Combined Aerobic and Resistance Exercises Evokes Longer Reductions on Ambulatory Blood Pressure in Resistant Hypertension: A Randomized Crossover Trial

Physical activity alters the effect of genetic determinants of adiposity on hypertension among individuals of European ancestry in the UKB

Hypertension is a leading risk factor for cardiovascular disease and is modulated by genetic variants. This study aimed to assess the effect of obesity genetic liability and physical activity on hypertension among European and African ancestry individuals within the UK Biobank (UKB). Participants were 230 115 individuals of European ancestry and 3239 individuals of African ancestry from UKB. Genetic liability for obesity were estimated using previously published data including genetic variants and effect sizes for body mass index (BMI), waist-hip ratio (WHR) and waist circumference (WC) using Plink software. The outcome was defined as stage 2 hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥90 mmHg, or the use of anti-hypertensive medications). The association between obesity genetic liability and the outcome was assessed across categories of self-reported physical activity using logistic regression. Among European ancestry participants, there was up to a 1.2 greater odds of hypertension in individuals with high genetic liability and low physical activity compared to individuals with low genetic liability and high physical activity (p < 0.001). In individuals engaging in low levels of physical activity compared with moderate/high physical activity, the effect of BMI genetic liability on hypertension was greater (p interaction = 0.04). There was no evidence of an association between obesity genetic liability and hypertension in individuals of African ancestry in the whole sample or within separate physical activity groups (p > 0.05). This study suggests that higher physical activity levels are associated with lower odds of stage 2 hypertension among European ancestry individuals who carry high genetic liability for obesity. This cannot be inferred for individuals of African ancestry, possibly due to the low African ancestry sample size within the UKB.

The impact of exercise modalities on blood glucose, blood pressure and body composition in patients with type 2 diabetes mellitus

BACKGROUND

Physical activity has been recommended as an important non-pharmacological therapeutic strategy for the management of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the effects of 12 weeks of strength, aerobic, and a combination of aerobic and resistance training on blood glucose level, blood pressure, and body composition in patients with T2DM.

METHODS

From Debremarkos referral hospital, 40 subjects with T2DM (mean age 42.45 years, 29 men, 11 women) were randomly assigned to one of three intervention groups or the control group. The following variables were measured: body mass index (BMI), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body fat percentage (BFP). Paired sample T-test and one-way ANCOVA were applied whilst controlling for diet, gender, and age.

RESULTS

All intervention groups showed improvement in a mean difference of FBG - 13.03 (t =-5.55, df = 39, p < 0.001), SBP - 21.63 mmHg - 17.6 mmHg (t =-6.51, df = 39, p < 0.001), DBP - 11.86 mmHg (t = -5.47, df = 39, p < 0.001) and BFP - 9.14 (t = -7.49, df = 39, p < 0.001). There was a significant difference in mean BMI reduction when diet, gender, and age were controlled in a one-way ANCOVA (F (3, 33) = 11.79, p < 0.001), SBP (F (3, 33) = 13.383, p < 0.001), DBP (F (3, 33) = 7.830, p < 0.001), FBG (F (3, 33) = 6.337, p < 0.001), BFP (F (3, 33) = 24.29, p < 0.001) between the exercise intervention groups and control group. Additionally, the estimated marginal means indicate that the combined strength and aerobic exercise intervention group experienced the greatest improvements.

CONCLUSION

Body composition, blood pressure, and fasting blood glucose were significantly lower in the combined (aerobic plus strength) treatment than in the individual treatment, indicating that the combined exercise intervention was more successful in altering these parameters.

Trends in exercise for hypertension: a bibliometric analysis

Objective

To investigate development trends and research hotspots of exercise for hypertension research and provide researchers with fresh perspectives for further studies.

Materials and methods

Articles and reviews regarding exercise and hypertension spanning May 1st 2003 to May 18th 2023 were retrieved from the Web of Science Core Collection (WOSCC) database. VOSviewer and Citespace were mainly used to perform and visualize co-authorship, co-citation, and co-occurrence analysis of countries, institutions, authors, references and keywords in this field.

Results

A total of 1,643 peer-reviewed papers were identified, displaying a consistent increasing trend over time. The most prolific country and institution were Brazil and University of Sao Paulo, respectively. And we identified the most productive author was lrigoyen, Maria Claudia C, while Pescatello Linda S was the most co-cited author. Journal of hypertension was the most prominent journal, and Hypertension was the journal which was the most co-cited. And this field can be divided into 3 research themes: exercise interventions for hypertension, age-specific relevance of exercise for hypertension, and the global burden of hypertension and the role of exercise. According to the result of keywords analysis, epidemiological information, types of exercise, target population, mechanism, and study design are significant research areas. "Resistance training", "adults", and "heart rate variability" were identified as the major future research foci.

Conclusions

The findings offer a scientific insight into exercise for hypertension research, presenting researchers with valuable information to understand the current research status, hotspots, and emerging trends for future investigation.

Impact of dynamic explosive resistance exercise with elastic bands on pulse pressure in hypertensive older adults: a randomized crossover study

OBJECTIVE

This study aimed to evaluate the acute responses of pulse pressure (PP), SBP, and DBP to dynamic explosive resistance exercise (DERE) with elastic resistance bands in hypertensive older adults.

METHODS

Eighteen hypertensive older adults were randomly assigned to participate in DERE and control sessions. PP, SBP, and DBP were measured before (baseline) and after each session (immediately, 10, and 20 min after the session). The DERE protocol has five sets of two consecutive exercises.

RESULTS

There was an important clinical decrease in PP (Δ = -7.8 mmHg; dz = 0.7) and in DBP (Δ = -6.3 mmHg; dz = 0.6) favoring the exercise session post-20 min in the intersession comparison. DERE also promoted lowering levels in SBP (140.3 ± 16.0 vs. 126.2 ± 14.3 mmHg; Δ = -14.1 mmHg; P  = 0.04) with a large effect size ( dz = 0.9) post-20 min when compared to the control session.

CONCLUSION

Our findings indicate that DERE with elastic resistance bands improved SBP in hypertensive older adults. In addition, our results support the hypothesis that DERE can an important clinical decrease in PP and DBP. According to this, professionals may have additional exercise training possibilities with elastic resistance bands when prescribing resistance exercises for systemic arterial hypertension treatment in this population.

When blood pressure refuses to budge: exploring the complexity of resistant hypertension

Resistant hypertension, defined as blood pressure that remains above goal despite using three or more antihypertensive medications, including a diuretic, affects a significant proportion of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Despite the availability of a wide range of pharmacological therapies, achieving optimal blood pressure control in patients with resistant hypertension remains a significant challenge. However, recent advances in the field have identified several promising treatment options, including spironolactone, mineralocorticoid receptor antagonists, and renal denervation. In addition, personalized management approaches based on genetic and other biomarkers may offer new opportunities to tailor therapy and improve outcomes. This review aims to provide an overview of the current state of knowledge regarding managing resistant hypertension, including the epidemiology, pathophysiology, and clinical implications of the condition, as well as the latest developments in therapeutic strategies and future prospects.

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.

Effects of Concurrent Aerobic Plus Resistance Training on Blood Pressure Variability and Blood Pressure Values in Patients with Hypertension and Coronary Artery Disease: Gender-Related Differences

The purpose of this study was to compare changes in blood pressure variability (BPV) and blood pressure (BP) values occurring in response to concurrent training (CT) between the two genders. A total of 35 males and 20 women aged 55–80 years, with hypertension and coronary artery disease, were included. They underwent a 12-week CT program. The aerobic component of CT was performed according to the rate of perceived exertion while the intensity of the resistance component was set at 60% of 1 repetition maximum for the first 4 weeks and then increased to 80%. BP and BPV were evaluated at baseline and at the end of the CT program through 24 h ambulatory blood pressure monitoring. After 12-weeks, 24 h and daytime systolic BPV decreased in both men and women without significant between-groups differences. Twenty-four-hour daytime and nighttime diastolic BPV decreased in both genders with a significantly greater decrease in women compared to men. Twenty-four-hour daytime systolic and 24 h diastolic BP decreased in men while they were unchanged in women. In conclusion, CT induced similar reductions of systolic BPV in men and women and a greater decrease in diastolic BPV in women. Conversely, CT decreased BP values in males but not in females. CT appears to be an effective intervention for reducing BPV in both genders.

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.

Cardiovascular Autonomic Responses to Aerobic, Resistance and Combined Exercises in Resistance Hypertensive Patients

Here, we report the acute effects of aerobic (AER), resistance (RES), and combined (COM) exercises on blood pressure, central blood pressure and augmentation index, hemodynamic parameters, and autonomic modulation of resistant (RH) and nonresistant hypertensive (NON-RH) subjects. Twenty participants (10 RH and 10 NON-RH) performed three exercise sessions (i.e., AER, RES, and COM) and a control session. Hemodynamic (Finometer®, Beatscope), office blood pressure (BP), and autonomic variables (accessed through spectral analysis of the pulse-to-pulse BP signal, in the time and frequency domain-Fast Fourrier Transform) were assessed before (T0), one-hour (T1), and twenty-four (T2) hours after each experimental session. There were no changes in office BP, pulse wave behavior, and hemodynamic parameters after (T0 and T1) exercise sessions. However, AER and COM exercises significantly reduced sympathetic modulation in RH patients. It is worth mentioning that more significant changes in sympathetic modulation were observed after AER as compared to COM exercise. These findings suggest that office blood pressure, arterial stiffness, and hemodynamic parameters returned to baseline levels in the first hour and remained stable in the 24 hours after the all-exercise sessions. Notably, our findings bring new light to the effects of exercise on RH, indicating that RH patients show different autonomic responses to exercise compared to NON-RH patients. This trial is registered with trial registration number NCT02987452.

Blood Pressure and Blood Glucose Responses to Combined Exercise Sessions of Different Intensities in Individuals with Cardiovascular Risk Factors

OBJECTIVE

The purpose of the present study was to verify the acute effects of blood pressure and blood glucose after two sessions of combined exercise sessions performed at two levels of intensity in trained individuals with cardiovascular risk factors.

METHODS

Eighteen individuals (66.22 ± 8.61 years) of both sexes (6 women/12 men) with cardiovascular risk factors performed two sessions of combined exercises at different levels of intensity: moderate (MOD) and high (HI). To control the intensity of the aerobic training, the Borg Rating of Perceived Exertion (RPE) Scale was used. For the strength training, the maximum number of repetitions was carried out within a predetermined duration of sets. Blood pressure and blood glucose measurements were collected before and 20 minutes after the sessions. The data were analyzed using Generalized Estimating Equations, α 5%.

RESULTS

Reductions were observed in systolic blood pressure (MOD - Δ = -4.95 mmHg; HI - Δ = -3.31 mmHg) and blood glucose (MOD - Δ = -16.06 mg/dL; HI - Δ = -29.45 mg/dL) after the two sessions, with no difference between sessions. Diastolic blood pressure did not change (p < .05).

CONCLUSION

Combined exercises sessions of moderate or high intensity can promote an acute reduction in systolic blood pressure and glycemia in individuals with cardiovascular risk factors.

Postexercise Hypotension Is Delayed in Men With Obesity and Hypertension

Background

Postexercise hypotension (PEH) can play a major role in the daily blood pressure management among individuals with hypertension. However, there are limited data on PEH in persons with obesity and hypertension, and no PEH data in this population beyond 90 min postexercise.

Purpose

The purpose of this study was to determine if PEH could be elicited in men with obesity and hypertension during a 4-h postexercise measurement period.

Methods

Seven men [age = 28 ± 4 years; body mass index = 34.6 ± 4.8 kg/m²; brachial systolic blood pressure (SBP): 138 ± 4 mmHg; brachial diastolic BP (DBP): 80 ± 5 mmHg; central SBP: 125 ± 4 mmHg; central DBP: 81 ± 8 mmHg] performed two exercise sessions on a cycle ergometer, each on a separate day, for 45 min at ∼65% VO_2max. One exercise session was performed at a cadence of 45 RPM and one at 90 RPM. Blood pressure was monitored with a SunTech Oscar2 ambulatory blood pressure monitor for 4 h after both exercise sessions, and during a time-matched control condition.

Results

Both brachial and central SBP were not changed during the first h postexercise but were reduced by ∼5-11 mmHg between 2 and 4 h postexercise (p < 0.05) after both exercise sessions. Brachial and central DBP were elevated by ∼5 mmHg at 1 h postexercise (p < 0.05) but were ∼2-3 mmHg lower compared to control at 4 h postexercise, and ∼2-4 mmHg lower at 3 h postexercise compared to baseline. Mean arterial pressure (MAP) was elevated compared to control at 1 h postexercise after both exercise sessions, but was ∼2-3 mmHg lower compared to control at 2, 3, and 4 h postexercise, and ∼4-7 mmHg lower at 3 h postexercise compared to baseline.

Conclusion

Despite the small sample size and preliminary nature of our results, we conclude that PEH is delayed in men with obesity and hypertension, but the magnitude and duration of PEH up to 4 h postexercise is similar to that reported in the literature for men without obesity and hypertension. The PEH is most pronounced for brachial and central SBP and MAP. The virtually identical pattern of PEH after both exercise trials indicates that the delayed PEH is a reproducible finding in men with obesity and hypertension.

Resistance training improves cognitive function in older adults with different cognitive status: a systematic review and Meta-analysis

The present study investigated the impact of resistance training (RT) on cognitive function in older adults with different cognitive status by conducting a systematic review and meta-analysis of intervention studies. We performed a literature search with no restriction on publication year in MEDLINE, Embase, CINAHL, SPORTDiscus, and AgeLine from inception up to August 2020. Experimental studies investigating the impact of RT on the cognitive function of cognitively healthy (CH) and cognitively impaired (CI) older adults (≥60 years) were included for analysis. Eighteen studies were included in the final analysis, of which ten studies investigated CH community-dwelling older adult, seven studies investigated CI older adults, and one study investigated both. RT significantly improved overall cognitive function in both CH (SMD = 0.54; 95% CI = 0.00 to 1.08, P = 0.047) and CI (SMD = 0.60; 95% CI = 0.21 to 1.16, P = 0.005) older adults. However, short-term memory was only improved in CH older adults (MD = -0.20; 95% CI = -0.25 to -0.15, P < 0.00001). In conclusion, RT improved overall cognitive function in CH and CI older adults, whereas short-term memory, assessed by the digit span of the WAIS III, was only significantly improved in CH older adults.

Hypertension telemonitoring and home-based physical training programs

PURPOSE

Hypertensive patients with access to telemedicine can receive telemonitoring of blood pressure and cardiovascular risk factors such as sedentary lifestyle, diet, and remote supervision of treatment compliance. Faced with this challenge, electronic devices for telemonitoring of BP have gained space. They have shown to be effective in the follow-up of hypertensive patients and assist in the adherence and control of associated risk factors such as physical inactivity and obesity.

MATERIALS AND METHODS

Narrative Review.

RESULTS

The use of advanced smartwatches, smartphone apps, and online software for monitoring physical activity is increasingly common. Electronic equipment is briefly presented here as a support for better addressing some cardiovascular variables. Using various automated feedback services with a follow-up multidisciplinary clinical team is the ideal strategy.

CONCLUSION

Mobile health can improve risk factors and health status, particularly for hypertensive patients, improving access to cardiac rehabilitation and reducing the cost.

Nonpharmacological Management of Resistant Hypertension

PURPOSE OF REVIEW

In the United States (US), 46% of adults have hypertension (systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 80 mmHg). Approximately, 16% of patients with hypertension have apparent treatment-resistant hypertension (aTRH) and the incidence of true resistant hypertension (RHT) is thought to be much lower (~ 2%). These patients with RHT are at a higher risk for adverse events and worse clinical outcomes.

RECENT FINDINGS

Although lifestyle interventions have proven to be effective as the first line of defense in treating hypertension, their role in the management of patients with RHT is not well established. Despite fewer in number, available studies examining lifestyle interventions in patients with RHT do indeed show promising results. In this review, we aim to discuss the role of common lifestyle interventions such as physical activity, exercise, weight loss, and dietary modifications on blood pressure control in patients with RHT.