Aerobic Exercise Reduces Blood Pressure in Resistant Hypertension

Dimeo, Fernando; Pagonas, Nikolaos; Seibert, Felix S.; Arndt, R; Zidek, Walter; Westhoff, Timm H.

doi:10.1161/hypertensionaha.112.197780

Cited by 296 publications

(219 citation statements)

References 26 publications

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“…Intensive lifestyle interventions including aerobic exercise ameliorate hypertension in these patients. 35 Moreover, in a recent study, 58% of patients with uncontrolled hypertension on triple antihypertensive therapy achieved their blood pressure goal when sequential pharmacological nephron blockade was added. 33 Device-based antihypertensive treatments, such as catheter-based renal nerve ablation or electrical carotid sinus stimulation, are promising new approaches for patients not responding to intense pharmacological therapy.…”

Section: Perspectivesmentioning

confidence: 99%

Catheter-Based Renal Nerve Ablation and Centrally Generated Sympathetic Activity in Difficult-to-Control Hypertensive Patients

et al. 2012

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5Catheter-based renal nerve ablation decreased renal norepinephrine spillover, reflecting efferent activity by 47%. 2 The mechanisms likely contribute to the blood pressure-lowering effect because efferent renal sympathetic nerves activate the renin-angiotensin system 6,7 and directly stimulate tubular sodium retention. 8,9 In addition, reduced afferent renal nerve traffic may have elicited a central nervous sympatholytic response. Indeed, massive reductions in muscle sympathetic nerve activity (MSNA) and systemic norepinephrine spillover have been reported in a single patient after renal nerve ablation.10 Similarly, removal of the diseased native kidney reduced MSNA in renal transplant recipients.11 These clinical observations translate the experimental finding that renal afferents convey signals to the brain, thus raising sympathetic activity and blood pressure 12,13 from animals to humans. See Editorial Commentary, pp 1385-1386Abstract-Endovascular renal nerve ablation has been developed to treat resistant hypertension. In addition to lowering efferent renal sympathetic activation, the intervention may attenuate central sympathetic outflow through decreased renal afferent nerve traffic, as evidenced by a recent case report. We tested the hypothesis in 12 nonpreselected patients with difficult-to-control hypertension (aged 45-74 years) admitted for renal nerve ablation. All patients received ≥3 antihypertensive medications at full doses, including a diuretic. Electrocardiogram, respiration, brachial and finger arterial blood pressure, and muscle sympathetic nerve activity were recorded before and 3 to 6 months after renal nerve ablation. Heart rate and blood pressure variability were analyzed in the time and frequency domain. Pharmacological baroreflex slopes were determined using the modified Oxford bolus technique. Resting heart rate was 61±3 bpm before and 58±2 bpm after ablation (P=0.4). Supine blood pressure was 157±7/85±4 mm Hg before and 157±6/85±4 mm Hg after ablation (P=1.0). Renal nerve ablation did not change resting muscle sympathetic nerve activity (before, 34±2 bursts per minute; after, 32±3 bursts per minute P=0.6), heart rate variability, or blood pressure variability. Pharmacological baroreflex control of heart rate and muscle sympathetic nerve activity did not change. We conclude that reduced central sympathetic inhibition may be the exception rather than the rule after renal nerve ablation in unselected patients with difficult-to-control arterial hypertension. (Hypertension. 2012;60:1485-1490.) • Online Data Supplement

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Section: Perspectivesmentioning

confidence: 99%

Catheter-Based Renal Nerve Ablation and Centrally Generated Sympathetic Activity in Difficult-to-Control Hypertensive Patients

et al. 2012

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“…41 Patients in the exercise group had significant reductions in systolic and diastolic blood pressure (6 ± 12 and 3 ± 7 mm Hg, respectively; p = 0.03 for both) compared with the control group.…”

Section: What Modifications Are Most Likely To Be Effective?mentioning

confidence: 85%

“…‡Aerobic exercise was found to reduce blood pressure by 6/3 mm Hg (p = 0.03 for both parameters) among patients with resistant hypertension. 41 The other health behaviour recommendations listed to optimize health behaviours apply to all patients with hypertension, including those with resistant hypertension. 11 tension.…”

Section: Renin Profilingmentioning

confidence: 99%

Assessment and management of resistant hypertension

Padwal

Rabkin

Khan

2014

CMAJ

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• Resistant hypertension is estimated to affect 10% of adults with hypertension.• Pseudoresistance and secondary hypertension must be excluded.• The optimal base regimen for most patients comprises a diuretic, an angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker, and a dihydropyridine calcium-channel blocker.• Long-acting combination products should be used to maximize adherence to treatment.• Mineralocorticoid receptor antagonists, and α-and β-blockers are the most commonly used add-on drugs. Key points Box 1: Evidence for this reviewWe searched MEDLINE (1946 through Apr. 21, 2013) using the keywords "resistant hypertension" and "refractory hypertension." We excluded duplicate articles and limited the search to human studies that were published in English. Of 1163 citations screened, we reviewed 187 full-text articles, including 8 randomized controlled trials and 2 consensus guideline statements. We also scanned reference lists to identify additional citations of relevance.

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“…[35][36][37][38][39][40][41] Because BP lowering is common in this setting, 29 it is difficult to distinguish whether arterial destiffening is an incipient contributor to this process or a favorable consequence of a shift in the operating point of the pressure-stiffness curve ( Figure 1). 12,30 Studies in isolated systolic hypertension provide some insights.…”

Section: Hypertensionmentioning

confidence: 99%