Rehabilitation in arterial hypertension

Exercise prescription for hypertensive patients

Physical conditioning has been suggested as a useful adjunct or alternative to pharmacologic therapy in the treatment of borderline or mild hypertension. This recommendation stems from numerous studies that have demonstrated modest decreases in blood pressure in hypertensive individuals. Exercise guidelines should be based on preliminary exercise testing and modified to accommodate those patients who are taking a variety of antihypertensive medications. Although pure isometric exercise is generally contraindicated in hypertensive patients, potentially valuable training activities that involve a substantial static component, including arm crank ergometry and mild-to-moderate load weight training, probably requires individual assessment.

Effects of exercise training on plasma catecholamines and blood pressure in labile hypertensive subjects

Plasma catecholamine concentrations (norepinephrine, NE; epinephrine, E) were measured along with heart rate (HR) and blood pressure (BP) at rest in supine (20 min) and standing (10 min) positions and in response to cycle ergometer exercise (5 min; 60% estimated maximal aerobic power) in 12 hypertensive patients before and after 20 weeks of aerobic training on cycle ergometer (six males, one female) or by jogging (five males). In a control group of labile hypertensive patients (five males, two females), estimated maximal aerobic power as well as HR and BP at rest in the supine and standing positions and in response to exercise were not modified from the first to the second evaluation (43 +/- 4 vs 43 +/- 5 ml.kg-1.min-1). In comparison estimated maximal aerobic power significantly increased in both training groups (cycle: 38 +/- 4 to 43 +/- 4; jogging: 38 +/- 3 to 46 +/- 4 ml.kg-1.min-1). However HR and BP were not modified following training, except for small reductions in systolic (18.9 to 18 kPa: 142 to 135 mmHg) and diastolic pressures (13.3 to 12 kPa: 100 to 90 mmHg) (p less than 0.05) at standing rest in the cycle group.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of spontaneous running on blood pressure, heart rate and cardiac dimensions in developing and established spontaneous hypertension in rats

The effect of chronic voluntary exercise on resting blood pressure and heart rate was measured in two different age groups of spontaneously hypertensive rats (SHR). In the younger group, left ventricular dimensions were also measured. The younger group was 9 weeks old at the start of the experiment and was in a period of rapid blood-pressure rise. The older group, 13 weeks old at the start of the experiment, already had established hypertension. During a period of 6 weeks, the animals ran spontaneously in wheels mounted in their cages and reached a maximum of 6-7 km per 24 h. Age-matched, sedentary SHR were used as controls. Both groups of runners showed a decrease in body weight in comparison to controls. The younger runners exhibited a delayed onset of hypertension. They also showed a significantly increased left ventricular (LV) end-diastolic volume for every measured end-diastolic pressure between 7.5 mmHg and 20 mmHg (P less than 0.05). This suggests the development of a structural growth-dependent increase of the internal LV radius while LV weight and wall-to-lumen ratio were largely unaltered in younger runners compared with controls. In SHR with established hypertension, physical training did not reduce arterial blood pressure but heart rate was significantly lower than in the controls. These results thus indicate that an early onset of physical exercise in SHR may delay the development of hypertension. In addition, a more favourable cardiac design could also be seen.

Antihypertensive and volume-depleting effects of mild exercise on essential hypertension

After a general clinical observation period of over 4 weeks, 20 essential hypertensive subjects (Japanese) were randomly divided into two groups. One group (n = 10; 4 men and 6 women; 51.4 +/- 2.8 years of age) agreed to physical training using bicycle ergometer exercise with the intensity at blood lactate threshold for 60 minutes three times a week for 10 weeks, while the other group (n = 10; 4 men and 6 women; 51.0 +/- 2.9 years of age) did no particular physical training and was followed once a week as the control. Changes in blood pressure, hemodynamics, and humoral factors of the exercised group were compared with values in the controls. The following significant changes were found only in the exercised group. Blood pressure was significantly (p less than 0.01) reduced. Whole blood and plasma volume indices were significantly reduced (p less than 0.05, p less than 0.01, respectively). The change in ratio of serum sodium to potassium positively correlated with the change in systolic blood pressure (r = 0.76, p less than 0.02). Plasma norepinephrine concentrations both at rest and at the workload of blood lactate threshold during graded exercise tests were significantly reduced (p less than 0.05, p less than 0.02 respectively) after 10 weeks of exercise training. The change in the resting level of plasma norepinephrine positively correlated with that in the mean blood pressure. No such changes were observed in the control group. In both groups, body weight and urinary sodium excretion showed no statistically significant changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Circulatory events following spontaneous muscle exercise in normotensive and hypertensive rats

In previous studies we have shown that spontaneously hypertensive rats (SHR) develop a running behaviour and, secondary to the running behaviour, develop an endorphin-mediated analgesic effect. In the present study the role of the central endorphin system in the cardiovascular responses to spontaneous exercise in normotensive Wistar Kyoto rats (WKY) and SHR was investigated. The experimental design allowed us to record mean arterial pressure (MAP) and heart rate (HR) continuously for more than 1 week without interfering with the daily activities of the animals. They were active in running wheels during the dark period (19.00-07.00 h) and the activity was accompanied by a marked rise in HR. In SHR, a clear depression of blood pressure lasting for about for about 50 min was noted following each running period. The MAP during the post-running depression was 131.4 +/- 1.6 mmHg which was significantly lower than the pre-running control value (145.2 +/- 2.3 mmHg, P less than 0.01). In contrast, MAP in the post-running period in WKY was not significantly different from the pre-running values. In addition, the depression period of SHR had a mean post-running length of 49.7 +/- 3.4 min, which is significantly longer than in the WKYs (37.8 +/- 3.5 min, P less than 0.05). In control rats, naloxone infusion had no effect on blood pressure but a marked bradycardia was observed. In nine running SHR receiving a naloxone infusion, their MAP during the depression period was not different from the control pressure. Our study indicates that endorphin systems are involved in the regulating of blood pressure and HR during muscle exercise in SHR. These systems trigger the transient depression of blood pressure observed immediately after a running period in the SHR.

Effect of acute exercise on plasma immunoreactive-atrial natriuretic factor

The effect of acute exercise on plasma immunoreactive-atrial natriuretic factor (IR-ANF) was studied in 5 healthy young males subjected to graded exercise on a bicycle ergometer at four different work intensities (approx. 30, 50, 70, and 90% VO2max respectively). Except for the final exercise period, which was continued until exhaustion, all the others were of 30 min duration. Venous blood samples were obtained in the last 2 min of each exercise period. The plasma IR-ANF response to exercise was similar to that of heart rate and systolic blood pressure in that mild exercise in the first stage (corresponding to approx. 30% VO2 max) caused a striking increase of plasma IR-ANF concentrations with a further augmentation in the next stages and a levelling off at exhaustion. Plasma arginine-vasopressin (AVP) and aldosterone (ALDO) rose significantly only in the last two stages, and the highest concentrations were observed at exhaustion. In conclusion, acute exercise stimulates ANF secretion in proportion to the intensity of exercise, while concomitant increases in plasma AVP and ALDO occur only when the work load exceeds the blood lactate (BLA) threshold.

Blood pressure and hormonal responses to aerobic exercise

Twelve patients with essential hypertension (WHO stages I-II) were subjected to mild aerobic exercise for 10 to 20 weeks. The time course of changes in the resting blood pressure and multiple hormonal responses (plasma catecholamines, prostaglandin E, renin-angiotensin system, kallikrein-bradykinin system) were monitored. Depressor response of both systolic and diastolic pressures was seen, and after 5 weeks of exercise blood pressure stabilized at a significantly lower level. Adjustment of work load in response to increased physical fitness at the 10th week produced further reduction of blood pressure especially in diastole. After exercise therapy we found significant reductions in plasma catecholamine levels, and increases in levels of plasma prostaglandin E and the urinary excretion of sodium. A reduction in systolic/diastolic (mean) pressures by more than 20/10 (13) mm Hg was seen in 50% of patients after 10 weeks and in 78% after 20 weeks of exercise. Those who achieved effective blood pressure fall after 10 weeks of training (n = 6) were compared with the rest (n = 6). This analysis revealed that the initial value of plasma renin activity of the former was significantly lower than that of the latter. Significant negative correlations (r = -0.78) also were observed between the blood pressure reduction and corresponding initial value of plasma renin activity. These results indicate that exercise therapy is a potent nonpharmacological tool for the treatment of essential hypertension, especially of the low renin type. Both diminished sympathoadrenergic activity and enhancement of prostaglandin mechanisms might be responsible for the falls in arterial pressure.

Effect of physical training on the development of hypertension in the spontaneously hypertensive rat

The effect of chronic physical exercise on the development of hypertension was measured in spontaneously hypertensive rats (SHR) and their progenitor normotensive wistar-kyoto controls (WK). Starting 4--5 weeks after birth groups of rats were subjected to swimming exercise 1 h x day-1, 4 days x week-1 for a total period of 11 weeks. Control rats were handled daily without exercise. Both in trained SHR and WK a significant delay in increase in body weight was observed. Physical training caused a small, but significant (P less than 0.001) reduction in systolic blood pressure of SHR, whereas it did not affect blood pressure in WK. Heart rate was significantly (P less than 0.001) lower in both trained SHR and WK than in their non-trained controls. At the end of the training period the degree of training was tested by measuring muscle cytochrome oxidase activity and relative heart weight. Cytochrome oxidase activity in gastrocnemius muscle was higher in the trained animals, although the difference was only significant (P less than 0.05) for WK. Training also caused a significant (P less than 0.01) increase in the ratio heart weight to body weight in WK. Both trained and non-trained SHR have a ca. 25% higher relative heart weight than WK controls. SHR hearts did not further hypertrophy as a consequence of physical exercise. These data indicate that swim training induces a trained state in both SHR and WK. Moreover, this form of training causes a slight, but significant attenuation of the development of hypertension in SHR.