Influence Of Exogenous Ketosis On Spontaneous Cardiovagal Baroreflex Gain And Blood Pressure Responses To Isometric Handgrip In Individuals With Metabolic Syndrome: A Placebo-Controlled Pilot Study

Authors

• Jon Stavres, The University of Southern Mississippi
• Ryan S. Aultman, Kent State University
• Caleb F. Brandner, University of Iowa
• Anabelle Vallecillo-Bustos, The University of Southern Mississippi
• Abby T. Compton, The University of Southern Mississippi
• Sydney H. Swafford, The University of Southern Mississippi
• Ta’Quoris A. Newsome, University of Mississippi School of Medicine
• Austin J. Graybeal, The University of Southern Mississippi

Document Type

Article

Publication Date

1-1-2026

School

Kinesiology and Nutrition

Abstract

Background: Prior studies have shown that ingestion of exogenous ketone esters (KE) significantly increases cerebral blood flow and skeletal muscle oxygenation in humans. This pilot study tested the hypothesis that KE may also lower exercise pressor responses and improve cardiovagal baroreflex sensitivity (cBRS) in individuals with metabolic syndrome (MetS). Methods: Twenty individuals (ten with MetS and ten matched controls) completed a three visit, single-blind, placebo-controlled, matched-pairs pilot study involving a cardiometabolic prescreening and two randomized experimental trials. In the experimental trials, cardiovagal baroreflex sensitivity (cBRS), heart rate variability (HRV), and exercise pressor responses to 2 min of isometric handgrip exercise (HG) were evaluated at baseline, and during a 105-min period following ingestion of a commercially available KE or a taste- and volume-matched placebo. Results: Main effects of condition and group by time interactions were observed for BP responses to HG (all p ≤ 0.050). The main effect of condition was explained by lower blood pressure values during HG in the KE trial compared to the placebo trial. The cBRS of all sequences (cBRSall) and all up-ramping sequences (cBRSup) were also attenuated in the KE condition compared to placebo (time by condition interaction: F ≥ 2.42, p ≤ 0.007), independent of group, and the normalized low- to high-frequency (LF/HF) HRV ratio decreased in both conditions (F = 0.176, p ≤ 0.031), but remained higher in the KE condition independent of group (p = 0.023). Conclusions: This study provides preliminary evidence that acute exogenous ketosis may reduce blood pressure responses to acute exercise and attenuate spontaneous baroreflex gain in individuals with MetS (NCT05651243).

Publication Title

European Journal of Applied Physiology

Volume

126

Issue

1

First Page

549

Last Page

562

Recommended Citation

Stavres, J., Aultman, R., Brandner, C., Vallecillo-Bustos, A., Compton, A., Swafford, S., Newsome, T., Graybeal, A. (2026). Influence Of Exogenous Ketosis On Spontaneous Cardiovagal Baroreflex Gain And Blood Pressure Responses To Isometric Handgrip In Individuals With Metabolic Syndrome: A Placebo-Controlled Pilot Study. European Journal of Applied Physiology, 126(1), 549-562.
Available at: https://aquila.usm.edu/fac_pubs/21987