S95 Effect of pulmonary rehabilitation on cardiovascular risk factors in COPD

BackgroundCardiovascular disease accounts for 27% of excess mortality seen in patients with chronic obstructive pulmonary disease (COPD). This may be attributed to the coexistence of cardiovascular risk factors such as smoking exposure and physical inactivity. Increased arterial stiffness has been demonstrated in patients with COPD, and this is an independent predictor of adverse cardiovascular events. Recent studies have shown that pulmonary rehabilitation (PR) can reduce blood pressure and arterial stiffness in COPD patients (Vivodtzev et al, 2009; Gale et al, 2011). However these studies comprised small numbers of highly selected patients. We investigated the effect of PR on resting blood pressure and heart rate in an unselected COPD population.Methods179 consecutive COPD patients completing an 8-week outpatient pulmonary rehabilitation programme were recruited. Resting blood pressure, heart rate, incremental shuttle walk (ISW) and Chronic Respiratory Disease Questionnaire (CRDQ) were measured immediately before and after PR. Paired t test (or non-parametric equivalent) was used to test the effect of PR.ResultsFollowing PR, there was no significant change in systolic, diastolic, mean arterial pressure and heart rate in all patients with COPD, although ISW and CRDQ improved significantly (see Abstract S95 table 1). Subset analysis in 124 COPD patients with no coexisting cardiovascular disease, diabetes or malignancy, and 31 patients with known hypertension also showed no significant change in blood pressure or heart rate.Abstract S95 Table 1Effect of PR on haemodynamic variables in patients with COPDBefore PR meanAfter PR meanMean difference (95% CI)p ValueSystolic BP (mm Hg)138.7138.6−0.0(−2.7 to 2.6)nsDiastolic BP (mm Hg)86.286.0−0.1 (−10.8 to 1.6)nsMAP (mm Hg)103.7103.6−0.1 (−1.8 to 1.6)nsHeart rate (bpm)81.880.8−1.0 (−2.7 to 0.6)nsISWT (m)203.4262.660.5 (48.6 to 72.5)