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(Circulation. 2000;101:611.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Diastolic Blood Pressure Changes During Exercise Positively Correlate With Serum Cholesterol and Insulin Resistance

Sally E. Brett, BN; James M. Ritter, FRCP; Philip J. Chowienczyk, FRCP

From the Department of Clinical Pharmacology, Centre for Cardiovascular Biology and Medicine, King’s College, St Thomas’ Hospital, London SE1 7EH, UK.

Correspondence to S.E. Brett, Department of Clinical Pharmacology, St Thomas’ Hospital, Lambeth Palace Rd, London, UK SE1 7EH. E-mail s.brett{at}umds.ac.uk

Background—Metabolic factors, including plasma concentrations of cholesterol and insulin resistance, may influence blood pressure through effects on vascular reactivity. Such effects might influence blood pressure during exercise more strongly than at rest.

Methods and Results—We examined whether there is an association between serum cholesterol or insulin resistance and change in blood pressure during mild exercise. Blood pressure was measured at rest and during fixed low-workload bicycle ergometry (50, 75, and 100 W, each for 3 minutes) in 75 healthy active men (age, 18 to 66 years). Blood pressure at rest was not significantly correlated with serum cholesterol or insulin resistance (estimated from the fasting glucose–insulin product). The change from resting values in diastolic but not systolic blood pressure during exercise was correlated with serum cholesterol (R>0.47, P<0.0001 for each workload) and insulin resistance (R>0.38, P<0.01 for each workload). Serum cholesterol and insulin resistance were the only independent predictors of the change in diastolic blood pressure during exercise in a stepwise regression model incorporating age, body mass index, serum cholesterol, triglycerides, HDL cholesterol, insulin resistance, and heart rate during exercise. In a further study, the change in diastolic blood pressure during exercise was greater in men with uncomplicated type 2 diabetes (13.6 mm Hg [95% CI, 8.5 to 18.8]; n=10) than in nondiabetic control men (2.7 mm Hg [95% CI, -2.0 to 7.3]; n=10; P=0.002).

Conclusions—Changes in diastolic blood pressure during gentle exercise are strongly associated with serum concentrations of total cholesterol and insulin resistance. This may contribute to development of hypertensive complications in dyslipidemic and/or insulin-resistant patients.

Key Words: blood pressure • diabetes mellitus • exercise • hypercholesterolemia

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