Blunted blood pressure response to exercise and isolated muscle metaboreflex activation in patients with cirrhosis.

We sought to test the hypothesis that the cardiovascular responses to isolated muscle metaboreflex activation would be blunted in patients with cirrhosis. Eleven patients with cirrhosis and 15 healthy controls were evaluated. Blood pressure (BP, oscillometric method), contralateral forearm blood flow (FBF, venous occlusion plethysmography) and heart rate (HR, electrocardiogram) were measured during baseline, isometric handgrip at 30% of maximal voluntary contraction followed by post-exercise ischemia (PEI). Forearm vascular conductance (FVC) was calculated as follows: (FBF/mean BP) x 100. Changes in HR during handgrip were similar between groups, but tended to be different during PEI (controls: ∆0.5 ± 1.1 bpm vs. cirrhotic patients: ∆3.6 ± 1.0 bpm, P = 0.057). Mean BP response to handgrip (controls: ∆20.9 ± 2.7 mmHg vs. cirrhotic patients: ∆10.6 ± 1.5 mmHg, P = 0.006) and PEI was attenuated in cirrhotic patients (controls: ∆16.1 ± 1.9 mmHg vs. cirrhotic patients: ∆7.2 ± 1.4 mmHg, P = 0.001). In contrast, FBF and FVC increased during handgrip and decreased during PEI similarly between groups. These results indicate that an abnormal muscle metaboreflex activation explained, at least partially, the blunted pressor response to exercise exhibited by cirrhotic patients. Novelty bullets: • Patients with cirrhosis present abnormal muscle metaboreflex activation • Blood pressure response was blunted, but forearm vascular response was preserved • Heart rate response was slightly elevated.