Post-exercise hemodynamic recovery in patients with peripheral artery disease

Introduction: An association between delayed blood pressure (BP) and heart rate (HR) recovery after exercise and cardiovascular events, independent of resting BP and HR has been reported. While studies have shown an exaggerated BP response to exercise in patients with peripheral artery disease (PAD), post-exercise hemodynamic recovery in PAD remains poorly understood. Aims/Hypothesis: This study aimed to assess post-exercise hemodynamic recovery in PAD. We hypothesized that PAD patients experience slower post-exercise hemodynamic recovery compared to the control group. Methods: Twenty-nine PAD patients (66.3±6.9 yrs; Male/female, N=20/9) and 19 healthy individuals (66.4±7.9 yrs; Male/female, N=13/6) participated in the study. The subjects performed one leg rhythmic plantar flexion (PFEx) with incremental loading (2-12 kg, + 1 kg/min) until the subject reached fatigue/tolerance or 14 min in maximum. Beat-by-beat BP and HR were recorded throughout the study. Hemodynamics were evaluated at baseline, during the final minute of PFEx, and throughout the 3 minutes following PFEx. Results: The peak increase in systolic BP (SBP) at the last min of PFEx in PAD was significantly higher than the control (D39.6±26.5 vs. D24.5±12.8 mmHg, P=0.03). The reduction in SBP from the peak to post 1-min PFEx showed no significant difference between groups (P>0.05). However, during the post 1 to 3 min from PFEx, PAD patients exhibited a notably lesser SBP decrease compared to the control group (ANCOVA, adjusting for ∆SBP changes by PFEx as a covariate: ∆-2.3±9.9 vs. ∆-5.2± 6.5 mmHg, P = 0.046). At post 3-min PFEx, the increase in SBP from the resting baseline remained greater in PAD compared to the control group (∆11.8±14.9 vs. ∆0.4±14.5 mmHg, P=0.01). The HR recovery following PFEx showed no significant difference between the groups. Conclusion: The data presented indicate that the SBP recovery after PFEx was delayed in PAD compared to the control group, leading to consistently higher SBP increases in PAD at the post 3-min PFEx. Our findings suggest that in addition to an exaggerated BP response during exercise, PAD patients experience abnormally delayed BP recovery, which could potentially contribute to a higher occurrence of adverse cardiovascular events in PAD patients. Further studies are needed to understand the mechanisms behind delayed BP recovery (e.g., abnormal muscle metaboreflex) and its influence on patient outcomes. This study is supported by NIH R01 HL141198 and R01 HL164571 This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.