Effects of intense aerobic exercise and/or antihypertensive medication in individuals with metabolic syndrome

Pharmacological modulation of vascular ageing: A review from VascAgeNet

Vascular ageing, characterized by structural and functional changes in blood vessels of which arterial stiffness and endothelial dysfunction are key components, is associated with increased risk of cardiovascular and other age-related diseases. As the global population continues to age, understanding the underlying mechanisms and developing effective therapeutic interventions to mitigate vascular ageing becomes crucial for improving cardiovascular health outcomes. Therefore, this review provides an overview of the current knowledge on pharmacological modulation of vascular ageing, highlighting key strategies and promising therapeutic targets. Several molecular pathways have been identified as central players in vascular ageing, including oxidative stress and inflammation, the renin-angiotensin-aldosterone system, cellular senescence, macroautophagy, extracellular matrix remodelling, calcification, and gasotransmitter-related signalling. Pharmacological and dietary interventions targeting these pathways have shown potential in ameliorating age-related vascular changes. Nevertheless, the development and application of drugs targeting vascular ageing is complicated by various inherent challenges and limitations, such as certain preclinical methodological considerations, interactions with exercise training and sex/gender-related differences, which should be taken into account. Overall, pharmacological modulation of endothelial dysfunction and arterial stiffness as hallmarks of vascular ageing, holds great promise for improving cardiovascular health in the ageing population. Nonetheless, further research is needed to fully elucidate the underlying mechanisms and optimize the efficacy and safety of these interventions for clinical translation.

Cardiopulmonary Exercise Testing, Rehabilitation, and Exercise Training in Postpulmonary Embolism

Long-term exercise intolerance and functional limitations are common after an episode of acute pulmonary embolism (PE), despite 3 to 6 months of anticoagulation. These persistent symptoms are reported in more than half of the patients with acute PE and are referred as "post-PE syndrome." Although these functional limitations can occur from persistent pulmonary vascular occlusion or pulmonary vascular remodeling, significant deconditioning can be a major contributing factor. Herein, the authors review the role of exercise testing to elucidate the mechanisms of exercise limitations to guide next steps in management and exercise training for musculoskeletal deconditioning.

Exploring Perceived Barriers to Physical Activity in Korean Older Patients with Hypertension: Photovoice Inquiry

This study attempted to explore the barriers to physical activity of older patients with Hypertension. It aimed to provide robust evidence produced through their eyes. First, through the data analysis of the accelerometer and the decision of the research team, 10 out of the 30 applicants were invited to participate in a photovoice study. Photovoice is one example of participatory action research. Photovoice participants can communicate their unique experiences through photographs, providing a highly realistic and authentic perspective that is not possible to be understood with traditional qualitative research. This study inductively identified four main themes; health illiteracy, distortion of health information, fear of physical activity, and rejection of any life changes. Based on a specific understanding of the population's perception of physical activity, this study attempted to provide evidence of why many elderly Korean patients with Hypertension stay inactive.

Effects of exercise modalities on decreased blood pressure in patients with hypertension

This study aimed to evaluate the acute effects of aerobic and resistance exercises on blood pressure and endothelial blood markers. We also correlated post-exercise blood pressure response with baseline cardiovascular parameters in middle-aged patients with hypertension. This cross-sectional study randomized 54 volunteers into the aerobic exercise group (AG, n = 27; 45.6 ± 7.7 years) or dynamic resistance exercise group (RG, n = 27; 45.8 ± 8.4 years). Blood marker evaluation, cardiopulmonary exercise tests, resting blood pressure monitoring, ambulatory blood pressure monitoring (ABPM), flow-mediated dilatation monitoring, and body composition evaluation were carried out. Exercise sessions were performed to evaluate post-exercise hypotension (PEH) and endothelial marker responses, in addition to post-exercise ABPM (ABPMex). This study is an arm of the study which was approved by the local ethics committee (No. 69373217.3.0000.5347) in accordance with the Helsinki Declaration and was registered at ClinicalTrials.gov (NCT03282942). The AG performed walking/running at 60% of the reserve heart rate, while the RG performed 10 exercises with two sets of 15–20 repetitions. The mean 24 h ABPM and ABPMex values showed no significant statistical differences. Systolic and diastolic blood pressure hypotension after aerobic and dynamic resistance were −10.59 ± 5.24/−6.15 ± 6.41 mmHg and −5.56 ± 7.61/−6.20 ± 8.25 mmHg, respectively. For an up-to-7 h assessment of resting pressure, there was a positive effect in the aerobic group. The concentrations of nitrites/nitrates (NOx) and endothelin-1 (ET-1) did not change during hypotension. Moreover, PEH and ABPMex were significantly correlated with baseline health variables. Thus, when middle-aged patients with hypertension perform aerobic or resistance exercise, the NOx/ET-1 pathway does not provide the best explanation for PEH. Finally, we found associations between baseline cardiovascular variables and endothelial vasoconstrictors with PEH.

Acute Aerobic Exercise Induces Short-Term Reductions in Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis

[Figure: see text].

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

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.

Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review

Objective

To compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.

Data sources

PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.

Eligibility criteria

Randomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.

Design

A systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.

Outcome

The BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.

Results

Twelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.

Conclusions

The combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.

PROSPERO registration number

The protocol is registered at PROSPERO CRD42020181754.

Ambulatory blood pressure variability and combined exercise training: comparison between hypertensive and normotensive postmenopausal women

AIM

The aim of the study was to verify the effects of moderate combined aerobic and resistance exercises training in ambulatory blood pressure (ABPM) and its variability in hypertensive and normotensive postmenopausal women.

METHODS

Twenty-six participants were divided into two groups: hypertensive (HT = 13) and normotensive (NT = 13). They performed 30 sessions of combined exercises (aerobic and resistance exercises at same session) over 10 weeks. We evaluated: resting BP and 24-h ABPM with systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR). To evaluate blood pressure variability (BPV), the following were considered: 24-h SD (SD24), the mean diurnal and nocturnal deviations (SDdn), average real variability (ARV24).

RESULTS

The two-way analysis of variance showed no difference in ABPM nor BPV responses after training between groups. Both HT and NT groups had similar BP reductions in 24-h DBP (P < 0.01; ΔNT = -3.1 ± 1.1, ΔHT = -1.8 ± 1.2 mmHg), 24-h area under the curve of DBP (P = 0.01; ΔNT = -73±105, ΔHT = -44 ± 115 mmHg), and wake DBP (P < 0.01; ΔNT = -3.4 ± 1.2, ΔHT = -1.8 ± 1.3 mmHg), without differences in BPV responses. Moreover, HT women had higher overall SBP SDdn (P = 0.01), SBP ARV (P = 0.02), and MBP ARV (P < 0.01) than NT women.

CONCLUSION

Ten-week combined exercise training resulted in similar BP reductions in hypertensive and normotensive postmenopausal women, but not in BPV responses.

Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men

BACKGROUND

Post-exercise hypotension (PEH) is greater after evening than morning exercise, but antihypertensive drugs may affect the evening potentiation of PEH. Objective: To compare morning and evening PEH in hypertensives receiving angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB).

METHODS

Hypertensive men receiving ACEi (n = 14) or ARB (n = 15) underwent, in a random order, two maximal exercise tests (cycle ergometer, 15 watts/min until exhaustion) with one conducted in the morning (7 and 9 a.m.) and the other in the evening (8 and 10 p.m.). Auscultatory blood pressure (BP) was assessed in triplicate before and 30 min after the exercises. Changes in BP (post-exercise - pre-exercise) were compared between the groups and the sessions using a two-way mixed ANOVA and considering P < .05 as significant.

RESULTS

In the ARB group, systolic BP decrease was greater after the evening than the morning exercise, while in the ACEi group, it was not different after the exercises conducted at the different times of the day. Additionally, after the evening exercise, systolic BP decrease was lower in the ACEi than the ARB group (ARB = -11 ± 8 vs -6 ± 6 and ACEi = -6 ± 7 vs. -8 ± 5 mmHg, evening vs. morning, respectively, P for interaction = 0.014).

CONCLUSIONS

ACEi, but not ARB use, blunts the greater PEH that occurs after exercise conducted in the evening than in the morning.