Patients with stage 2 or 3 chronic kidney disease had significantly greater increases in mean arterial pressure during static handgrip exercise compared with hypertensive controls (P=0.045).
Cross-Sectional (n=26)
Do patients with stage 2 or 3 CKD and hypertension have an augmented blood pressure and sympathetic nervous system response during exercise compared to hypertensive controls?
Patients with CKD exhibit an exaggerated blood pressure response during exercise, driven by underlying sympathetic nervous system overactivation that is unmasked when arterial baroreflex constraint is relieved.
p-value: p=0.045
Patients with chronic kidney disease (CKD) have poor exercise capacity, which contributes to cardiovascular risk. We sought to determine whether patients with stage 2 or stage 3 CKD have an augmented blood pressure (BP) response during exercise, and if so, whether overactivation of the sympathetic nervous system (SNS) during exercise might play a role. In 13 patients with CKD and hypertension and 13 controls with hypertension, we measured hemodynamics and muscle sympathetic nerve activity (MSNA) during the following maneuvers: low-level rhythmic handgrip (RHG 20%), which primarily stimulates mechanoreceptors, and moderate static handgrip exercise (SHG 30%) followed by posthandgrip circulatory arrest (PHGCA), which isolates metaboreceptors. During baseline studies, patients with CKD had significantly greater increases in mean arterial pressure (MAP) during SHG 30% (P = 0.045), RHG 20% (P = 0.031), and PHGCA (P = 0.043); however, the MSNA response was not augmented in patients with CKD compared with controls. We hypothesized that an augmented SNS response during exercise might be revealed in CKD if arterial baroreflex constraint was equalized using nitroprusside (NTP). These exercise maneuvers were repeated in patients with CKD during NTP infusion to equalize the BP response between groups, thereby relieving baroreflex-mediated suppression of SNS activity. With NTP infusion, patients with CKD had significantly increased MSNA responses during SHG 30% (P = 0.0044), and RHG 20% (P = 0.0064), but not during PHGCA (P > 0.05), suggesting increased reflex activation of the SNS during exercise, which may be mediated by mechanoreceptors but not metaboreceptors. Patients with CKD have an exaggerated BP response during rhythmic and static exercise with underlying SNS overactivation that is revealed during arterial baroreflex unloading during exercise.
Park et al. (Fri,) conducted a cross-sectional in Chronic kidney disease and hypertension (n=26). Exercise maneuvers (handgrip) and nitroprusside infusion vs. Hypertensive controls was evaluated on Increase in mean arterial pressure (MAP) during moderate static handgrip exercise (SHG 30%) (p=0.045). Patients with stage 2 or 3 chronic kidney disease had significantly greater increases in mean arterial pressure during static handgrip exercise compared with hypertensive controls (P=0.045).