{"doi":"10.1113/jp280041","title":"Attenuation of exaggerated blood pressure responses to exercise: a byproduct of improved vascular function with passive heat therapy?","abstract":"Cardiovascular diseases (CVDs) are the leading cause of mortality in developed societies. An exaggerated blood pressure response to exercise (i.e. one that is in excess of that needed to supply adequate blood flow to working skeletal muscle) is an underappreciated, yet important, indicator of CVD risk. Not only does an exaggerated blood pressure response reduce exercise tolerance, thereby limiting individuals’ abilities to participate in a healthy lifestyle intervention, but it is associated with an as much as 4-fold higher risk of future CVD, even when accounting for traditional CVD risk factors (Miyai et al. 2002). Certain populations, such as those with hypertension or peripheral artery disease (PAD), are predisposed to exaggerated blood pressure responses to exercise, consistent with a greater CVD risk profile. However, this phenomenon is not exclusive to these patient populations – it can also occur in healthy individuals who are normotensive at rest. Furthermore, otherwise healthy individuals who have exaggerated blood pressure responses to exercise also have worse vascular endothelial function and stiffer arteries (two other independent predictors of CVD risk) compared to individuals with normal exercise blood pressure (Sarma et al. 2020). Therefore, identifying interventions that attenuate exaggerated exercise blood pressure may help to reduce the overall risk of CVD and could have significant implications in public health. Although other mechanisms exist, a major contributor to exaggerated blood pressure responses to exercise is a hypersensitive exercise pressor reflex. The exercise pressor reflex is composed of the skeletal muscle mechano- and metabo-reflexes, which respond to mechanical (i.e. muscle contraction) and metabolic (i.e. byproducts of muscle metabolism) stimuli within the working muscle, respectively. One specific receptor that is associated with the metabo-reflex is the purinergic P2X3 receptor, located on the sensory nerves that travel from the skeletal muscle to the spinal cord. Upon activation of P2X3 receptors by elevations in extracellular ATP, which indicates ischaemia in the muscle, the sensory nerves transduce signals to the rostral ventrolateral medulla to increase sympathetic outflow, thereby increasing blood pressure and subsequently blood flow to the exercising muscle. In muscle that experiences recurrent ischaemia during exercise, such as occurs downstream of the atherosclerotic lesions in PAD, abundance and/or sensitivity of P2X3 receptors may increase as a compensatory response to the ischaemia and accumulation of metabolites (Liu et al. 2011). In turn, this contributes to the exaggerated blood pressure responses during exercise that are common in these patients. One healthy lifestyle intervention that has recently gained attention for its widespread beneficial effects on the cardiovascular system is passive heat therapy, i.e. the repeated, chronic use of hot baths or saunas. In epidemiological studies, lifelong passive heat therapy (habitual sauna use) lowers the risk of CVD-related mortality and incident hypertension (Laukkanen et al. 2015). Furthermore, we have shown that a heat therapy intervention (repeated hot water immersion) reduces resting blood pressure (Brunt et al. 2016). As such, heat therapy may be an effective lifestyle intervention for attenuating exaggerated blood pressure responses to exercise. In a recent study published in the Journal of Physiology, Qin et al. (2020) sought to determine if 3 days of lower limb heat treatment could attenuate exaggerated blood pressure responses to exercise via effects on the exercise pressor reflex and P2X3 receptors in a rat model of PAD. Rats underwent either sham surgery (control) or femoral artery ligation of their right hindlimb to create an ischaemic condition via arterial stenosis, comparable to that caused by atherosclerosis in PAD. For heat treatment, two heating pads were placed on the examined limb to raise and maintain gastro","journal":"The Journal of Physiology","year":2020,"id":130477,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9585,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":307105,"name":"Vienna E. Brunt","orcid":"0000-0002-1941-7936","position":1,"is_corresponding":false},{"id":583165,"name":"Kathy Nguyen","orcid":"0000-0002-9014-6972","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-18T23:15:56.698770Z","pmid":"32687606","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}