Interarm blood pressure difference which is observed relatively common in clinical practice has been reported with association to the increased cardiovascular or all-cause death as well as several atherosclerotic markers. The aim of this study is to investigate the association between interarm systolic blood pressure (SBP) difference and heart rate recovery (HRR) after symptom-limited treadmill exercise, an index of autonomic dysfunction in patients with chest discomfort.Design and Method:
One thousand thirteen patients (56 ± 10 yrs) who measured SBP in both arms with ankle-brachial index (ABI) and underwent treadmill stress echocardiography with chest discomfort were consecutively enrolled. Carotid arterial evaluations including intima-media thickness (IMT), existence of plaques, maximal plaque size and segments with plaques and HRR at 2 minutes following exercise were also assessed.Results:
Patients with interarm SBP difference ≥ 10 mmHg had higher body mass index, and mean blood pressure, increased carotid IMT, more existence of plaques, larger maximal plaque size and segments with plaques and lower ABI and metabolic equivalents and slower HRR. Among them, the interarm SBP difference ≥ 10 mmHg was independently associated with slower HRR after adjusting for all possible confounders.Conclusions:
Increased interarm SBP difference was associated with slower HRR in patients with chest discomfort. This result may suggest that one possible mechanism related to adverse outcome in patients with increased interarm SBP difference is linked to abnormalities of parasympathetic activation.