Intense aerobic exercise lowers blood pressure in individuals with metabolic syndrome taking antihypertensive medicine
Miguel Ramírez-JiménezValentín E. Fernández-ElíasFélix Morales-PalomoJuan F. OrtegaRicardo Mora‐Rodríguez
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Objective There is a growing tendency for physicians to prescribe exercise in accordance with the ‘exercise is medicine’ global health initiative. However, the exercise-pharmacologic interactions for controlling blood pressure are not well described. Our purpose was to study whether angiotensin II receptor type 1 blocker (ARB) antihypertensive medicine enhances the blood pressure-lowering effects of intense exercise. Participants and methods Fifteen hypertensive individuals with metabolic syndrome chronically medicated with ARB underwent two exercise trials in a blind randomized order. One trial was conducted after taking their habitual dose of ARB (ARB MED trial) and another after 48 h of placebo medicine (i.e. dextrose; PLAC trial). Results After placebo medication, brachial systolic blood pressure increased by 5.5 mmHg [P=0.009; effect size (ES)=0.476] and diastolic by 2.5 mmHg (P=0.030; ES=0.373). Exercise reduced systolic and diastolic blood pressures to the same extent in ARB MED and PLAC trials (7 and 8 mmHg, respectively, for systolic and 5 and 4 mmHg, respectively, for diastolic, all P<0.05). Pulsatile measures of arterial stiffness did not reveal an interaction effect between exercise and medication. However, postocclusion reactive hyperemia increased after exercise only in the ARB MED trial (361±169 to 449±240% from baseline; P=0.033; ES=0.429). Conclusion ARBs and a bout of intense exercise each have an independent effect on lowering blood pressure in hypertensive individuals, and these effects are additive.Keywords:
Aerobic Exercise
Antihypertensive drug
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Background: Although aerobic exercise has been shown to lower blood pressure (BP) in human beings, its additive BPreducing effect on antihypertensive drug therapy seems to have been investigated in only laboratory animals.Objectives: This study investigated the effects of aerobic dance combined with antihypertensive drugs on BP and number of antihypertensive drugs in individuals with hypertension.Methods: This open label randomised-controlled trial involved new-diagnosed male and female individuals with mild-tomoderate essential hypertension after at least four weeks of treatment. They were randomly assigned to drug therapy (Normoretic: Hydrochlorothiazide + amiloride hydrochloride, and Amlodipine) (control: n=33) and aerobic dance combined with drug therapy (exercise: n=30) groups. Intervention in each group lasted 12 weeks. BP was measured at baseline and during and pos-intervention. Number of antihypertensive drugs was recorded post-intervention.Results: There were significant reductions in SBP at some periods of the intervention in the exercise group (p=0.000 to 0.002) and control group (p=0.001 to 0.002), and significant difference in DBP at some periods of the intervention in exercise group (p=0.000 to 0.003) and control group (p=0.000 to 0.001). SBP (p=0.066) and DBP (p=0.100) did not differ between the two groups post-12-week intervention. The BP control rates were similar between the exercises (56.7%) and control (35.5%) groups (p=0.075). Similarly, between-group difference in the number of drugs was not significant (p=0.511). Conclusion: This preliminary report demonstrates the tendency of aerobic dance to enhance BP control in individuals on two antihypertensive drugs without BP control.Key words: Aerobic exercise, drug therapy, blood pressure, randomised controlled trial
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Antihypertensive drug
Amlodipine
Pharmacotherapy
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Μελέτη της πολυπαραγοντικής αναλγησίας στο μετεγχειρητικό πόνο μετά από λαπαροσκοπική χολοκυστεκτομή
Σκοπός:Ο βασικός σκοπός της μελέτης ήταν να ελεγχθεί αν ο συνδυασμός γκαμπαπεντίνης (600mg 4ώρες προεγχειρητικά, 600mg 24ώρες μετά), κεταμίνης (0.3mg/kg πριν την αναισθησία), λορνοξικάμης (8mg πριν την αναισθησία και 8mg/12ώρες) και τοπικής έγχυσης ροπιβακαΐνης (5ml 7.5% στα σημεία εισόδου των trocar) έχει καλύτερη αναλγητική δράση σε σχέση με το καθένα από αυτά τα φάρμακα ξεχωριστά τις πρώτες 24 ώρες μετά από λαπαροσκοπική χολοκυστεκτομή. Δευτερεύων σκοπός ήταν να εξετασθεί αν αυτός συνδυασμός έχει λιγότερες επιπλοκές σχετιζόμενες με την κατανάλωση οπιοειδών.Μέθοδος:Διεξήχθη μία ελεγχόμενη τυχαιοποιημένη μελέτη σε 2 νοσηλευτικά κέντρα. 148 ασθενείς ηλικίας 18-70 ετών κατανεμήθηκαν τυχαία σε 6 ομάδες (28 σε κάθε ομάδα) με τη χρήση λογισμικού: A (γκαμπαπεντίνη/κεταμίνη/λορνοξικάμη/ροπιβακαΐνη), B (γκαμπαπεντίνη/placebo/placebo/placebo), Γ (placebo/κεταμίνη/placebo/placebo), Δ (placebo/placebo/λορνοξικάμη/placebo), E (placebo/placebo/placebo/ροπιβακαΐνη) και ΣΤ (placebo/placebo/placebo/placebo). Μόνο ο κύριος ερευνητής γνώριζε την ομάδα κάθε ασθενούς και παρείχε τα φάρμακα και τα εικονικά φάρμακα σε καλυμμένες προγεμισμένες σύριγγες. Η κύρια έκβαση της μελέτης ήταν η 24ωρη κατανάλωση μορφίνης. Δευτερεύουσες εκβάσεις ήταν η συχνότητα των σχετιζόμενων με τα οπιοειδή επιπλοκών (ναυτία, έμετος, καταστολή, κνησμός και δυσκολία ούρησης).Αποτελέσματα:Μόνο οι ομάδες Α (6.4mg), B (9.46mg) και Δ (9.36mg) είχαν χαμηλότερη κατανάλωση μορφίνης σε σχέση με την ομάδα ελέγχου (20.29mg) (p<0.001, p=0.01 και p=0.008 αντίστοιχα). Η ομάδα Α δε διέφερε από τις ομάδες Β και Δ (p=0.92, p=0.93). Υπήρξε διαφορά μόνο στα επεισόδια ναυτίας και μόνο μεταξύ των ομάδων Α (n=5) και της ομάδας ελέγχου (n=12) (p=0.018). Συμπεράσματα:Ο συνδυασμός γκαμπαπεντίνης, κεταμίνης, λορνοξικάμης, και τοπικής έγχυσης ροπιβακαΐνης δεν έχει ισχυρότερη αναλγητική δράση σε σχέση με μόνη την γκαμπαπεντίνη ή τη λορνοξικάμη μετά από λαπαροσκοπική χολοκυστεκτομή. Ο συνδυασμός μειώνει μόνο τη συχνότητα της μετεγχειρητικής ναυτίας αλλά απαιτούνται μεγαλύτερες μελέτες για την εξαγωγή ασφαλών συμπερασμάτων.
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Aging causes functional and structural arterial changes in both sexes. However, aerobic exercise shows beneficial effects on arterial function and structure in older men, whereas older women show limited to no effect on arterial function after aerobic exercise. Currently, little is known about effects of longer aerobic exercise intervention on arterial structure as well as function in older women. PURPOSE: To elucidate the effect of a 6-month moderate intensity aerobic exercise intervention on arterial structure and function in older women. METHODS: Carotid artery beta-stiffness and compliance (arterial structure) as well as flow-mediated dilation (%FMD) of brachial artery (arterial function) were measured in eleven older women (75 ± 9 y) at baseline and after a 6-month moderate exercise (3-4x/week) intervention. Furthermore, central arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV). RESULTS: There were no significant differences pre and post intervention in %FMD (2.93 ± 2.03 vs. 3.49 ± 2.77, p=0.49), PWV (9.36 ± 1.14 vs. 9.12, p=0.09, n=9), and arterial compliance (0.48 ± 0.18 vs. 0.58 ± 0.24, p=0.07). A significant decrease in beta stiffness (13.85 ± 5.1 vs. 11.27 ± 5.70, p= 0.03) was seen compared to baseline. CONCLUSION: Moderate intensity aerobic exercise intervention improves the carotid artery stiffness in older women despite a lack of improvement in overall arterial responsiveness to increased flow. Funding – NIH R01AG0557552 (Smith)
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Obesity and increasing of arterial stiffness are known as independent risk factors for cardiovascular disease. Previously, we demonstrated that dietary modification or aerobic exercise training can decrease arterial stiffness in obese individuals. However, it has not been compared the effect of dietary modification and/or aerobic exercise training on arterial stiffness in obese men. We compared the effect of three patterns of lifestyle modification (i.e., dietary modification, aerobic exercise training or combined them) on arterial stiffness in obese men. Fifty-three obese men completed the 12-week lifestyle modification program, dietary modification (D), aerobic exercise training (E) or combined D and E (DE). Before and after the program, all participants were measured central, peripheral, and systemic arterial stiffness (measured by carotid-femoral pulse wave velocity [cfPWV], femoral-ankle PWV [faPWV] and brachial-ankle PWV [baPWV]). We demonstrated that the degree of decrease in BMI was the greatest after DE, and that was greater after D than E. The level of decrease in baPWV after DE was the greatest among three interventions. On the other hand, the level of decrease in baPWV in D group was similar to E group. These results suggested that systemic arterial stiffness may be decreased by different mechanisms between D and E groups. We demonstrated that dietary modification decreased central and systemic arterial stiffness, and aerobic exercise training decreased central, systemic, and peripheral arterial stiffness in obese individuals. We also showed an additional effect of decreasing systemic arterial stiffness by combining dietary modification and aerobic exercise training in obese individuals.
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Antihypertensive drug
Interval training
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There is a well-established relationship between increased arterial stiffness and cardiovascular mortality. We examined whether a long-term aerobic exercise intervention (6 months) would increase arterial compliance in older adults with hypertension complicated by Type 2 diabetes (T2DM) and hyperlipidemia. A total of 52 older adults (mean age 69.3±0.6 years, 30 males and 22 females) with diet/oral hypoglycemic-controlled T2DM, hypertension and hypercholesterolemia were recruited. Subjects were randomly assigned to one of two groups: an aerobic group (6 months vigorous aerobic exercise, AT group) and a non-aerobic group (6 months of no aerobic exercise, NA group). Arterial stiffness was measured as pulse-wave velocity (PWV) using the Complior device. Aerobic training decreased arterial stiffness as measured by both radial (P=0.001, 2-way analysis of variance with repeated measures) and femoral (P=0.002) PWV. This was due to a decrease in arterial stiffness in the AT group after 3 months of training, which was not maintained after 6-month training for either radial (P=0.707) or femoral (P=0.680) PWV. Our findings indicate that in older adults with multiple cardiovascular risk factors, short-term improvements in arterial stiffness became attenuated over the long term.
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