Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension

Abstract

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 moderateintensity 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 MEASURESThe 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.

Telehealth versus Self-Directed Lifestyle Intervention to Promote Healthy Blood Pressure: a Randomized Controlled Trial

“…Increased physical activity during awake hours of BP measurement could have resulted in transiently higher daytime BP related to physical activity, which was higher in the dietitian telehealth arm than the self-directed arm. In contrast to our findings, Lopes et al reported that a supervised aerobic training program successfully reduced 24-hr systolic BP and daytime BP with no significant effect on nighttime systolic BP (31). A key difference in their trial was that participants were instructed to not exercise during 24-hr ambulatory BP measurements whereas we instructed participants to continue their regular daily routine without any specific restrictions on exercise.…”

“…The magnitude of the improvements in BP were substantial, similar to a BP medication, and in line with much more resource-intensive feeding studies and lifestyle intervention trials (2, 4, 19, 31). Both the self-directed and the telehealth dietitian arms are scalable interventions that can be easily deployed remotely as the intervention only required internet access and telephone access (no smartphone required).…”

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

“…Ten studies ( N = 380 participants, 51% female , age range 52 to 67 years) were included in the review, of which four ( 15 , 16 , 27 , 28 ) ( N = 58, 50% female) assessed the short-term (≤ 24 h) effects of acute physical exercise and six ( 17 , 18 , 20 , 29 – 31 ) ( N = 322, 51% female) assessed the mid-term (up to 6 months) effects of exercise training intervention ( Table 1 , Flowchart available as Supplementary Figure 1 ). Participants of two studies ( 19 , 32 ) were enrolled in a larger RCT ( 18 ).…”

“…Available evidence on the effects of exercise intervention in individuals with RH shows promising results, as confirmed by some non-systematic reviews ( 11 – 14 ). Different trials have reported a beneficial effect of acute ( 15 , 16 ) or regular exercise ( 17 – 20 ) on office BP or ABP in patients with RH. However, to the best of our knowledge there has been no previous attempts to systematically synthesize the evidence available on the effects of acute or regular exercise on BP measures in patients with RH.…”

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

“…In this sense, Santos et al [ 20 ] found significant postexercise hypotension in RH patients who performed low- and moderate-intensity aerobic exercise. Additionally, evidences have demonstrated that aerobic training has a strong capacity to collaborate with changes on BP in RH patients [ 21 , 22 ]. Although some studies have investigated the impacts of aerobic exercise, the effects of resistance exercises on BP and autonomic modulation in this population remain relatively unexplored in the literature.…”