Effects of aerobic exercise intensity on ambulatory blood pressure and vascular responses in resistant hypertension: a crossover trial

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Background:Resistant hypertension often exposes patients to poor blood pressure (BP) control, resulting in clinical vulnerability, possible need for device-based procedures (denervation) and increased therapy costs. Regular exercise markedly benefits patients with hypertension, including resistant patients. However, little is known about short-term exercise effects in resistant hypertension.Objective:To evaluate acute hemodynamic effects of exercise in resistant hypertension.Method:After maximal exercise testing, 20 patients (54.0 ± 5.7 years, 30.2 ± 4.9 kg/m2) with resistant hypertension participated in three crossover interventions, in random order, and on separate days: control (45′ of rest), and light intensity and moderate intensity (45′ of aerobic exercise at 50 and 75% of maximum heart rate, respectively). Ambulatory BP, forearm blood flow (with subsequent calculation of vascular resistance), and reactive hyperemia were measured before and after interventions trough venous occlusion plethysmography.Results:Compared with control, both exercise intensities reduced ambulatory systolic pressure over 5 h (light: −7.7 ± 2.4 mmHg and moderate: −9.4 ± 2.8 mmHg, P < 0.01), whereas only light intensity reduced diastolic pressure (−5.7 ± 2.2 mmHg, P < 0.01). Light intensity also lowered systolic and diastolic pressures over 10-h daytime (−3.8 ± 1.3 and −4.0 ± 1.3 mmHg, respectively, P < 0.02), night-time (−6.0 ± 2.4 and −6.1 ± 1.6 mmHg, respectively, P < 0.05), and diastolic pressure over 19 h (−4.8 ± 1.2 mmHg, P < 0.01). Forearm blood flow changed (decreased) compared with baseline only at 50 min after light intensity (P < 0.05). After the control and light intensity sessions, vascular resistance increased at the end of 1 h, and after moderate intensity, it decreased only at the moment (∼2 min) immediately after intervention (P < 0.05).Conclusion:A single session of light or moderate aerobic exercise acutely reduces ambulatory BP in resistant hypertension, although benefits persist longer following light intensity.

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