Background Exercise is key in the primary prevention and management of hypertension. Yet, current exercise recommendations are predominantly based on meta-analyses involving populations of European descent. Since blood pressure (BP) responses to pharmaceutical interventions are known to differ among ethnic groups, we aimed to investigate the BP responses to exercise training in non-European descendants. Purpose The aim of this study was to systematically summarize the available literature on the efficacy of exercise on BP in healthy adults (age ≥18 years) of African or Asian origin. Methods We searched the MEDLINE database for randomized controlled trials that evaluated the effect of exercise training on BP in healthy African and Asian adults with optimal BP, elevated BP or hypertension and published in a peer-reviewed journal up to May 2019. Random effect models were fitted to estimate the effect sizes. Results We identified 22 trials involving individuals of Asian origin ( n = 931; mean age: 44 years; 41% male) and four trials involving individuals of African origin ( n = 510; mean age: 56.7 years; 80% male). Aerobic exercise training significantly ( p < 0.001) reduced systolic and diastolic BP in each ethnic group. Resistance training did not affect the BP of Asian participants with optimal BP. The effect of resistance training in Asians with elevated BP or hypertension and Africans could not be determined due to lack of data. Sub-analyses suggested somewhat larger reductions in systolic BP following aerobic training in hypertensive Africans compared with hypertensive Asians. Conclusions We found favorable effects of aerobic exercise training on BP in the African and the Asian populations. However, the overall low number of studies and especially the lack of data on resistance training and combined training in African and Asian populations warrant more research to improve the quality of evidence.

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Funding Acknowledgements Type of funding sources: None. Background Worldwide, raised blood pressure (BP) or hypertension (HT) is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African-origin populations. Post-exercise hypotension (PEH) defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management which can last up to 24 hours. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. Objectives To systematically summarize the acute effects of a single bout of aerobic exercise on blood pressure in a population of African or Asian origin. Methods We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or HT published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random effect models fitted to estimate effect sizes. Results We identified 10 aerobic exercise trials of individuals of Asian origin (n= 156; mean age: 27.05 years: 72% male; baseline SBP/DBP: 114.93 [99,142] / 67.34 [61,74] mmHg) and 11 aerobic exercise trials involving individuals of African origin (n=112; mean age: 41.37 years; 62% male; baseline SBP/DBP: 125.77 [106.6,140.2] / 79.72 [69.9, 84.3] mmHg). Non-significant moderate reductions in office SBP and DBP at 30 minutes postexercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28 / -1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 minutes postexercise (-2.80 [-7.90, 2.28], p = 0.27 / -1.95, [-5.66, 1.75], p = 0.3) were observed compared to control group. No statistically significant differences were found between ethnic groups (p &gt; 0.05). Ambulatory BP was reported only in the African groups. No effect was found on 24h-SBP post-exercise, but 24h-DBP was statistically signficantly reduced (-1.89 [-3.47, -0.31] mmHg, p &lt; 0.01) after a bout of aerobic exercise. Conclusions A single bout of aerobic exercise did not significantly reduce BP immediately in the African and Asian group. In the African group a small though statistically significant lower 24h-DBP was observed. Unfortunately, no data was found on the 24h-BP response in Asians. The low number of studies in both ethnic groups and lack of data on isometric and resistance exercise in African and Asian populations warrant more research to improve quality of evidence.

Funding Acknowledgements Type of funding sources: None. Introduction Current national and international guidelines recommend exercise as the first line treatment (class IA recommendation) for hypertension. These guidelines are based on research performed in predominantly Caucasian populations, yet the potency of exercise for lowering blood pressure (BP) is less studied in non-Caucasian populations. It is well-known that a great variability exists in the response to pharmacological antihypertensive treatments among ethnic groups. However, it is not clear whether this variability is also present regarding the BP response to exercise.  The ‘Hypertension, Ethnicity and Exercise’ (HYPE²X ) trial will i) investigate whether a short bout of isometric strength or endurance exercise lowers blood pressure in African and Asian populations; ii) evaluate and compare differences in acute response to exercise between the Africans and Asians, and iii) increase our understanding on mechanisms related to blood pressure responses to exercise in these non-Caucasian populations. Methods and analyses A randomized controlled crossover trial will be conducted in 60 adults of African (n = 30; 50% female) or Asian (n = 30, 50% female) origin, ≥ 18 years. Healthy individuals with high to normal blood pressure (SBP: 130 – 139 mmHg or and DBP: 85 – 89 mmHg) or grade I hypertension (grade 1, SBP: 140 – 159 mmHg or DBP: 90 – 99 mmHg) will be recruited at outpatient clinics in Suriname between November 2020 – February 2021. Patients will complete three experimental sessions in a randomized order: a 30 minute walking/running bout at 40-60% of heart rate reserve; an isometric handgrip session at 30% of maximal handgrip strength and a sitting control session. (See Figure 1). Measurements will be performed before and immediately after each session. The primary outcome is daytime blood pressure measured by means of 24h blood pressure monitoring.  Secondary outcomes include office BP, autonomic function (heart rate variability), cardiac function (left ventricle function), vascular function (pulse wave velocity and flow-mediated dilation) and the renin-angiotensin aldosterone system (plasma renin and aldosterone levels). Analyses will be performed using mixed models for repeated measures. A two-tailed p-value &lt;0.05 will be considered statistically significant. Conclusion It is anticipated that the HYPE²X trial will contribute to a better understanding of the response of non-Caucasians to lifestyle interventions, in particular exercise therapy. Abstract Figure 1. Flowchart of the RCOT

Objective:Hypertension is the global leading risk factor for the development of cardiovascular diseases, with the highest prevalence in Asian and African populations. Post-exercise hypotension (PEH) defined as a sustained reduction in blood pressure (BP) after a single bout of exercise is an important physiological phenomenon in BP management. However, little is known about PEH in non-Caucasian populations.Therefore, we aim to systematically summarize the effects of a single bout of aerobic exercise on BP in non-Caucasian populations.Design and method:We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations published in a peer reviewed journal up to August 2021. A meta-analysis was performed to estimate random effect sizes within 95% of confidence intervals.Results:We identified 10 aerobic exercise trials in individuals of Asian origin (n = 156; mean age: 27.05 years: 72% male) and 11 aerobic exercise trials involving individuals of African origin (n = 112; mean age: 41.37 years; 62% male). Non-significant reductions in office BP at 30 minutes (-1.18 [-9.98, 7.62]/-1.29 [-7.32, 4.74] mmHg) and 60 minutes postexercise (-1.80 [-9.98, 7.62]/ -1.28 [-6.03, 3.46] mmHg) were observed in the African group. Similar to the African group, non-significant reductions in office BP at 30 minutes (-2.17 [-6.78, 2.43] / -0.82 [-2.41, 0.77] mmHg) postexercise were observed in the Asian group. No effect was found on 24h-systolic BP postexercise, but 24h-diastolic BP reduced significantly (-1.89 [-3.47, -0.31] mmHg) in the African group.Conclusions:Except for a small, though statistically significant effect on 24h-DBP in the African group, a single bout of aerobic exercise does not seem to cause clinically relevant PEH in the African and Asian populations. It should be acknowledged that the available studies on PEH applying aerobic exercise are limited and there is a lack of data on PEH following isometric and resistance exercise in these populations. This systematic review and meta-analysis is a call for more research on exercise therapy in non-Caucasians.

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