Effects of Repeated Remote Ischaemic Preconditioning on Arterial Stiffness, Organ Damage, and Oxidative Stress in Patients with Intermittent Claudication: A Sham Controlled Randomised Trial.

Abstract

The clinical efficacy of remote ischaemic preconditioning (RIPC) remains unclear. This pilot study, a substudy of a randomised controlled trial, tested whether repeated RIPC reduces arterial stiffness, end organ damage, and oxidative stress in patients with intermittent claudication (IC). In a single centre, randomised, sham controlled, double blind trial, 42 males with Fontaine stage IIa or IIb IC were allocated at a ratio of 1:1 to receive RIPC or sham using an automated device for 28 days in an outpatient setting (ClinicalTrials.gov ID NCT05084066). Secondary outcomes included changes in augmentation index (AIx), heart rate corrected AIx, carotid-femoral pulse wave velocity (cf-PWV), and biomarkers for cardiac (high sensitivity troponin T [hs-TnT], N-terminal pro B-type natriuretic peptide [NT-proBNP]), renal (creatinine, urea, cystatin C, β2 microglobulin, neutrophil gelatinase associated lipocalin, kidney injury molecule 1), and oxidative stress (high sensitivity C reactive protein, interleukin-6, interleukin-18, myeloperoxidase, adiponectin, oxidised low density lipoprotein). Data from 41 patients (RIPC n = 23, sham n = 18) aged 64.9 ± 7.4 years were analysed. The median change in cf-PWV was 0.2 m/s (interquartile range [IQR] -0.6, 0.6) in the RIPC group vs. 0.2 m/s (IQR -0.3, 0.8) in the sham group (p = .54). The median change in hs-TnT was 0 ng/L (IQR -1, 2) in the RIPC group vs. 1 ng/L (IQR -1, 2) in the sham group (p = .54). NT-proBNP showed a median change of -7 ng/L (IQR -32, 18) in the RIPC group vs. 6 ng/L (IQR -14, 35) in the sham group (p = .14). No statistically significant differences were observed between groups for arterial stiffness, oxidative stress, or renal biomarkers. Repeated RIPC did not significantly alter arterial stiffness, end organ damage, or oxidative stress biomarkers compared with sham treatment. It is possible that patients with IC already experience repeated RIPC from their ischaemic legs, thereby attenuating any additional effects from arm induced RIPC.