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Aerobic exercise improves central blood pressure and blood pressure variability among patients with resistant hypertension: results of the EnRicH trial

Hypertension Research volume 46, pages 1547–1557 (2023)Cite this article

Abstract

Central blood pressure (BP) and BP variability are associated with cardiovascular disease risk. However, the influence of exercise on these hemodynamic parameters is unknown among patients with resistant hypertension. The EnRicH (The Exercise Training in the Treatment of Resistant Hypertension) was a prospective, single-blinded randomized clinical trial (NCT03090529). Sixty patients were randomized to a 12-week aerobic exercise program or usual care. The outcome measures include central BP, BP variability, heart rate variability, carotid-femoral pulse wave velocity, and circulating cardiovascular disease risk biomarkers including high-sensitivity C-reactive protein, angiotensin II, superoxide dismutase, interferon gamma, nitric oxide, and endothelial progenitor cells. Central systolic BP decreased by 12.22 mm Hg (95% CI, −1.88 to −22.57, P = 0.022) as did BP variability by 2.85 mm Hg (95% CI, −4.91 to −0.78, P = 0.008), in the exercise (n = 26) compared to the control group (n = 27). Interferon gamma −4.3 pg/mL (95%CI, −7.1 to −1.5, P = 0.003), angiotensin II −157.0 pg/mL (95%CI, −288.1 to −25.9, P = 0.020), and superoxide dismutase 0.4 pg/mL (95%CI, 0.1–0.6, P = 0.009) improved in the exercise compared to the control group. Carotid-femoral pulse wave velocity, heart rate variability, high-sensitivity C-reactive protein, nitric oxide, and endothelial progenitor cells were not different between groups (P > 0.05). In conclusion, a 12-week exercise training program improved central BP and BP variability, and cardiovascular disease risk biomarkers in patients with resistant hypertension. These markers are clinically relevant as they are associated with target organ damage and increased cardiovascular disease risk and mortality.

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Acknowledgements

Cátia Leitão is grateful to the Portuguese Foundation for Science and Technology (FCT) for the research contract CEECIND/00154/2020 and the projects UIDB/50025/2020 & UIDP/50025/2020, financed by national funds through the FCT/MEC. Institute of Biomedicine (iBiMED; reference No. UID/BIM/04501/2020), Research Center in Physical Activity, Health and Leisure (CIAFEL; reference No. UID/DTP/00617/ 2020), and Research Center in Sports Sciences, Health and Human Development (CIDESD; reference No. UID/DTP/ 04045/2020) are research units supported by the Portuguese FCT.

Funding

Funding

This work was funded by the European Union through the European Regional Development Fund Operational Competitiveness Factors Program (COMPETE) and by the Portuguese government through the Foundation for Science and Technology (grants P2020-PTDC/DTP-DES/1725/2014 and POCI-01-0145-FEDER-016710). Susana Lopes was awarded with a Portuguese Foundation for Science and Technology PhD grant (grant SFRH/ BD/129454/2017).

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Authors and Affiliations

  1. Institute of Biomedicine – iBiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal

    Susana Lopes, José Mesquita-Bastos, Manuel Teixeira & Fernando Ribeiro

  2. Physiotherapy Department, Polytechnic of Coimbra, ESTeSC, Coimbra Health School, Coimbra, Portugal

    Susana Lopes

  3. Cardiology Department, Hospital Infante D. Pedro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal

    José Mesquita-Bastos & Verónica Ribau

  4. Research Center in Sports Sciences, Health and Human Development - CIDESD, University of Maia, Maia, Portugal

    Catarina Garcia & Alberto J. Alves

  5. I3N, Department of Physics, University of Aveiro, Aveiro, Portugal

    Cátia Leitão

  6. Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, & Hypertension and Cardiovascular Risk Unit, ULS Matosinhos, Matosinhos, Portugal

    Susana Bertoquini & Jorge Polonia

  7. University of Coimbra, Cytogenetics and Genomics Laboratory, Institute of Cellular and Molecular Biology & Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation on Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine and Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

    Ilda P. Ribeiro & Joana Barbosa de Melo

  8. Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal

    José Oliveira

  9. Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal

    Daniela Figueiredo

  10. University of São Paulo (USP), School of Medicine, Heart Institute, Butanta, São Paulo, Brazil

    Guilherme V. Guimarães

  11. Department of Kinesiology, University of Connecticut, Storrs, CT, USA

    Linda S. Pescatello

  12. OncoMove, Associação de Investigação de Cuidados de Suporte em Oncologia - AICSO, Vila Nova de Gaia, Portugal

    Alberto J. Alves

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Lopes, S., Mesquita-Bastos, J., Garcia, C. et al. Aerobic exercise improves central blood pressure and blood pressure variability among patients with resistant hypertension: results of the EnRicH trial. Hypertens Res 46, 1547–1557 (2023). https://doi.org/10.1038/s41440-023-01229-7

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