Exercise hope for drug-resistant hypertension

By Eleanor McDermid, Senior MedWire Reporter

Even patients who have hypertension despite taking multiple antihypertensive drugs can achieve blood pressure (BP) reductions with a program of aerobic exercise, research shows.

"Hence, a low responsiveness to antihypertensive drug therapy does not inevitably go along with a low responsiveness to exercise," say Timm Westhoff (Charité-Campus Benjamin Franklin, Germany) and co-workers.

All the patients in their study, which appears in Hypertension, required at least four antihypertensive medications to keep their BP below 140/90 mmHg or had elevated BP despite taking three medications.

Yet an 8- to 12-week exercise program resulted in an average BP fall of 5.4/2.8 mmHg among the 24 patients (average age 63 years) who were randomly assigned to participate in, and completed, the program. This change was significantly different from that in 26 patients (average 68 years) who did not participate in the exercise program; their BP rose by 7.3/4.1 mmHg over the same time period.

Westhoff et al measured the patients' BP using 24-hour ambulatory monitoring, which is a better predictor of cardiovascular events than is office measurement. They say that a 6/3 mmHg reduction is "of clinical relevance," noting that a reduction of 5/2 mmHg has been shown to reduce stroke incidence by 29%.

The exercise program involved treadmill training three times a week, to a target lactate concentration of 2.0 mmol/L in capillary blood.

The positive effects of aerobic training were evident for daytime ambulatory BP, but not for blood pressure during the night. The team suggests this could be due to the effect of exercise on sympathetic tone, which is lower at night than during waking hours.

"Aerobic exercise on a regular basis is a helpful adjunct to control BP and should be included in the therapeutic approach to resistant hypertension," say Westhoff and team.

They add: "Even if we have to prompt patients to maximal therapeutic options like renal sympathetic denervation or baroreceptor stimulation, these approaches should always be accompanied by recurrent recommendations of lifestyle modifications like regular exercise."

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