Effects of aerobic exercise intensity on ambulatory blood pressure and vascular responses in resistant hypertension

Santos, Lucas Porto; Moraes, Roque; Vieira, Paulo José Cardoso; Ash, Garrett I.; Waclawovsky, Gustavo; Pescatello, Linda S.; Umpierre, Daniel

doi:10.1097/hjh.0000000000000961

Cited by 52 publications

(56 citation statements)

References 38 publications

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“…Few studies have evaluated the impact of HIIT on BP measured by ambulatory BP monitoring, a measurement that is more specific for systemic arterial hypertension diagnosis Santos et al, 2016;Whelton et al, 2018). Our results represent clinically positive findings for endurance-trained participants since systemic arterial hypertension is the most common cardiovascular disease in these individuals (Leddy & Izzo, 2009) and it is often masked (Trachsel et al, 2015).…”

Section: Hiit and Blood Pressuresupporting

confidence: 53%

Cardiac remodeling after six weeks of high-intensity interval training to exhaustion in endurance-trained males

Mahjoub

Blanc

Paquette

et al. 2019

Preprint

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Keywords: high-intensity interval training, endurance-trained individuals, ambulatory blood pressure, left atrium, right ventricle Table of contents category: CardiovascularRunning title: High-intensity exercise training and the heart Key points:• High-intensity interval training improves physical performance of endurance athletes, although studies examining its cardiovascular effects are sparse.• We evaluated the impact of submaximal (85% maximal aerobic power) and supramaximal (115% maximal aerobic power) high-intensity interval training on ambulatory blood pressure, heart rate and cardiac cavities size and function in endurance-trained adults.• Irrespective of training intensity, six weeks of high-intensity interval training increase left atrial volumes in endurance-trained adults, whereas the submaximal training decreases right ventricular systolic function.• These results may help identify the exercise threshold for potential toxicity of intense exercise training for at-risk individuals and ideal exercise training regimens conferring optimal cardiovascular protection and adapted endurance training for athletes. ABSTRACTHigh-intensity interval training (HIIT) improves physical performance of endurance athletes, although studies examining its cardiovascular effects are sparse. We evaluated the impact of HIIT on blood pressure, heart rate and cardiac cavities size and function in endurance-trained adults. Seventeen endurance-trained males underwent 24-hour ambulatory blood pressure monitoring (ABPM) and Doppler echocardiography at baseline and after 6 weeks of HIIT.Participants were divided in 2 groups (85% maximal aerobic power (MP); HIIT85, n=8 and 115% MP; HIIT115 , n = 9) in order to compare the impact of different HIIT intensities. ABPM and cardiac chambers size and function were similar between groups at baseline. HIIT reduced heart rate (55 ± 8 vs. 51 ± 7 bpm; p= 0.003), systolic blood pressure (SBP; 121 ± 11 vs 118 ± 9 mmHg; p = 0.01), mean arterial pressure (MAP; 90 ± 8 vs 89 ± 6 mmHg; p = 0.03) and pulse pressure (52 ± 6 vs 49 ± 5 mmHg; p = 0.01), irrespective of training intensity. Left atrium (LA) volumes increased after HIIT (maximal: 50 ± 14 vs 54 ±14 ml; p= 0.02; minimal: 15 ± 5 vs 20 ± 8 ml; p = 0.01) in both groups. Right ventricle (RV) global longitudinal strain lowered after training in the HIIT85 group only (20 ± 4 vs. 17 ± 3%, p = 0.04). In endurance-trained males, six weeks of HIIT reduce SBP and MAP and increase LA volumes irrespective of training intensity, whereas submaximal HIIT deteriorates RV systolic function.

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Section: Hiit and Blood Pressuresupporting

confidence: 53%

Cardiac remodeling after six weeks of high-intensity interval training to exhaustion in endurance-trained males

Mahjoub

Blanc

Paquette

et al. 2019

Preprint

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“…There are only a few studies that have investigated physical exercise as an alternative therapy for resistant hypertension treatment, and they have presented promising results [29, 30, 32, 33]. However, these studies did not perform randomization, allocation blindness, appropriate pairing, or detailed description of methods (mainly statistical analysis).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies with this population analyzed peripheral [33] or central [29] variables to try to explain the reduced BP. This study aims to deepen these analyzes by simultaneously collecting signals that will be assessed at baseline and post intervention, and to evaluate central and peripheral modulatory variables through cardiovascular autonomic evaluation and vasodilatory response.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical trials [29–32] have identified significant reductions in SBP and DBP levels after 12 weeks of continuous moderate aerobic exercise training (based on lactate concentration) and strength training (resistance exercise in a pool). Recently, a crossover trial investigated short-term exercise (mild and moderate intensity) effects in resistant hypertension and found significant reductions in both SBP and DBP levels at both intensities [33]. These studies show the importance of physical exercise as a therapeutic strategy for this population.…”

Section: Introductionmentioning

confidence: 98%

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Acute and chronic effects of aerobic exercise on blood pressure in resistant hypertension: study protocol for a randomized controlled trial

Nascimento

Santos

Lucena

et al. 2017

Trials

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BackgroundResistant hypertension is a specific condition that affects approximately 10% of subjects with hypertension, and is characterized by persistently high blood pressure levels even using therapy of three or more antihypertensive agents or with blood pressure control using therapy with four or more antihypertensive agents. Changes in lifestyle, such as physical exercise, are indicated for controlling blood pressure. However, investigating studies about this therapy in individuals with resistant hypertension are few.Methods/designThis is a randomized controlled clinical trial. Forty-eight patients with resistant hypertension will be submitted to perform four short-term interventions: aerobic exercise sessions (mild-, moderate- and high-intensity) and control session, in random order and on separate days. After the short-term sessions, the patients will be randomly allocated into four groups for 8 weeks of follow-up: mild-, moderate- and high-intensity aerobic exercise, and a control group. The primary outcome is the occurrence of blood pressure reduction (office and ambulatory analysis, and acute and chronic effects). Secondary outcomes are autonomic and hemodynamic mechanisms: cardiac and vasomotor autonomic modulation, spontaneous baroreflex sensitivity, forearm blood flow and vascular resistance.DiscussionThe importance of exercise for hypertension has been known for decades, but little is known about the effects on patients with resistant hypertension. This study will help to understand whether different aerobic exercise intensities can induce different responses, as well as by what mechanisms adjustments in blood pressure levels may occur.Trial registrationClinicalTrials.gov, ID: NCT02670681. Registered on 28 January 2016 (first version); Brazilian Registry Platform Clinical Trials: protocol RBR-5q24zh. Registered on 24 June 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1985-5) contains supplementary material, which is available to authorized users.

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“…Although the data obtained in populations recruited in different studies are difficult to be compare with each other, our results show a BP reduction in response to HEx training more pronounced in magnitude than that induced by land-based exercise training in resistant HT patients. 30, 31 This appears to be the case also for plasma norepinephrine, epinephrine, NO, endothelin-1…”

Section: Study Limitationsmentioning

confidence: 82%

Neurohumoral and Endothelial Responses to Heated Water-Based Exercise in Resistant Hypertensive Patients

Cruz¹,

Bocchi²,

Guimarães³

2017

Circ J

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155 patients with a diagnosis of resistant HT were screneed for the HEx trial in the HT outpatient clinic of the University Hospital of São Paulo, Brasil. We excluded 111 patients, with the remaining 44 patients included in the present study. They were sedentary, aged between 40 and 65 years, diagnosed as affected by resistant HT for more than 5 years, and who in the previous 6 months had unchanged and regular use of at least 3 optimally dosed antihypertensive drugs, including a diuretic, and displayed office systolic BP >140 mmHg, and/or diastolic BP >90 mmHg. 7 We used medical records to exclude patients with a history of secondary HT [e.g., chronic kidney disease (creatinine W e recently showed that heated water-based exercise (HEx) training exerts blood pressure (BP) lowering effects in patients with true resistant hypertension (HT) by significantly reducing office as well as ambulatory BP values recorded during a 24-h period. 1 Whether and to what extent these BP-lowering effects are associated with, and presumably triggered by, modifications in the behavior of the neurohumoral systems that participate in the homeostatic control of BP and are activated in resistant HT, such as the sympathetic nervous system and the renin-angiotensin-aldosterone axis, 2-5 is largely unknown. In addition, no information is available on whether and to what extent HEx training is capable of exerting favorable effects on the endothelial dysfunction that characterizes resistant HT patients. 5, 6 The present study was designed to provide information on the neurohumoral mechanisms of the BP-lowering effects of HEx training in resistant HT patients by assessing the sympathetic and renin-angiotensin as well as the Guido Grassi, MD; Guilherme Veiga Guimaraes, PhDBackground: The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water-based

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Effects of aerobic exercise intensity on ambulatory blood pressure and vascular responses in resistant hypertension

Abstract: A single session of light or moderate aerobic exercise acutely reduces ambulatory BP in resistant hypertension, although benefits persist longer following light intensity.

Cited by 52 publications

References 38 publications

Cardiac remodeling after six weeks of high-intensity interval training to exhaustion in endurance-trained males

Cardiac remodeling after six weeks of high-intensity interval training to exhaustion in endurance-trained males

Acute and chronic effects of aerobic exercise on blood pressure in resistant hypertension: study protocol for a randomized controlled trial

Neurohumoral and Endothelial Responses to Heated Water-Based Exercise in Resistant Hypertensive Patients

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