The differential impact of aerobic and isometric handgrip exercise on blood pressure variability and central aortic blood pressure

Effects of dynamic, isometric, and combined resistance training on ambulatory blood pressure in treated men with hypertension: a randomized controlled trial

Ambulatory blood pressure (ABP) monitoring is a widespread recommendation for the diagnosis and management of hypertension. Dynamic resistance training (DRT) and isometric handgrip training (IHT) have been recommended for hypertension treatment, but their effects on ABP have been poorly studied. Additionally, combined dynamic and isometric handgrip resistance training (CRT) could produce an additive effect that has yet to be tested. Thus, this randomized controlled trial was designed to evaluate the effects of DRT, IHT and CRT on mean ABP and ABP variability. Fifty-nine treated men with hypertension were randomly allocated to 1 of four groups: DRT (8 dynamic resistance exercises, 50% of 1RM, 3 sets until moderate fatigue), IHT (4 sets of 2 min of isometric handgrip at 30% of MVC), CRT (DRT + IHT) and control (CON - 30 min of stretching). Interventions occurred 3 times/week for 10 weeks, and ABP was assessed before and after the interventions. ANOVAs and ANCOVAs adjusted for pre-intervention values were employed for analysis. Mean 24-h, awake and asleep BPs did not change in either group throughout the study (all, P > 0.05). Nocturnal BP fall as well as the standard deviation, coefficient of variation and the average real variability of ABP also did not change significantly in either group (all, P < 0.05). Changes in all these parameters adjusted to the pre-intervention values were also similar among the four groups (all, p > 0.05). In treated men with hypertension, 10 weeks of DRT, IHT or CRT does not decrease ABP levels nor change ABP variability.

Geneenvironment interaction between phthalate exposure and pubertal genetic polymorphisms on blood pressure variability in children: Exploring the moderating effects of lifestyle behaviours

Phthalates (PAEs) are synthetic compounds extensively employed in consumer products. Blood pressure (BP) in children can vary, the degree of visit-to-visit BP variability (VVV) is at least partially independent of BP. The interactions between PAEs exposure, pubertal-related genetic susceptibility and lifestyles on childhood VVV are not investigated. This study utilized data from a cohort collected from Oct 2017-2020 in Xiamen, China. Seven urine PAE metabolites were measured. The long-term VVV was characterized employing the standard deviation (SD) and average real variability. We constructed a genetic risk score (GRS) of pubertal-related genes and healthy lifestyle scores. Exposed to high levels of mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) (OR=1.43, 95 %CI=1.07, 1.92) and mono-2-ethyl-5-oxohexyl phthalate (OR=1.36, 95 % CI=1.01, 1.83) was related to increased SBP-SD, and the OR for high SBP-SD related to high GRS was 1.38 (95 % CI=1.02, 1.85). Compared to participants who had low GRS and low MEHHP exposure, participants exhibiting high GRS and MEHHP levels were more likely to experience high SBP-SD (OR=2.00, P<0.05). Individuals exhibiting low GRS, low MEHHP levels, and adhering to healthy lifestyles were associated with the least probability of experiencing high SBP-SD (OR=0.31, P<0.05). Increased PAEs exposure could elevate childhood systolic VVV, and exacerbated the adverse impact of pubertal-related genetic susceptibility on the high VVV of SBP; however, healthy lifestyles might alleviate these adverse effects. Promoting healthy lifestyles and reducing PAEs exposure for preventing elevated BP variability among children is important, especially for individuals with greater genetic susceptibility to early pubertal onset. ENVIRONMENTAL IMPLICATION: Blood pressure (BP) in children can vary, as a noninvasive, inexpensive and applicable method, the extent of visit-to-visit variability (VVV) is at least partially independent of BP. The interactions between phthalates (PAEs) exposure, variants of puberty-related genes and lifestyles on VVV are not investigated. Increased childhood systolic VVV might be associated with PAEs exposure, with the associations more pronounced combined with pubertal genetic susceptibility. Yet, healthy habits could partly eliminate such adverse effects. Our study underscores the importance of advocating for healthy lifestyles and reducing exposure to PAEs, especially among individuals with high genetic susceptibility to early puberty onset.

Effects of Isometric Handgrip Training on Ambulatory Blood Pressure in Individuals Over 18 Years Old: A Systematic Review and Meta-Analysis

PURPOSE

The aim of this study was to analyze the effects of isometric handgrip training (IHT) on ambulatory blood pressure (BP) in individuals aged 18 yr and older.

REVIEW METHODS

A systematic review and meta-analysis was performed in Medline and Web of Science, encompassing studies published until July 2023, as well as the gray literature. We calculated the mean difference (MD) and 95% CI using an inverse variance method with a random effects model.

SUMMARY

Considering both published and unpublished studies, we observed an effect of IHT on awake diastolic BP (MD = -2.02; 95% CI, -3.89 to -0.15 mmHg; P = .03). There were no significant effects on 24-hr systolic BP (MD = -1.31; 95% CI, -3.84 to 1.22 mmHg; P = .31), asleep systolic BP (MD = -0.84; 95% CI, -3.31 to 1.63 mmHg; P = .50), awake systolic BP (MD = -0.93: 95% CI, -3.10 to 1.23 mmHg; P = .40), 24-hr diastolic BP (MD = -0.96; 95% CI, -2.65 to 0.74 mmHg; P = .27), or asleep diastolic BP (MD = -1.27; 95% CI, -3.22 to 0.67 mmHg; P = .20). In conclusion, the effects of IHT on ambulatory BP were observed primarily in awake diastolic BP among individuals over 18 yr of age.

Isometric Exercise Training and Arterial Hypertension: An Updated Review

Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.

Sports activities and cardiovascular system change

Sports activity is generally considered to be beneficial to health. The World Health Organization (WHO) recommends physical activity as part of a healthy lifestyle. Sports activities significantly affect the cardiovascular system. A number of studies show that they significantly reduce the risk of cardiovascular disease as well as decrease cardiovascular mortality. This review discusses changes in various cardiovascular parameters in athletes - vagotonia/bradycardia, hypertrophy of heart, ECG changes, blood pressure, and variability of cardiovascular parameters. Because of its relationship to the cardiovascular system, VO2max, which is widely used as an indicator of cardiorespiratory fitness, is also discussed. The review concludes with a discussion of reactive oxygen species (ROS) and oxidative stress, particularly in relation to changes in the cardiovascular system in athletes. The review appropriately summarizes the above issues and points out some new implications.

Effect of exercise training on blood pressure variability in adults: A systematic review and meta-analysis

BACKGROUND AND AIMS

Targeting blood pressure variability (BPV) can potentially reduce cardiovascular events and incidence of mortality, but whether exercise reduces BPV remains controversial. This systematic review and meta-analysis were designed to study the impact of an exercise intervention on BPV in adults.

METHODS

A systematic search of PubMed, Web of Science, Scopus, EBSCO host, Cochrane, Embase, Science direct databases was done to retrieve controlled trials published from inception to January 10, 2023 that investigated the effects of exercise on BPV. The main characteristics of each study were synthesized, re-evaluated, and used in this meta-analysis.

RESULTS

Eleven studies with 514 adults with exercise training were eligible for single-arm meta-analysis and six randomized controlled trials (RCTs) were selected for further meta-analysis. After exercise training, systolic blood pressure variability (SBPV) (effect size = -0.76, 95%CI: -1.21 to -0.30, I2 60%), especially the average real variability SBP (-0.85, -1.44 to -0.27, I2 59%), was significantly improved. SBPV (-0.68, -1.18 to -0.18, I2 64%) significantly improved in hypertension patients. Aerobic exercise improved SBPV (-0.66, -1.32 to -0.00, I2 45%), and combined training improved both SBPV (-0.74, -1.35 to -0.14, I2 65%) and diastolic blood pressure variability (DBPV) (-0.36, -0.65 to -0.02, I2 33%). The SBPV of daytime (-0.90, -1.39 to -0.40, I2 57%) and DBPV of daytime (-0.31, -0.53 to -0.08, I2 0%) values demonstrated significant improvement compared to the night-time values. Moreover, six RCTs demonstrated a decrease in SBPV (-1.03, -1.77 to -0.28, I2 45%).

CONCLUSION

This study provides quantitative evidence that exercise training can improve BPV, especially SBPV, in adults. This meta-analysis suggests that aerobic exercise and combined training should be recommended for hypertension patients.

Prevalence of ideal cardiovascular health and its relationship with relative handgrip strength in rural northeast China

Objectives

We aimed to investigate ideal cardiovascular health (CVH), its relationship with handgrip strength, and its components in rural China.

Methods

We conducted a cross-sectional study of 3,203 rural Chinese individuals aged ≥35 years in Liaoning Province, China. Of these, 2,088 participants completed the follow-up survey. Handgrip strength was estimated using a handheld dynamometer and was normalized to body mass. Ideal CVH was assessed using seven health indicators (smoking, body mass index, physical activity, diet, cholesterol, blood pressure, and glucose). Binary logistic regression analyses were performed to assess the correlation between handgrip strength and ideal CVH.

Results

Women had a higher rate of ideal cardiovascular health (CVH) than men (15.7% vs. 6.8%, P < 0.001). Higher handgrip strength correlated with a higher proportion of ideal CVH (P for trend <0.001). After adjusting for confounding factors, the odds ratios (95% confidence interval) of ideal CVH across increasing handgrip strength tripartite were 1.00 (reference), 2.368 (1.773, 3.164), and 3.642 (2.605, 5.093) in the cross-sectional study and 1.00 (reference), 2.088 (1.074, 4.060), and 3.804 (1.829, 7.913) in the follow-up study (all P < 0.05).

Conclusion

In rural China, the ideal CVH rate was low, and positively correlated with handgrip strength. Grip strength can be a rough predictor of ideal CVH and can be used to provide guidelines for improving CVH in rural China.

Isometric Resistance Training to Manage Hypertension: Systematic Review and Meta-analysis

PURPOSE OF REVIEW

Hypertension is the primary risk factor for cardiovascular disease and adequate blood pressure control is often elusive. The objective of this work was to conduct a meta-analysis of trial data of isometric resistance training (IRT) studies in people with hypertension, to establish if IRT produced an anti-hypertensive effect. A database search (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and MEDLINE) identified randomised controlled and crossover trials of IRT versus a sedentary or sham control group in adults with hypertension.

RECENT FINDINGS

We included 12 studies (14 intervention groups) in the meta-analyses, with an aggregate of 415 participants. IRT reduced systolic blood pressure (SBP), mean difference (MD) - 7.47 mmHg (95%CI - 10.10, - 4.84), P < 0.01; diastolic blood pressure (DBP) MD - 3.17 mmHg (95%CI - 5.29, - 1.04), P < 0.01; and mean arterial blood pressure (MAP) MD - 7.19 mmHg (95%CI - 9.06, - 5.32), P < 0.0001. Office pulse pressure and resting heart rate was not significantly reduced, neither were 24-h or day-time ambulatory blood pressures (SBP, DBP). Night-time blood pressures, however, were significantly reduced with SBP MD - 4.28 mmHg (95%CI - 7.88, - 0.67), P = 0.02, and DBP MD - 2.22 mmHg (95%CI - 3.55, - 0.88), P < 0.01. IRT does lower SBP, DBP and MAP office and night-time ambulatory SBP and DBP, but not 24-h mean ambulatory blood pressures in people with hypertension.

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.

Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts' consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.