Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: a randomized controlled trial (HEx trial)

Investigation and management of resistant hypertension: British and Irish Hypertension Society position statement

People living with resistant hypertension (RH) are at high risk of adverse cardiovascular events. The British and Irish Hypertension Society has identified suspected RH as a condition for which specialist guidance may improve rates of blood pressure control and help clinicians identify those individuals who may benefit from specialist review. In this position statement we provide a practical approach for the investigation and management of adults with RH. We highlight gaps in the current evidence and identify important future research questions. Our aim is to support the delivery of high-quality and consistent care to people living with RH across the UK and Ireland.

Effect of Mat Pilates Training on Blood Pressure, Inflammatory, and Oxidative Profiles in Hypertensive Elderly

To determine the effects of mat Pilates training on blood pressure, inflammatory, and antioxidative markers in hypertensive elderly people, 34 hypertensive subjects aged 60-75 years were randomly divided into a control group (CON; n = 17) and a mat Pilates training group (MP; n = 17). The CON participants conducted normal daily activities and participated in neither organized exercises nor sports training, while those in the MP group received mat Pilates training for 60 min three times/week for 12 weeks. Parameters including blood pressure, cardiovascular function, nitric oxide (NO), tumor necrotic factor-alpha (TNF-α), superoxide dismutase (SOD), and malonaldehyde (MDA) were collected at baseline and the end of 12 weeks. The MP group had significantly decreased blood pressure, improved cardiovascular variables, decreased MDA and TNF-α, and increased NO and SOD compared with the CON group and the pre-training period (p < 0.05). In conclusion, these findings demonstrate the positive effects of 12 weeks of mat Pilates training in terms of reducing blood pressure and increasing blood flow related to improvements in anti-inflammatory and antioxidative markers in hypertensive elderly people. Mat Pilates training might be integrated as an alternative therapeutic exercise modality in clinical practice for hypertensive elderly individuals.

Lifestyle Medicine as a Treatment for Resistant Hypertension

PURPOSE OF REVIEW

Approximately 10% of the adults with hypertension fail to achieve the recommended blood pressure treatment targets on 3 antihypertensive medications or require ≥ 4 medications to achieve goal. These patients with 'resistant hypertension' have an increased risk of target organ damage, adverse clinical events, and all-cause mortality. Although lifestyle modification is widely recommended as a first-line approach for the management of high blood pressure, the effects of lifestyle modifications in patients with resistant hypertension has not been widely studied. This review aims to provide an overview of the emerging evidence on the benefits of lifestyle modifications in patients with resistant hypertension, reviews potential mechanisms by which lifestyles may reduce blood pressure, and discusses the clinical implications of the recent findings in this field.

RECENT FINDINGS

Evidence from single-component randomized clinical trials demonstrated that aerobic exercise, weight loss and dietary modification can reduce clinic and ambulatory blood pressure in patients with resistant hypertension. Moreover, evidence from multi-component trials involving exercise and dietary modification and weight management can facilitate lifestyle change, reduce clinic and ambulatory blood pressure, and improve biomarkers of cardiovascular risk. This new evidence supports the efficacy of lifestyle modifications added to optimized medical therapy in reducing blood pressure and improving cardiovascular risk biomarkers in patients with resistant hypertension. These findings need to be confirmed in larger studies, and the persistence of benefit over extended follow-up needs further study.

New Horizons: Testosterone or Exercise for Cardiometabolic Health in Older Men

Middle-aged and older men have typically accumulated comorbidities, are increasingly sedentary, and have lower testosterone concentrations (T) compared to younger men. Reduced physical activity (PA) and lower T both are associated with, and may predispose to, metabolically adverse changes in body composition, which contribute to higher risks of cardiometabolic disease. Exercise improves cardiometabolic health, but sustained participation is problematic. By contrast, rates of T prescription have increased, particularly in middle-aged and older men without organic diseases of the hypothalamus, pituitary, or testes, reflecting the unproven concept of a restorative hormone that preserves health. Two recent large randomized trials of T, and meta-analyses of randomized trials, did not show a signal for adverse cardiovascular (CV) events, and T treatment on a background of lifestyle intervention reduced type 2 diabetes by 40% in men at high risk. Men with both higher endogenous T and higher PA levels have lower CV risk, but causality remains unproven. Exercise training interventions improve blood pressure and endothelial function in middle-aged and older men, without comparable benefits or additive effects of T treatment. Therefore, exercise training improves cardiometabolic health in middle-aged and older men when effectively applied as a supervised regimen incorporating aerobic and resistance modalities. Treatment with T may have indirect cardiometabolic benefits, mediated via favorable changes in body composition. Further evaluation of T as a pharmacological intervention to improve cardiometabolic health in aging men could consider longer treatment durations and combination with targeted exercise programs.

Multicomponent Training and Optimal Dosing Strategies for Adults with Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

(1) Background: Non-pharmacological interventions have demonstrated efficacy in the prevention, management, and control of hypertension. Multicomponent training confers a host of benefits to the general populace. The aim of this research was to assess the impact of multicomponent training on the blood pressure of adults with hypertension and ascertain the nature of the dose-response relationship. (2) Methods: This systematic review adhered to the PRISMA guidelines and was registered in PROSPERO. Eight studies were included, following a literature search across PubMed, Web of Science, Cochrane, and EBSCO. Randomized controlled trials implementing multicomponent training interventions on adults with hypertension were considered for inclusion. A quality assessment was performed using the PEDro scale, with a random-effects model utilized for all analyses. (3) Results: Multicomponent training yielded a significant reduction in systolic (MD = -10.40, p < 0.001) and diastolic (MD = -5.97, p < 0.001) blood pressure relative to the control group. Interventions lasting over 14 weeks with a minimum frequency of three sessions per week, each lasting 60 min, were deemed most effective. (4) Conclusion: An optimal training intensity was achieved with 30 min of aerobic exercise at 75% of the heart rate reserve, whereas sets of 10 repetitions at 75% of one repetition maximum produced the best outcomes in strength training.

Effect of Different Types of Aerobic Exercise on Individuals With and Without Hypertension: An Updated Systematic Review

High blood pressure (BP) is one of the main modifiable risk factors for cardiovascular disease (CVD) and preventing it greatly reduces the vascular consequences of aging and, along with intensive treatment of hypertension, eliminates a large portion of the burden of CVD-related mortality. Many meta-analyses and studies proved that regular aerobic exercise (AE) reduces BP but most of these studies consider only hypertensive populations or only AE but not resistant exercise or their combination. In this review, we aimed to study the effect of different types of physical activity (PA)/AE on various populations including normotensive, prehypertensive, primary hypertensive, and resistant hypertensive with different comorbidities. We searched PubMed, Web of Science, and Google Scholar for English articles with keywords for physical activity, aerobic exercise, and blood pressure from January 2010 until September 2021. Finally, 24 studies were included. Results showed that chronic or acute AE (long-term or short-term), either alone or as combined with different sessions and programs can reduce systolic and diastolic BP in every group including normotensive, prehypertensive, primary hypertensive, resistant hypertensive individuals and diabetic patients and those with kidney problems but not in people with chronic heart failure. Isometric exercise training showed to be useful in reducing BP in all groups either as low intensity or as high intensity but the rate of reduction was different in terms of gender. AE showed to be effective in terms of BP reduction in a different age range. It can be seen that different types and duration of AE independent of the modality and programs and independent of the BP medical situation of individuals have been successful in terms of BP reduction. For those with chronic heart failure, more concern and help might be needed to decrease BP via exercise.

Aerobic exercise improves central blood pressure and blood pressure variability among patients with resistant hypertension: results of the EnRicH trial

Central blood pressure (BP) and BP variability are associated with cardiovascular disease risk. However, the influence of exercise on these hemodynamic parameters is unknown among patients with resistant hypertension. The EnRicH (The Exercise Training in the Treatment of Resistant Hypertension) was a prospective, single-blinded randomized clinical trial (NCT03090529). Sixty patients were randomized to a 12-week aerobic exercise program or usual care. The outcome measures include central BP, BP variability, heart rate variability, carotid-femoral pulse wave velocity, and circulating cardiovascular disease risk biomarkers including high-sensitivity C-reactive protein, angiotensin II, superoxide dismutase, interferon gamma, nitric oxide, and endothelial progenitor cells. Central systolic BP decreased by 12.22 mm Hg (95% CI, -1.88 to -22.57, P = 0.022) as did BP variability by 2.85 mm Hg (95% CI, -4.91 to -0.78, P = 0.008), in the exercise (n = 26) compared to the control group (n = 27). Interferon gamma -4.3 pg/mL (95%CI, -7.1 to -1.5, P = 0.003), angiotensin II -157.0 pg/mL (95%CI, -288.1 to -25.9, P = 0.020), and superoxide dismutase 0.4 pg/mL (95%CI, 0.1-0.6, P = 0.009) improved in the exercise compared to the control group. Carotid-femoral pulse wave velocity, heart rate variability, high-sensitivity C-reactive protein, nitric oxide, and endothelial progenitor cells were not different between groups (P > 0.05). In conclusion, a 12-week exercise training program improved central BP and BP variability, and cardiovascular disease risk biomarkers in patients with resistant hypertension. These markers are clinically relevant as they are associated with target organ damage and increased cardiovascular disease risk and mortality.

Effects of water exercise on body composition and components of metabolic syndrome in older females with sarcopenic obesity

[Purpose] Very few studies have been conducted on the benefits of water exercise for older adults with sarcopenic obesity. Whether the water exercise intervention is effective for improving sarcopenia and/or obesity remains unclear. This study aimed to investigate the effects of water exercise on body composition and components of metabolic syndrome in older females with sarcopenic obesity. [Participants and Methods] Participants (aged ≥60 years) were divided into a water exercise group and a control group. Water-based strength and endurance exercises were performed three times a week for 12 weeks. Lean soft tissue mass, fat mass, and body fat percentage were measured by dual-energy x-ray absorptiometry. [Results] Two-way analysis of variance revealed significant interactions (time × group) for total body fat percentage and leg body fat percentage. In the exercise group, leg body fat percentage significantly decreased after the intervention, but no significant change was observed in the control group. The components of metabolic syndrome showed no significant interactions in either group (time × group). [Conclusion] No significant changes were observed in the components of metabolic syndrome. However, 12-week water exercise may be effective for reducing fat mass in females with sarcopenic obesity.

Short-Term Effects of Land-Based Versus Water-Based Resistance Training Protocols on Post-Exercise Hypotension in Normotensive Men: A Crossover Study

Considering that water immersion may acutely reduce blood pressure (BP) and that exercise may elicit positive post-exercise hypotension (PEH) responses, we aimed to analyze the presence of PEH in normotensive individuals and compare its magnitude between two resistance training sessions performed in aquatic or land environments. Ten physically active men (23.2 ± 3.1 years) performed the two training protocols in a randomized, counterbalanced fashion. BP measurements were performed for 30 min (at 5 min intervals) both prior to (resting) and after each of the protocols. No differences were observed between protocols at baseline (p > 0.05). Only the water-based resistance training protocol resulted in a systolic BP reduction from 10 to 20 min post-exercise (all p < 0.05) compared to baseline. Compared to the land-based session, systolic BP was lower in the water-based protocol from 10 to 25 min post-exercise (all p < 0.05). On the other hand, diastolic BP showed a similar PEH effect between water and land-based protocols for the entire 30 min post-session period (all p < 0.001). Our results suggest that water-based resistance training holds the potential as a nonpharmacological strategy to lower BP levels following exercise.

Exercise to Treat Hypertension: Late Breaking News on Exercise Prescriptions That FITT

ABSTRACT

Hypertension is the leading risk factor for cardiovascular disease and an independent predictor of mortality. The prevalence of hypertension has doubled in the last two decades and evidence suggests that almost half the individuals are unaware of their condition. The antihypertensive effects of exercise are now undisputable, and exercise training is recommended by the major professional and scientific societies, including the American College of Sports Medicine (ACSM), as first-line treatment to prevent, treat, and control hypertension. This review aims to overview the evidence supporting the current ACSM Frequency, Intensity, Time, and Type exercise recommendations for hypertension, discuss new and emerging evidence on exercise in the treatment of hypertension from our laboratories; and propose future directions of research integrating this new and emerging evidence.

The blood pressure response to acute exercise predicts the ambulatory blood pressure response to exercise training in patients with resistant hypertension: results from the EnRicH trial

Reports suggest that the blood pressure (BP) response to an acute bout of exercise is associated with the BP response to aerobic training in participants with elevated BP. These associations have not been tested among patients with resistant hypertension. This study aimed to determine whether the BP response to acute exercise predicts the 24-h ambulatory BP response to a 12-week exercise training program in patients with resistant hypertension (n = 26, aged 59.3 ± 8.2 years, 24-h ambulatory BP 127.4 ± 12.2/75.6 ± 7.8 mm Hg) who completed the exercise arm of the EnRicH trial. Ambulatory BP measurements were obtained before and after the exercise program to assess the chronic BP response. To assess acute BP changes, resting BP was measured before and 10 min after three exercise sessions in the third week of training and averaged. The resting systolic (9.4 ± 6.7, p < 0.001) and diastolic BP (1.9 ± 3.2, p = 0.005) were reduced after acute exercise. The 24-h systolic (6.2 ± 12.2, p = 0.015) and diastolic BP (4.4 ± 6.1, p = 0.001) were decreased after exercise training. The reductions in systolic BP after acute exercise were associated with the reductions in 24-h systolic BP after exercise training (ß = 0.538, adjusted r² = 0.260, P = 0.005). The reductions in diastolic BP after acute exercise (ß = 0.453, adjusted r² = 0.187) and baseline 24-h diastolic BP (ß = -0.459, adjusted r² = 0. 199) accounted for 38.6% (p = 0.008) of the 24-h diastolic BP response to exercise training. In conclusion, the magnitude of the BP response to acute exercise appears to predict the ambulatory BP response to exercise training among patients with resistant hypertension.

Physical Exercise in Resistant Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Physical exercise reduces blood pressure (BP) in patients with hypertension in general but more evidence is needed specifically for a high-risk phenotype associated with intensive medication, resistant hypertension (RH). In this systematic review and meta-analysis, we aimed to summarize current evidence of the exercise effects on BP in patients with RH. A systematic search was conducted in PubMed, Web of Science and Cochrane Library (from inception to 3rd November, 2021). A random effects meta-analysis was performed when at least two trials assessed the effect of either acute or regular exercise (vs. a control condition) on the same outcome. Ten studies (N = 380 participants; 51% female; mean age 52 to 67 years) were included in the review, of which four (N = 58) and six (N = 322) assessed the effects of acute and regular exercise, respectively. Evidence overall suggests that a single bout of acute exercise results in a short-term (≤ 24 h) reduction of BP, although no meta-analysis could be performed. As for regular exercise, three randomized controlled trials (N = 144, 50% female) could be meta-analyzed, which showed that exercise training intervention (8-12 weeks, 3 sessions/week) significantly reduces 24-h (-9.9 mmHg, 95% confidence interval -15.4-4.4 for systolic BP; and -5 mmHg, -7.0-3.0 for diastolic BP) and daytime ambulatory BP (-11.7 mmHg, -17.8-5.7; and -7.4 mmHg, -11.9-2.9). In summary, physical exercise appears as an effective option to reduce BP in patients with RH, although more research is needed to confirm these findings as well as to determine the most effective exercise characteristics.

Effectiveness of Physical Activity and Exercise on Ambulatory Blood Pressure in Adults with Resistant Hypertension: A Systematic Review and Meta-Analysis

INTRODUCTION

Resistant hypertension (RHT) is a phenotype of hypertension that is challenging to manage by medications alone. While high grade evidence supports physical activity (PA) and exercise to reduce blood pressure (BP) in hypertension, it is unclear whether these are also effective for RHT.

AIMS

To determine the quality of evidence for the effectiveness of PA and exercise and the change of magnitude of 24-hour ambulatory BP (24hABP) in adults with RHT.

METHODS

Scopus, MEDLINE, CINHAL, Web of Science, Embase and SPORTDiscus databases were searched. Cochrane risk of bias tools, Review Manager and Grading of the Recommendation Assessment, Development and Evaluation were used to assess the methodological quality, the clinical heterogeneity and quality of the evidence.

RESULTS

Four studies comprising 178 individuals in total were included. A meta-analysis with random effects showed decreased 24hABP. The experimental group demonstrated grater mean differences for 24hABP following the PA and exercise programmes (systolic - 9.88 mmHg, 95% CI: - 17.62, - 2.14, I2 = 72%, p = 0.01; diastolic - 6.24 mmHg, 95% CI: - 12.65, 0.17, I2 = 93%,p = 0.06); and aerobic exercise (systolic - 12.06 mmHg, 95% CI: - 21.14, - 2.96, I2 = 77%, p = 0.009, diastolic - 8.19 mmHg, 95% CI: - 14.83, - 1.55, I2 = 92% ,p = 0.02). In the included studies, indirectness and publication bias were 'moderate' while inconsistency and imprecision were rated as 'low'. Thus, the overall quality of the evidence was considered to be 'low'.

CONCLUSIONS

Low certainty evidence suggests that PA and aerobic exercise added to usual care may be more effective in 24hABP reduction in RHT than usual care alone.

REGISTRATION

PROSPERO-2019 CRD42019147284 (21.11.2019).

Acute high-intensity interval exercise versus moderate-intensity continuous exercise in heated water-based on hemodynamic, cardiac autonomic, and vascular responses in older individuals with hypertension

OBJECTIVES

This crossover study design aimed to assess hemodynamic, cardiac autonomic, and vascular responses to high-intensity interval (HIIE) vs moderate-intensity continuous exercise (MICE) in older individuals with hypertension.

METHODS

Twenty (67 ± 7 y) older individuals with hypertension were randomly assigned to perform HIIE, MICE, or control (CON) sessions in the heated swimming pool (30-32°C). Blood pressure (BP), arterial stiffness, endothelial reactivity, and heart rate variability (HRV) were measured pre, post, and 45 min (recovery) after each intervention followed by 24-h ambulatory BP and HRV.

RESULTS

One single aerobic exercise session was not effective to provoke post-exercise hypotension and vascular improvements. HIIE was superior to MICE and CON to increasing parasympathetic modulation at post and recovery. Exercise sessions showed to disturb the autonomic system at nighttime compared to CON.

CONCLUSIONS

These results may have important implications in water-based therapy and the elderly with hypertension.

Association between Exercise and Blood Pressure in Hypertensive Residents: A Meta-Analysis

BACKGROUND

Exercise is recommended as an effective lifestyle behaviour for adults to prevent and treat hypertension. In this study, a randomized-effect meta-analysis was used to analyse the influence of exercise interventions on blood pressure in patients with hypertension.

METHODS

Candidate papers were retrieved from PubMed, Web of Science, Embase, and Cochrane Library electronic databases, and 46 studies were finally included and analysed.

RESULTS

It was shown that preplanned walking (systolic blood pressure (SBP): WMD (weighted mean difference) = -5.94, 95% CI: -8.57, -3.30; diastolic blood pressure (DBP): WMD = -2.66, 95% CI: -3.66, -1.67), yoga (SBP: WMD = -5.09, 95% CI: -9.28, -0.89; DBP: WMD = -3.06, 95% CI: -5.16, -0.96), aquatic sports (SBP WMD = -7.53, 95% CI: -11.40, -3.65; DBP: WMD = -5.35, 95% CI: -9.00, -1.69), and football (SBP: WMD = -6.06, 95% CI: -9.30, -2.82; DBP: WMD = -5.55, 95% CI: -8.98, -2.13) had significant effects on blood pressure reduction. However, Tai Chi (SBP: WMD = -8.31, 95% CI: -20.39, 3.77; DBP: WMD = -3.05, 95% CI: -6.96, 0.87) and Qigong (SBP: WMD = -4.34, 95% CI: -13.5, 4.82; DBP: WMD = -3.44, 95% CI: -7.89, 1.01) did not significantly reduce blood pressure. The heterogeneity of the meta-analysis was high.

CONCLUSION

Walking, yoga, aquatic sports, and football were feasible and independent lifestyle interventions, and they were effective options for treating hypertension. More scientifically designed randomized controlled trials are needed in the future to further compare different forms of exercise for the treatment of hypertension.

Analysis of Cardiovascular Hemodynamic and Autonomic Variables in Individuals with Systemic Arterial Hypertension, Type 2 Diabetes Mellitus, and Parkinson's Disease: A Comparative Study

BACKGROUND

Systemic arterial hypertension (SAH), type 2 diabetes mellitus (T2DM), and Parkinson's disease (PD) are highly prevalent chronic diseases that can significantly impact the cardiovascular system.

AIM

The aim of this study was to compare hemodynamic and autonomic variables at rest in individuals with SAH, T2DM, or PD.

METHODS

Fifty sedentary or insufficiently active individuals (22 men) with SAH (age = 66 ± 5.0 yr), T2DM (age = 52 ± 10 yr) or PD (age = 68 ± 8.0 yr) had their resting blood pressure (BP), arterial stiffness, endothelial function, and heart rate variability (HRV) assessed and compared.

RESULTS

Systolic and diastolic BP were higher in SAH (130 ± 10 / 80 ± 10 mmHg) than T2DM (110 ± 14 / 75 ± 11 mmHg) and PD, and (123 ± 20 / 70 ± 11 mmHg) respectively. T2DM individuals showed lower arterial stiffness (8.4 ± 1.1 m/s), when compared to SAH (10.3 ± 2.3 m/s) and PD (10.6 ± 3.0 m/s). T2DM had greater resting tachycardia showed by the mean RR (759 ± 79 ms), than SAH (962 ± 169 ms) and PD (976 ± 134 ms), which was accompanied by higher sympathetic modulation (low frequency [LF]: 62 ± 19 nu) and lower parasympathetic modulation (high frequency [HF]: 32 ± 16 nu) when compared to SAH (LF: 40 ± 16 nu; HF: 61 ± 33 nu). No differences among groups were found on non-linear HRV markers and endothelial reactivity indexes.

CONCLUSIONS

Individuals with T2DM showed impaired levels of cardiac autonomic markers when compared to individuals with SAH and PD, despite of having lower levels of BP and arterial stiffness.

Prescribing and Self-Regulating Heated Water-Based Exercise by Rating of Perceived Exertion in Older Individuals With Hypertension

We aimed to analyze the usefulness of the 6-20 rating of perceived exertion (RPE) scale for prescribing and self-regulating high-intensity interval (HIIE) and moderate-intensity continuous (MICE) aerobic exercise performed in a heated swimming pool (32 °C). Fifteen older individuals (65 ± 3 years) treated for hypertension underwent a symptom-limited maximal graded exercise test to determine their heart rate at anaerobic threshold, and respiratory compensation point. On different days, participants were randomized to HIIE (walking/jogging between 11 and 17 of RPE; 25 min) and MICE (walking at 11-13 of RPE; 30 min). Heart rate during the low-intensity intervals of HIIE and MICE remained below the graded exercise test's heart rate at anaerobic threshold (-7 ± 18 bpm/-16 ± 15 bpm) and respiratory compensation point (-18 ± 18 bpm/-30 ± 16 bpm), respectively, and maintained in the aerobic training zone during the high-intensity intervals of HIIE (+8 ± 18 bpm/-4 ± 19 bpm). The RPE scale at 15-17 is a useful tool for prescribing and self-regulating heated water-based HIIE and may have important implications for water-based exercise in older individuals with hypertension.

Acute Aerobic Exercise Induces Short-Term Reductions in Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis

[Figure: see text].

A CHecklist for statistical Assessment of Medical Papers (the CHAMP statement): explanation and elaboration

Misuse of statistics in medical and sports science research is common and may lead to detrimental consequences to healthcare. Many authors, editors and peer reviewers of medical papers will not have expert knowledge of statistics or may be unconvinced about the importance of applying correct statistics in medical research. Although there are guidelines on reporting statistics in medical papers, a checklist on the more general and commonly seen aspects of statistics to assess when peer-reviewing an article is needed. In this article, we propose a CHecklist for statistical Assessment of Medical Papers (CHAMP) comprising 30 items related to the design and conduct, data analysis, reporting and presentation, and interpretation of a research paper. While CHAMP is primarily aimed at editors and peer reviewers during the statistical assessment of a medical paper, we believe it will serve as a useful reference to improve authors' and readers' practice in their use of statistics in medical research. We strongly encourage editors and peer reviewers to consult CHAMP when assessing manuscripts for potential publication. Authors also may apply CHAMP to ensure the validity of their statistical approach and reporting of medical research, and readers may consider using CHAMP to enhance their statistical assessment of a paper.

Physical Activity is Associated With Lower Arterial Stiffness in Patients With Resistant Hypertension

BACKGROUND

Physical activity is associated with reduced arterial stiffness, although such a relationship has not been reported in those with resistant hypertension. Therefore, this study aimed to determine the association between daily physical activity and arterial stiffness in patients with resistant hypertension.

METHODS

Fifty-seven (57) patients with resistant hypertension (50.9% men), aged 58.8±9.4 years, were consecutively recruited. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV). Daily physical activity was objectively assessed with accelerometers during 7 consecutive days.

RESULTS

Patients had a body mass index of 29.0±4.0 kg/m² (84.3% overweight/obese) and were taking an average 4.5 antihypertensive medications. Overall, the cf-PWV was 9.2±2.4 m/s and the majority of participants (n=41, 71.9%) presented a cf-PWV <10 m/s. The cf-PWV showed an inverse correlation with light-intensity physical activity (r = -0.290, p=0.029) and total daily physical activity (r = -0.287, p=0.030). The correlation between light physical activity and cf-PWV remained significant after adjustment for systolic and diastolic blood pressure, but lost significance when further adjusted for age.

CONCLUSIONS

Higher daily levels of light-intensity and total physical activity were associated with lower arterial stiffness. Nonetheless, this association is weak and attenuated or abolished when adjusted for blood pressure and age. These results suggest that physical activity may play an important role as a lifestyle intervention for patients with resistant hypertension. Future studies with larger samples sizes are necessary to confirm this preliminary data.

Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension: A Randomized Clinical Trial

Importance

Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy.

Objective

To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension.

Design, Settings, and Participants

The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals' hypertension outpatient clinic.

Interventions

Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care.

Main Outcomes and Measures

The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness.

Results

A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, -12.8 to -1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (-5.1 mm Hg; 95% CI, -7.9 to -2.3; P = .001), daytime systolic BP (-8.4 mm Hg; 95% CI, -14.3 to -2.5; P = .006), and daytime diastolic BP (-5.7 mm Hg; 95% CI, -9.0 to -2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (-10.0 mm Hg; 95% CI, -17.6 to -2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group.

Conclusions and Relevance

A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population.

Trial Registration

ClinicalTrials.gov Identifier: NCT03090529.

Exercise Reduces Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Although exercise training reduces office blood pressure (BP), scarcer evidence is available on whether these benefits also apply to ambulatory blood pressure (ABP), which is a stronger predictor of cardiovascular disease and mortality. The present study aims to assess the effects of exercise training on ABP in patients with hypertension based on evidence from randomized controlled trials. Methods and Results A systematic search of randomized controlled trials on the aforementioned topic was conducted in PubMed and Scopus (since inception to April 1, 2020). The mean difference between interventions (along with 95% CI) for systolic BP and diastolic BP was assessed using a random-effects model. Sub-analyses were performed attending to (1) whether participants were taking antihypertensive drugs and (2) exercise modalities. Fifteen studies (including 910 participants with hypertension) met the inclusion criteria. Interventions lasted 8 to 24 weeks (3-5 sessions/week). Exercise significantly reduced 24-hour (systolic BP, -5.4 mm Hg; [95% CI, -9.2 to -1.6]; diastolic BP, -3.0 mm Hg [-5.4 to -0.6]), daytime (systolic BP, -4.5 mm Hg [-6.6 to -2.3]; diastolic BP, -3.2 mm Hg [-4.8 to -1.5]), and nighttime ABP (systolic BP, -4.7 mm Hg [-8.4 to -1.0]; diastolic BP, -3.1 mm Hg [-5.3 to -0.9]). In separate analyses, exercise benefits on all ABP measures were significant for patients taking medication (all P<0.05) but not for untreated patients (although differences between medicated and non-medicated patients were not significant), and only aerobic exercise provided significant benefits (P<0.05). Conclusions Aerobic exercise is an effective coadjuvant treatment for reducing ABP in medicated patients with hypertension.

Resistant hypertension: new insights and therapeutic perspectives

Resistant hypertension (RH) is a concept that currently goes beyond the classical definition of blood pressure ≥140/90 mmHg in subjects receiving three or more drugs of different classes at maximally tolerated doses. Here, we review the clinical relevance of RH and the different types of RH-associated phenotypes, namely refractory hypertension, controlled resistant hypertension, and masked uncontrolled hypertension. We also discuss current drug strategies and future treatments for these high-risk phenotypes.

Lifestyle interventions for the prevention and treatment of hypertension

Hypertension affects approximately one third of the world's adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.

Effect of water exercise in blood pressure and sleep quality of hypertensive adults

BACKGROUND

Together with ageing there is an increase in blood pressure levels. However, physical activity is one of the most recommended strategies for preventing the increase of blood pressure. Water exercise involves numerous advantages, one of which is the comfort proportioned by water temperature. The aim of this study was to evaluate the effects of a water exercise program on blood pressure, physical fitness, quality of sleep and the likelihood of having sleep apnea (SA) in hypertensive adults.

METHODS

We evaluated 21 sedentary hypertensive subjects of both sexes. The water exercise was conducted over 13 weeks, three times/week, 50 min/day. Resting blood pressure, height, body weight, waist and hip circumference, functional capability, as well as sleep quality and the likelihood of having sleep apnea were evaluated before and after the experimental period.

RESULTS

There was a significant decrease in systolic and mean blood pressure. Significant increases in strength, muscular and aerobic endurance, coordination, agility, dynamic balance and flexibility were also seen. In addition, a reduction in the likelihood of sleep apnea was identified, despite a deterioration in sleep quality.

CONCLUSIONS

Water exercise was effective in reducing systolic blood pressure, in improving functional capacity variables, and in reducing probability of sleep apnea in hypertensive subjects, however it promoted worsening of sleep quality.

Impact of therapeutic lifestyle changes in resistant hypertension

Hypertensive individuals are at an increased risk of developing heart disease and stroke. Adopting healthy lifestyles, such as being active on ≥4 days per week, weight-loss in the presence of obesity, consuming a diet rich in fruits and vegetables, and sodium below the recommended threshold, avoiding high alcohol consumption and refraining from smoking have been effective lifestyle therapies to prevent or control stage 1 hypertension (HTN). Among the 1 in 3 Americans who have HTN (systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg), 16% are diagnosed with resistant HTN (RHT). Although there are comparatively fewer studies examining the blood pressure lowering effects of therapeutic lifestyle interventions in patients with resistant HTN, the available literature appears promising. This paper reviews key studies that quantify the blood pressure lowering effects of certain therapeutic lifestyles in patients with RHT and highlights areas needing more attention.

A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: cancer, cardiovascular disease, and diabetes

BACKGROUND

Physical activity is effective for the prevention and treatment of chronic disease, yet insufficient evidence is available to make comparisons regarding adherence to aerobic physical activity interventions among chronic disease populations, or across different settings. The purpose of this review is to investigate and provide a quantitative summary of adherence rates to the aerobic physical activity guidelines among people with chronic conditions, as physical activity is an effective form of treatment and prevention of chronic disease.

METHODS

Randomized controlled (RCTs) trials where aerobic physical activity was the primary intervention were selected from PsychInfo, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Clinical Key, and SCOPUS from 2000 to 2018. Studies were included if the program prescription aligned with the 2008 aerobic physical activity guidelines, were at least 12 weeks in length, and included adult participants living with one of three chronic diseases. The data was extracted by hand and the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines were used to evaluate risk-of-bias and quality of evidence. Data were pooled using random-effect models. The primary outcome measure was program adherence and the secondary outcome measures were dropout and setting (e.g. home vs. clinic-based). Pooled effect sizes and 95% CiIs (confidence intervals) were calculated using random-effect models.

RESULTS

The literature search identified 1616 potentially eligible studies, of which 30 studies (published between 2000 and 2018, including 3,721 participants) met the inclusion criteria. Three clinical populations were targeted: cancer (n = 14), cardiovascular disease (n = 7), and diabetes (n = 9). Although not statistically significant, adherence rates varied across samples (65, 90, and 80%, respectively) whereas dropout rates were relatively low and consistent across samples (5, 4, and 3%). The average adherence rate, regardless of condition, is 77% (95% CI = 0.68, 0.84) of their prescribed physical activity treatment. The pooled adherence rates for clinic-based and home-based programs did not differ (74% [95% CI, 0.65, 0.82] and 80% [95% CI, 0.65, 0.91], respectively).

CONCLUSIONS

The current evidence suggests that people with chronic conditions are capable of sustaining aerobic physical activity for 3+ months, as a form of treatment. Moreover, home-based programs may be just as feasible as supervised, clinic-based physical activity programs.

AEROBIC AND RESISTANCE EXERCISE IN PATIENTS WITH RESISTANT HYPERTENSION

ABSTRACT Introduction: Physical training is recommended by current guidelines as a preventive measure and as a tool to supplement pharmacological therapy in the treatment of hypertension and its pathological manifestations. However, there is considerable uncertainty regarding the best training prescription for blood pressure control in patients with resistant hypertension. Objective: To evaluate the effect, over twelve weeks, of an aerobic and resistance exercise program on blood pressure, anthropometric and biochemical parameters of patients with resistant hypertension. Methods: Eleven patients with resistant hypertension were randomly divided into two groups: resistance training and aerobic training. Blood pressure was recorded by 24-hour outpatient monitoring before and after 12-week training. The Student t-test was used to compare resistance and aerobic exercise groups, while the paired t and Wilcoxon tests were used to analyze pre- and post-exercise data. The level of significance was 0.05. Results: In the group that underwent aerobic training, mean systolic, diastolic and total blood pressure readings were significantly lower over the 24 hours analyzed, dropping by 14 mmHg, 7 mmHg and 10 mmHg, respectively, and in the waking period. The resistance training group showed no significant change in blood pressure, despite the significant improvement in HDL levels. Conclusion: Twelve weeks of aerobic exercises resulted in significantly lowered blood pressure in individuals with resistant hypertension, while resistance exercises were more effective in increasing HDL. Level of evidence II, Therapeutic study.

Achieving control of resistant hypertension: Not just the number of blood pressure medications

Resistant hypertension (RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance. Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a re-designed catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy (BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in long-term follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-based therapies in select individuals.

Physical Activity In Renal Disease (PAIRED) and the effect on hypertension: study protocol for a randomized controlled trial

BACKGROUND

The prevalence of hypertension among people with chronic kidney disease is high with over 60% of people not attaining recommended targets despite taking multiple medications. Given the health and economic implications of hypertension, additional strategies are needed. Exercise is an effective strategy for reducing blood pressure in the general population; however, it is not known whether exercise would have a comparable benefit in people with moderate to advanced chronic kidney disease and hypertension.

METHODS

This is a parallel-arm trial of adults with hypertension (systolic blood pressure greater than 130 mmHg) and an estimated glomerular filtration rate of 15-45 ml/min 1.73 m2. A total of 160 participants will be randomized, with stratification for estimated glomerular filtration rate, to a 24-week, aerobic-based exercise intervention or enhanced usual care. The primary outcome is the difference in 24-h ambulatory systolic blood pressure after 8 weeks of exercise training. Secondary outcomes at 8 and 24 weeks include: other measurements of blood pressure, aortic stiffness (pulse-wave velocity), change in the Defined Daily Dose of anti-hypertensive drugs, medication adherence, markers of cardiovascular risk, physical fitness (cardiopulmonary exercise testing), 7-day accelerometry, quality of life, and adverse events. The effect of exercise on renal function will be evaluated in an exploratory analysis. The intervention is a thrice-weekly, moderate-intensity aerobic exercise supplemented with isometric resistance exercise delivered in two phases. Phase 1: supervised, facility-based, weekly and home-based sessions (8 weeks). Phase 2: home-based sessions (16 weeks).

DISCUSSION

To our knowledge, this study is the first trial designed to provide a precise estimate of the effect of exercise on blood pressure in people with moderate to severe CKD and hypertension. The findings from this study should address a significant knowledge gap in hypertension management in CKD and inform the design of a larger study on the effect of exercise on CKD progression.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03551119 . Registered on 11 June 2018.

Hypotensive Effect of Heated Water-Based Exercise Persists After 12-Week Cessation of Training in Patients With Resistant Hypertension

BACKGROUND

Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx.

METHODS

We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 ± 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32^oC [89.6°F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities.

RESULTS

HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 ± 4.6 vs 3.0 ± 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 ± 2.4 vs 2.06 ± 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 ± 3.8 vs 6.3 ± 3.5 mm Hg, P = 0.01 and -7.5±2.2 vs 2.2 ± 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated.

CONCLUSIONS

BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.

Exercise as a tool for hypertension and resistant hypertension management: current insights

Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension. Aerobic exercise, dynamic resistance exercise, and concurrent training - the combination of dynamic resistance and aerobic exercise training in the same exercise session or on separate days - has been demonstrated to reduce blood pressure and help in the management of hypertension. The present review draws attention to the importance of exercise training in the management of blood pressure in both hypertension and resistant hypertension individuals.

Effects of heated water-based exercise on blood pressure: a systematic review

Abstract Introduction: Systemic arterial hypertension is one of the main cardiovascular risk factors affecting several population. In this context, heated water-based exercise has emerged as a potential alternative to land- based physical exercise to reduce blood pressure (BP) in hypertensive patients. Objective: To systematically synthesize evidence for the lowering effects of heated water-based exercise on BP in a non-specific population. Methods: Scielo, Pubmed and Scopus electronic databases were searched for studies from 2005 to 2016, with the following descriptors in English: “blood pressure, exercise, immersion, blood pressure and hydrotherapy”. A total of 10,461 articles were found and, after applying the inclusion and exclusion criteria, 13 articles were selected and included in the final analysis. All included articles evaluated individuals from different populations and age groups, submitted to a heated water-based exercise session and/or program. Results: The results suggest that both an acute single session and chronic training period (12 to 24 weeks) of heated water-based exercise may reduce BP in different populations (normotensive, hypertensive, postmenopausal women, and heart transplant populations). The magnitude and duration of acute and chronic hypotensive effect of exercise ranged substantially, which was probably due to the variety of exercise frequency, duration and intensity, as well as due to the studied population. Conclusion: These results suggest that heated water-based exercise may promote acute and chronic hypotensive effects in different populations. However, there is no homogeneity in the protocols used, which may have led to the heterogeneity in magnitude and duration of BP reductions.

Water-Based Aerobic Training Successfully Improves Lipid Profile of Dyslipidemic Women: A Randomized Controlled Trial

PURPOSE

This study aimed to investigate the effects of water-based aerobic training on the lipid profile and lipoprotein lipase (LPL) levels in premenopausal women with dyslipidemia.

METHOD

Forty women were randomly assigned to: aquatic training (WA; n = 20) or a control group (CG; n = 20). The WA group underwent 12 weeks of water-based interval aerobic training twice a week at intensities ranging from 9 to 15 on the Borg Scale of Perceived Exertion. Total cholesterol (TC), triglycerides (TG), high- (HDL) and low- (LDL) density lipoprotein, TC/HDL ratio, LPL levels, and peak oxygen consumption (VO₂peak) were evaluated before and after 12 weeks in both groups.

RESULTS

The WA group elicited decreases in TC (9%; effect size [ES] = 0.69; 95% CI [0.05, 1.33]), LDL (16%; ES = 0.78; 95% CI [0.13, 1.42]), and the TC/HDL ratio (17%; ES = 1.13; 95% CI [0.46, 1.79]), as well as increases in VO₂peak (10%; ES = 0.64; 95% CI [0.002, 1.27]) and HDL (10%; ES = 0.28; 95% CI [-0.35. 0.90]), without significant changes in TG (ES = 0.16; 95% CI [-0.46, 1.79]) and LPL (ES = 0.36; 95% CI [-0.27, 0.98]) levels. In the CG, no statistically significant changes in any of these variables were found (TC, ES = 0.19, 95% CI [-0.43, 0.82]; LDL, ES = 0.22, 95% CI [-0.40, 0.85]; HDL, ES = 0.05, 95% CI [-0.57, 0.67]; TG, ES = 0.09, 95% CI [-0.53, 0.71]; TC/HDL ratio, ES = 0.20, 95% CI [-0.42, 0.82]; LPL, ES = 0.02, 95% CI [-0.60, 0.64]; VO₂peak, ES = 0.20, 95% CI [-0.42, 0.82]).

CONCLUSION

Water-based interval aerobic training positively affected the lipid profile in premenopausal dyslipidemic women.

Aquatic Training in Upright Position as an Alternative to Improve Blood Pressure in Adults and Elderly: A Systematic Review and Meta-Analysis

BACKGROUND

Meta-analyses have shown that land training (LT) reduces blood pressure; however, it is not known whether aquatic training (AT) promotes this same effect.

OBJECTIVE

The aim was to conduct a meta-analysis on the effects of AT on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults and elderly and compare them to those of LT and no training [control group (CG)].

DATA SOURCES

Embase, PubMed, Cochrane and Scopus were searched up to May 2017.

STUDY ELIGIBILITY CRITERIA

Studies that evaluated the effect of upright AT (i.e., AT performed in upright position) on the blood pressure of adult individuals and the elderly who did not present with cardiovascular disease (other than hypertension) were included.

DATA ANALYSIS

Two independent reviewers screened search results, performed data extraction and assessed risk of bias. Random effect was used, and the effect size (ES) was calculated by using the standardized mean difference with a 95% confidence interval.

RESULTS

AT promoted a reduction in SBP (ES - 1.47; 95% CI - 2.23 to - 0.70; p < 0.01) compared to CG. This effect is maintained with training progression (ES - 1.52; 95% CI - 2.70 to - 0.33; p = 0.01) and no progression (ES - 1.43; 95% CI - 2.64 to - 0.23; p = 0.02). These effects were significant only in hypertensive (ES - 2.20; 95% CI - 2.72 to - 1.68; p < 0.01), and not in pre-hypertensive individuals. AT promoted a decrease in DBP (- 0.92; 95% CI - 1.27 to - 0.57; p < 0.01) after training with progression (- 0.81; 95% CI - 1.62 to - 0.001; p = 0.04) and no progression (- 1.01; 95% CI - 1.40 to - 0.62; p < 0.01) in pre-hypertensive (- 1.12; 95% CI - 1.53 to - 0.70; p < 0.01) and hypertensive patients (- 0.69; 95% CI - 1.31 to - 0.06; p = 0.03). AT promoted similar reductions in SBP compared to LT; however, reduction of DBP in hypertensive patients was lower (1.82; 95% CI 0.84 to 2.79; p < 0.01).

CONCLUSION

AT promotes blood pressure reduction in adults and elderly. The reduction in SBP in those performing AT is similar to those performing LT, but reduction of DBP is lower in the AT group compared to that in the LT group.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42016049716.

Effect of the physical activity program on the treatment of resistant hypertension in primary care

BACKGROUND

Regular physical activity is widely recommended for patients with arterial hypertension as an essential component of lifestyle modification. Much less is known about the impact of physical exercise on the management of treatment of resistant hypertension (RH). The aim was to assess the effect of physical activity program intensified by mobile phone text reminders on blood pressure control in subjects with RH managed in the primary care.

METHODS

In total, 53 patients with primary hypertension were qualified, including 27 who met the criteria for RH and 26 with well-controlled hypertension (WCH). Ambulatory 24-h blood pressure was monitored and body composition evaluated with bioimpedance and habitual physical activity profile was determined continuously over 72 h with accelerometer. All measurements were performed at baseline and after three and six months. The patients were asked to modify their lifestyle according to American Heart Association Guidelines that included regular aerobic physical activity tailored to individual needs.FindingsPhysical activity in RH increased significantly after six months compared with control subjects (P=0.001). Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the RH group decreased significantly after three months but after six months only office DBP remained significantly lower. After three months 24-h SBP decreased by 3.1±11 mmHg (P=0.08) and DBP by 2.0±6 mmHg (P=0.17) in RH, whereas in WCH respective changes were +1.2±10 and -0.3±6 mmHg. After six months 24-h BP changes were similar.

CONCLUSION

Individualized structured physical activity program increases physical activity in the treatment of resistant hypertensives in primary care but the effect on 24-h blood pressure is only transient.

The effect of regular aquatic exercise on blood pressure: A meta-analysis of randomized controlled trials

Background

No meta-analysis has examined the effect of regular aquatic exercise on blood pressure. The purpose of this study was to perform a meta-analysis to evaluate the effects of regular aquatic exercise on blood pressure.

Design

A meta-analysis of randomized controlled trials.

Methods

Databases were searched for literature published up to April 2017. The randomized controlled trials analysed involved healthy adults, an intervention group that only performed aquatic exercise and a control group that did not exercise, no other intervention, and trials indicated mean systolic blood pressure or diastolic blood pressure. The net change in blood pressure was calculated from each trial, and the changes in blood pressure were pooled by a random effects model, and the risk of heterogeneity was evaluated. Subgroup analysis of subjects with hypertension, subjects who performed endurance exercise (or not), and subjects who only swam (or not) was performed, and the net changes in blood pressure were pooled.

Results

The meta-analysis examined 14 trials involving 452 subjects. Pooled net changes in blood pressure improved significantly (systolic blood pressure −8.4 mmHg; diastolic blood pressure −3.3 mmHg) and the changes in systolic blood pressure contained significant heterogeneity. When subjects were limited to those with hypertension, those who performed endurance exercise and subjects who did not swim, pooled net changes in systolic and diastolic blood pressure decreased significantly, but the heterogeneity of systolic blood pressure did not improve.

Conclusion

Like exercise on land, aquatic exercise should have a beneficial effect by lowering blood pressure. In addition, aquatic exercise should lower the blood pressure of subjects with hypertension, and other forms of aquatic exercise besides swimming should also lower blood pressure.

Postexercise hypotension during different water-based concurrent training intrasession sequences in young women

The purpose of the study was to compare the acute effects of water-based resistance-aerobic (RA) and aerobic-resistance (AR) sequences on systolic blood pressure, diastolic blood pressure (DBP), and mean blood pressure (MBP) in young women. Thirteen active women participated in four sessions: (1) exercises familiarization, (2) aquatic maximal test to determine the heart rate (HR) corresponding to the anaerobic threshold (HR_AT), (3) concurrent protocol RA, and (4) concurrent protocol AR. Both protocols were initiated with the blood pressure measurements at rest in supine position. After that, either RA or AR concurrent protocol was performed. At the end of both protocols, blood pressure was measured throughout 60 minutes (every 10 minutes). The water-based resistance protocol was made up by exercises at maximal velocity, and the water-based aerobic protocol was performed at ±5 bpm of HR_AT continuously. Two-way analysis of variance with repeated measures was used to analyze the data (α = 0.05). There was no hypotensive effect on systolic blood pressure among the time points (P = .235) in both water-based intrasession exercise sequences (P = .423). Regarding the DBP and MBP, both intrasession exercise sequences presented similar (DBP: P = .980; MBP: P = .796) hypotensive effects in the first 10 minutes (DBP: P = .003; MBP: P = .008) at the end of RA and AR sessions (DBP: -4 vs. -13 mm Hg; MBP: -3 vs. -10 mm Hg). It was concluded that both RA and AR water-based concurrent training sessions resulted in postexercise hypotension (DBP and MBP) in normotensive young women.

Effects of aerobic exercise intensity on ambulatory blood pressure and vascular responses in resistant hypertension: a crossover trial

BACKGROUND

Resistant hypertension often exposes patients to poor blood pressure (BP) control, resulting in clinical vulnerability, possible need for device-based procedures (denervation) and increased therapy costs. Regular exercise markedly benefits patients with hypertension, including resistant patients. However, little is known about short-term exercise effects in resistant hypertension.

OBJECTIVE

To evaluate acute hemodynamic effects of exercise in resistant hypertension.

METHOD

After maximal exercise testing, 20 patients (54.0 ± 5.7 years, 30.2 ± 4.9 kg/m) with resistant hypertension participated in three crossover interventions, in random order, and on separate days: control (45' of rest), and light intensity and moderate intensity (45' of aerobic exercise at 50 and 75% of maximum heart rate, respectively). Ambulatory BP, forearm blood flow (with subsequent calculation of vascular resistance), and reactive hyperemia were measured before and after interventions trough venous occlusion plethysmography.

RESULTS

Compared with control, both exercise intensities reduced ambulatory systolic pressure over 5 h (light: -7.7 ± 2.4 mmHg and moderate: -9.4 ± 2.8 mmHg, P < 0.01), whereas only light intensity reduced diastolic pressure (-5.7 ± 2.2 mmHg, P < 0.01). Light intensity also lowered systolic and diastolic pressures over 10-h daytime (-3.8 ± 1.3 and -4.0 ± 1.3 mmHg, respectively, P < 0.02), night-time (-6.0 ± 2.4 and -6.1 ± 1.6 mmHg, respectively, P < 0.05), and diastolic pressure over 19 h (-4.8 ± 1.2 mmHg, P < 0.01). Forearm blood flow changed (decreased) compared with baseline only at 50 min after light intensity (P < 0.05). After the control and light intensity sessions, vascular resistance increased at the end of 1 h, and after moderate intensity, it decreased only at the moment (∼2 min) immediately after intervention (P < 0.05).

CONCLUSION

A single session of light or moderate aerobic exercise acutely reduces ambulatory BP in resistant hypertension, although benefits persist longer following light intensity.

Heart rate recovery improves after exercise in water when compared with on land

BACKGROUND

Water immersion has demonstrated its effectiveness in the recovery process after exercise. This study presents for the first time the impact of water immersion on heart rate recovery after low-intensity cycle exercise.

METHODS

Sixteen male volunteers were involved in the study. The experiment consisted of two cycling exercises: 1 h in ambient air and 1 h in water (temperature: 32 ± 0·2°C). The exercise intensity was individually prescribed to elicit around 35%-40% of VO₂ peak for both conditions. Heart rate recovery was analysed according to recognized methods, such as the differences between heart rate at exercise completion and within the 2 min recovery period.

RESULTS

Although the two exercises were performed both at same energy expenditure and heart rate, the indexes used to assess the fast and slow decay of the heart rate recovery were significantly shortened after exercise in water.

CONCLUSION

The results of the present study suggest that cycling in thermoneutral water decreases the cardiac work after exercise when compared with cycling on land.

Acute and chronic effects of aerobic exercise on blood pressure in resistant hypertension: study protocol for a randomized controlled trial

BACKGROUND

Resistant hypertension is a specific condition that affects approximately 10% of subjects with hypertension, and is characterized by persistently high blood pressure levels even using therapy of three or more antihypertensive agents or with blood pressure control using therapy with four or more antihypertensive agents. Changes in lifestyle, such as physical exercise, are indicated for controlling blood pressure. However, investigating studies about this therapy in individuals with resistant hypertension are few.

METHODS/DESIGN

This is a randomized controlled clinical trial. Forty-eight patients with resistant hypertension will be submitted to perform four short-term interventions: aerobic exercise sessions (mild-, moderate- and high-intensity) and control session, in random order and on separate days. After the short-term sessions, the patients will be randomly allocated into four groups for 8 weeks of follow-up: mild-, moderate- and high-intensity aerobic exercise, and a control group. The primary outcome is the occurrence of blood pressure reduction (office and ambulatory analysis, and acute and chronic effects). Secondary outcomes are autonomic and hemodynamic mechanisms: cardiac and vasomotor autonomic modulation, spontaneous baroreflex sensitivity, forearm blood flow and vascular resistance.

DISCUSSION

The importance of exercise for hypertension has been known for decades, but little is known about the effects on patients with resistant hypertension. This study will help to understand whether different aerobic exercise intensities can induce different responses, as well as by what mechanisms adjustments in blood pressure levels may occur.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02670681 . Registered on 28 January 2016 (first version); Brazilian Registry Platform Clinical Trials: protocol RBR-5q24zh . Registered on 24 June 2015.