Insulin resistance is associated with an exaggerated blood pressure response to ischemic rhythmic handgrip exercise in nondiabetic older adults.
Insulin resistance is associated with an exaggerated blood pressure response to ischemic rhythmic handgrip exercise in nondiabetic older adults.
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胰岛素抵抗与非糖尿病老年人对缺血性节律性握力运动的过度血压反应有关。
DOI：
10.1152/japplphysiol.00247.2020
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Mizuno,Masaki
中科院分区：
文献类型：
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作者：
Hotta,Norio;Hori,Amane;Okamura,Yukiko;Baba,Reizo;Watanabe,Hidehiro;Sugawara,Jun;Vongpatanasin,Wanpen;Wang,Jijia;Kim,Han-Kyul;Ishizawa,Rie;Iwamoto,GaryA;Mitchell,JereH;Smith,ScottA;Mizuno,Masaki
2型糖尿病患者对运动表现出夸大的升压反应。然而，在非糖尿病受试者中，支持运动升压反应的幅度与胰岛素抵抗相关因素包括血红蛋白A1c(HbA1c)或胰岛素抵抗的稳态模型评估(HOMA-IR)之间的关联的证据仍然很少，也没有定论。因此，我们调查了60岁以上非糖尿病健康男性(n=23)和女性(n=22)对运动的心血管反应与胰岛素抵抗相关因素的关系。我们测量了心率(HR)和血压(BP)在以下过程中的反应：30%最大自主收缩的等长握力(IHG)运动，IHG后手臂止血所致的一段时间的骨骼肌缺血(SMI)，以及SMI期间的有节奏的动态握力(DHG)运动。男性(r= 0.44，P=0.0 2)、高糖化血红蛋白(r= 0.33，P=0.0 3)、心脏-脚踝脉搏波速度(r= 0.45，P=0.0 1)和静息收缩压(r= 0.36，P=0.0 2)与舒张压增大有关。在多变量模型中，尽管对性别、haPWV和静息SBP进行了调整，但HbA1c仍然是解释DBP对dHG和SMI反应差异的重要决定因素。HOMA-IR异常组(Δ33 ± 3 mm Hg)的舒张压反应显著高于中度组(Δ20 ± 4 mm Hg)和正常组(Δ23 ± 2 mm Hg)。这些数据表明，即使在非糖尿病老年人中，胰岛素抵抗也与运动的过度升压反应有关，特别是在缺血条件下进行运动时。新与诺特沃特赫特在非糖尿病老年人中，缺血条件下有节奏的动态握手运动的舒张压反应被证明与胰岛素抵抗相关因素相关。这一发现为这一特殊患者群体的运动处方提供了重要的见解，因为运动对血压的反应，特别是在缺血条件下，可能被夸大到不安全的水平。
Patients with type 2 diabetes display an exaggerated pressor response to exercise. However, evidence supporting the association between the magnitude of the pressor response to exercise and insulin resistance-related factors including hemoglobin A1c (HbA1c) or homeostatic model assessment of insulin resistance (HOMA-IR) in nondiabetic subjects has remained sparse and inconclusive. Thus we investigated the relationship between cardiovascular responses to exercise and insulin resistance-related factors in nondiabetic healthy men (n= 23) and women (n= 22) above 60 yr old. We measured heart rate (HR) and blood pressure (BP) responses during: isometric handgrip (IHG) exercise of 30% maximal voluntary contraction, a period of skeletal muscle ischemia (SMI) induced by tourniqueting the arm after IHG, and rhythmic dynamic handgrip (DHG) exercise during SMI. Greater diastolic BP (DBP) responses to DHG with SMI was associated with male sex (r= 0.44,P= 0.02) and higher HbA1c (r= 0.33,P= 0.03), heart-ankle pulse wave velocity (haPWV) (r= 0.45,P< 0.01), and resting systolic BP (SBP) (r= 0.36,P= 0.02). HbA1c persisted as a significant determinant explaining the variance in the DBP response to DHG with SMI in multivariate models despite adjustment for sex, haPWV, and resting SBP. It was also determined that the DBP response to DHG with SMI in a group in which HOMA-IR was abnormal (Δ33 ± 3 mmHg) was significantly higher than that of groups in which HOMA-IR was at intermediate (Δ20 ± 4 mmHg) and normal (Δ23 ± 2 mmHg) levels. These data suggest that even in nondiabetic older adults, insulin resistance is related to an exaggerated pressor response to exercise especially when performed under ischemic conditions.NEW & NOTEWORTHYThe diastolic blood pressure response to rhythmic dynamic handgrip exercise under ischemic conditions was demonstrated to be correlated with insulin resistance-related factors in nondiabetic older adults. This finding provides important insight to the prescription of exercise in this particular patient population as the blood pressure response to exercise, especially under ischemic conditions, could be exaggerated to nonsafe levels.