Effects of antihypertensive medication and high‐intensity interval training in hypertensive metabolic syndrome individuals

Abstract

Pharmacological and non‐pharmacological therapies are simultaneously prescribed when treating hypertensive individuals with elevated cardiovascular risk (ie, metabolic syndrome individuals). However, it is unknown if the interactions between antihypertensive medication (AHM) and lifestyle interventions (ie, exercise training) may result in a better ambulatory blood pressure (ABP) control. To test this hypothesis, 36 hypertensive individuals with metabolic syndrome (MetS) under long‐term prescription with AHM targeting the renin‐angiotensin‐aldosterone system (RAAS) were recruited. Before and after 4 months of high‐intensity interval training (HIIT), participants completed two trials in a double‐blind, randomized order: (a) placebo trial consisting of AHM withdrawal for 3 days and (b) AHM trial where individuals held their habitual dose of AHM. In each trial, 24‐h mean arterial pressure (MAP) was monitored and considered the primary study outcome. Secondary outcomes included plasma renin activity (PRA) and aldosterone concentration to confirm withdrawal effects on RAAS, along with the analysis of urine albumin‐to‐creatinine ratio (UACR) to assess kidney function. The results showed main effects from AHM and HIIT reducing 24‐h MAP (−5.7 mmHg, p < 0.001 and −2.3 mmHg, p = 0.007, respectively). However, there was not interaction between AHM and HIIT on 24‐h MAP (p = 0.240). There was a main effect of AHM increasing PRA (p < 0.001) but no effect on plasma aldosterone concentration (p = 0.368). HIIT did not significantly improve RAAS hormones or the UACR. In conclusion, AHM and HIIT have independent and additive effects in lowering ABP. These findings support the combination of habitual AHM with exercise training with the goal to reduce ABP in hypertensive MetS individuals.

A Mixed Comparisons of Aerobic Training With Different Volumes and Intensities of Physical Exercise in Patients With Hypertension: A Systematic Review and Network Meta-Analysis

“…All of the 12 studies reported on SBP and 11 of them showed that SBP levels decreased significantly compared with the baseline, after a period of exercise training (p < 0.05) (38,39,(44)(45)(46)(47)(48)(49)(50)(51)53), only 1 study showed no significant change in SBP levels after exercise (p > 0.05) (54). Of the 9 studies reported on DBP (38,39,44,46,47,(49)(50)(51)54), only 1 study showed no significant change in DBP after exercise (p > 0.05) (49), and the other 8 studies showed DBP decreased significantly after the exercise. Subsequently, 6 studies reported on BMI (38,47,48,50,51,53), and only 2 studies showed a significant decrease in BMI after exercise (38,47,48).…”

“…Subsequently, 6 studies reported on BMI (38,47,48,50,51,53), and only 2 studies showed a significant decrease in BMI after exercise (38,47,48). Based on 8 studies reported on rest HR (38,39,(46)(47)(48)(49)(50)54), 6 studies showed rest HR decreased after exercise (38,39,47,48,50,54), and 2 studies showed rest HR did not change significantly after exercise (46,49). However, in the study by Lins-Filho et al, rest HR decreased significantly in the blank control group (49).…”

“…The transient increase in blood pressure from the exercise did not fully recover after rest. In Ramirez-Jimenez et al (54) investigating of both groups of subjects received LVHIIT intervention, with a group taking antihypertensive drugs and the other group receiving placebo, aiming to achieve an additional drop in blood pressure. However, the results showed only the placebo group had a significant decrease in resting heart rate (p < 0.05), and no statistically significant difference was found in other indicators.…”

“…According to the definition of age defined by the United Nations World Health Organization, of the 12 studies evaluated, 8 studies were young hypertensive patients aged 31.8-63.5 years old (38,39,44,47,50,51,53,54), and 7 of these studies showed that after a period of physical exercise, the blood pressure and/or other health conditions of the subjects improved significantly (p < 0.05). However, there was no statistically significant change in SBP and DBP after receiving HIIT exercise intervention (54).…”

“…According to the definition of age defined by the United Nations World Health Organization, of the 12 studies evaluated, 8 studies were young hypertensive patients aged 31.8-63.5 years old (38,39,44,47,50,51,53,54), and 7 of these studies showed that after a period of physical exercise, the blood pressure and/or other health conditions of the subjects improved significantly (p < 0.05). However, there was no statistically significant change in SBP and DBP after receiving HIIT exercise intervention (54). All the subjects who participated in HIIT exercise intervention were patients with metabolic syndrome in addition to high blood pressure, with one group of subjects also receiving antihypertensive drugs during the intervention, while the other group was receiving a placebo (54).…”