Association between adiposity indices and exercise-induced blood pressure response in patients with thoracic aortic aneurysm

Background/Introduction Individuals with thoracic aortic aneurysms (TAA) must maintain optimal control of blood pressure, ideally keeping it as low as tolerated. Poorly controlled hypertension significantly increases the risk of aortic dissection and mortality in this population. Because blood pressure rises during physical activity, various concerns may limit engagement in exercise. Although higher adiposity indices are linked to greater aortic dilatation, the relationship between adiposity and exercise-induced blood pressure responses in patients with TAA has not yet been explored. Purpose The aim of this study was to evaluate the association between exercise-induced blood pressure response and adiposity indices in patients with TAA. Methods Anthropometric and body composition measurements as well as medical history and pharmacotherapy were collected. Participants performed a maximal exercise testing on ergocycle until volitional exhaustion. During this test, blood pressure was taken every two minutes. Maximal exercise systolic blood pressure (SBP) response was defined as the ratio between the increase in SBP and the increase in metabolic equivalents between rest and maximal exercise. Maximal SBP and the SBP response were used to characterize the exercise-induced blood pressure response. Results A total of 43 participants with TAA (54±11 years ; 79%male) were divided into two groups according to their antihypertensive treatment status: the treatment group (n=31, 56±10 years ; 78%male) and the untreated group (n=12, 48±12 years ; 83%male). Compared to the untreated group, the treatment group showed a trend toward higher body mass index (BMI) (28.6±5.3 vs. 26.5±2.7 kg/m²; p=0.09) and waist circumference (WC) (100.7±13.9 vs. 91.8±9.8 cm; p=0.07) as well as a significant higher waist-to-height ratio (0.59±0.1 vs. 0.53±0.1; p=0.03). Among participants with antihypertensive treatment, each adiposity indices was associated (p<0.05) with the SBP response to exercise (weight: r=0.49; BMI: r=0.55; WC: r=0.62; waist-to-height ratio: r=0.63), but no relationship was observed between adiposity indices and maximal SBP. In participants without antihypertensive treatment, BMI (r=0.67), WC (r=0.66), and waist-to-height ratio (r=0.77) were significantly associated with maximal SBP. Conclusion In patients with TAA, adiposity indices were positively associated with maximal SBP among those not receiving treatment, and with a greater SBP response in those undergoing treatment. These findings indicate that, regardless of antihypertensive therapy status, adiposity influences the blood pressure response to exercise in this population. Our results underscore the importance of considering both treatment status and adiposity indices when interpreting exercise-induced SBP.