1 ± 11.6	86.2 ± 8.7	0.283
Exercise capacity (METs)	11.9 ± 1.6	12.1 ± 1.7	0.475
Exercise duration (min)	9.3 ± 1.5	9.3 ± 1.5	0.927
Hypertensive response to exercise (%)	39 (58)	6 (9)	0.001
Rest pulse pressure	46.2 ± 7.0	43.8 ± 10.6	0.132
Peak pulse pressure	110.5 ± 16.9	80.2 ± 19.5	0.001
Delta systolic BP (mmHg)	76.4 ± 16.1	46.0 ± 16.1	0.001
Delta diastolic BP (mmHg)	12.5 ± 12.2	9.7 ± 8.1	0.105

Data are expressed as mean ± standard deviation for normally distributed data and percentage (%) for categorical variables. BP, blood pressure; MET, metabolic equivalents.

Figure 1. Blood pressures in patients with type 2 diabetes mellitus (group 1) compared with healthy volunteers (group 2) at rest, during exercise and in 24-h ambulatory blood pressure monitoring. DM, diabetes mellitus; HV, healthy volunteers.

Table III. Independent correlates of exercise peak systolic blood pressure in linear regression analysis.

Independent variable	Standardized β	% R^2	p-value
Type 2 diabetes mellitus	0.61	38	0.001
Rest systolic blood pressure	0.28	8	0.001
Gender (male)	0.12	1	0.046
Age (year)	0.11	–	0.066
Body mass index (kg/m^2)	0.05	–	0.422

Overall R² = 52% p 0.001. % R² indicates the percentage contribution of the independent variable to the overall R².

Table IV. Independent predictors of hypertensive response to exercise in logistic regression analysis.

Independent variable	Odds ratio (95% CI)^a	p-value
Type 2 diabetes mellitus	20.699 (6.538–66.157)	0.001
Rest systolic blood pressure	1.106 (1.055–1.160)	0.001
Gender (male)	0.469 (0.175–1.254)	0.131
Age (years)	0.067 (1.006–1.130)	0.025
Body mass index (kg/m^2)	0.997 (0.885–1.124)	0.964

^aAdjusted for age, gender, rest systolic blood pressure, type 2 diabetes mellitus, body mass index. CI, confidence interval.