Improvements in Insulin Sensitivity and Muscle Blood Flow in Aerobic‐Trained Overweight‐Obese Hypertensive Patients Are Not Associated With Ambulatory Blood Pressure

Abstract

To verify whether there are relationships between vascular and hormonal responses to aerobic training in hypertensive persons, sedentary hypertensive patients were randomized to an aerobic training or a callisthenic exercise group. The patients' 24-hour blood pressure, arterial compliance, forearm blood flow, and hormonal profile were evaluated at baseline and after 3-month training protocols. Mean maximal oxygen consumption (VO 2 max) increased by 8% in the aerobic group (P<.001), while no change was observed in the control group. There was a decrease in insulin resistance (homeostatic model assessment of insulin resistance, P=.039) and plasma cortisol (P=.006) in the aerobic group only, that also demonstrated an increase in forearm blood flow (P<.001) after training. No relationship was observed between change in blood pressure or change in body mass and other parameters. Aerobic training can promote a decrease in cardiovascular risk in hypertensive adults by improving vascular function and insulin resistance, despite no changes in ambulatory blood pressure after a 3-month intervention. J Clin Hypertens (Greenwich). 2011;13:89-96. H ypertension is an enormous public health challenge in both industrialized and developing countries, and it is the most important risk factor for cardiovascular (CV) diseases.1 Physical exercise is recommended to help reduce blood pressure (BP) and lower the risk for developing CV disease.2 A recent meta-analysis 3 of randomized controlled trials showed that in a hypertensive population, endurance training reduced resting systolic and diastolic BP by 6.9 mm Hg and 4.9 mm Hg, respectively, and ambulatory systolic BP and diastolic BP (4 studies, 5 groups) decreased by 3.4 mm Hg and 2.7 mm Hg, respectively. Despite this apparent reduction, changes in ambulatory systolic BP were nonsignificant in 3 groups, whereas reductions in diastolic BP were nonsignificant in 4 groups of these studies. These disparate results might be partially explained by methodologic differences, including small sample sizes and poor supervision of prescribed training intensity. Ambulatory BP (ABP) may be the more appropriate method of monitoring BP in exercise studies because, unlike office BP, it is not influenced by the ''white coat effect'' during treatment, placebo-induced hypotension, and regression to the mean phenomenon.

Plasma Renin Response to Treadmill Exercise in Secondary Hypertension Kidney Disease Patients

“…Changes in plasma aldosterone and cortisol could also be involved in blood pressure regulation during aerobic training. Neuro-hormonal and vascular adaptations are also potential mechanisms that could explain blood pressure lowering effect of endurance training in hypertension [37]. The results of the current study were confirmed by Aoike DT et al The decrease in blood pressure due to mild/moderate aerobic exercise has been well established both in normotensive and hypertensive individuals as well as in chronic kidney disease patients.…”

Endurance exercise beneficially affects ambulatory blood pressure

“…The trials were conducted between 1988 and 2012. Four studies were conducted in Europe [13,22,24,25], three in the USA [15,17,19], four in South America [11,12,16,23], three in Asia [18,20,21] and one in Australia [14]. Twelve trials had a parallel design and the remaining three used a cross-over design [18,22,25].…”

“…The percentage of dropouts ranged from 0 to 38% in the exercise group and between 0 and 35% in the control group, so that a total of 633 participants could be included in the final analysis (394 exercise participants and 239 control participants). Five trials included only men [14,15,18,22,25], two studies were restricted to women only [11,12] while the remaining eight trials [13,16,17,[19][20][21]23,24] included both men and women. In the final analysis, 301 participants were men, 246 women and 86 unknown sex [13].…”

“…We identified 15 trials that fulfilled the inclusion criteria [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Some of these trials applied different training regimens [12,16], so that a total of 17 study groups were available for analysis.…”

“…Moreover, ABP measures, more accurately than office BP, reflect the extent of BP reduction induced by treatment because of a higher reproducibility over time and an absent or negligible 'white-coat' and placebo effect [3,9,10]. To date, randomized controlled trials investigating the effect of exercise on ABP are mostly inconclusive [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Contemporary meta-analysis methodologies offer greater precision of point estimates, enhanced statistical power and they may contribute to resolve uncertainty and answer questions not posed at the start of individual trials [26].…”