Physical activity and essentialhypertension

Ylva Hellsten

Department of Nutrition, Exercise and Sports

University of Copenhagen, Denmark

• What blood pressure changes can we expect with exercise training?

• How do we obtain good blood pressure measurements?

• What hemodynamic variables are involved in the reduction in blood pressure with physical activity?

OUTLINE

How much can we expect to lower bloodpressure by physical activity?

What do cross- sectional studies show?

The influence of life long physical activity behaviour on blood pressure

Older men (Nyberg et al. JPhysiol. 2012)

The influence of life long physical activity behaviour on blood pressure

Older Women (Gliemann et al. MSSE 2019)

11.1±0.3

Physical activity(Hours/week)

How much can we expect to lower bloodpressure by physical activity?

Longitudinal studies

4 months of light to moderate intensity endurance exerciseand resistance training lowers blood pressure in mild hypertension

Hansen et al. 2011

0

20

40

60

80

100

120

Category 1

100

80

60

40

20

0

-7 mmHg

Pre Post

training

Mean arterial pressure (mmHg)

Mild hypertension(no medication)

Age 49+/_ 1 yrs

BMI 23+/_ 0.5

Trainingperiod

16 weeks

CONT HYP HYP

3 to 6 months of football training reduces meanarterial blood pressure in men with essential

hypertension

Andersen et al. 2014

Subjects(FTG)

Age 30-55 yrs

BMI 29.9+/_ 0.5

MAP 111+/-3 mmHg

CON

FTG

-9 mmHg

8 weeks of endurance versus resistance traininglowers arterial blood pressure in prehypertensives

0

20

40

60

80

100

120

140

160

Beck et al. Exp Biol Med 2013

Systolic Diastolic Systolic DiastolicResistance Endurance

Training Training

*

*

*

*

-8 mmHg -7 mmHg

Before study: 27.2 km running/week distributed over 3 times/week

Intervention group: n=125; (hypertensive group >140/90 mmHg; n=30)

Conducted one endurance plus two 10-20-30 sessions/week

Control group: n=27

Maintained their training

Can you reduce blood pressure in already trained individuals?

Can you reduce blood pressure in already trained individuals?

Systolic blood pressure and 5 km running time Subject characteristics

Systolic: - 4.6 mmHg

Diastolic: -2.9 mmHg

How do we get a good measure of blood pressure?

#1 143 87 139 80

#2 139 89 133 81

#3 144 90 129 78

#4 140 86 132 80

#5 138 91 117 75

Average of 5measurements in lab

Average of measurements by subjects at home

Syst Diast Syst Diast

Blood pressure variations

Morning 127/77

Evening 142/86

Morning 122/80

Evening 142/80

Morning 130/81

Evening 137/79

Morning

Evening

132 79126 79124 77126 77124 77125 77

146 88140 86143 86140 85142 87146 84

Six repeated measurements at home

Systolic Diastolic

Home measurements for one subject. Average of 6 measurements on eachoccasion

KEY POINTS

Arterial blood pressure is reduced by regular physicalactivity of most kinds but may be more effective with more high intensity exercise

Blood pressure is generally lowered between 3 and 10 mmHg within 2-3 months with an effective trainingprogram

Blood pressure should be measured on several daysand avoid whitecoat syndrome

Factors influencing blood pressure

Mean Arterial blood pressure Cardiac outputVascularresistance

= X

Sympatheticnerve activity

Functionalsympatholysis

Formation of vasodilators vs

vasoconstrictors

Sensitivity to vasodilatorcompounds

Arterialelasticity

Blood volume

What hemodynamic variables are involved in the reduction in blood pressure with physical activity?

Vasodilator systems

Vascular function assessed by infusion of acetylcholine

AcetylcholineNO

ProstaglandinsEDH

Endothelial cell

R VasodilationSmoothMuscle

Leg vascular conductance

Ultrasound doppler

Training induced lowering of blood pressure is related to nitric oxide and prostaglandin production

Nyberg et al. JPhysiol 2012

Nitricoxide

Prostacyclin

TRAINING

Reduced blood pressure

AND/OR

Block of nitric oxide and prostacyclin

Mean arterial pressure

Vascular function assessed by infusion of sodium nitroprusside

Nitric oxide donor(Sodium nitro prusside)

NOProstaglandins

EDHF

Endothelial cell

VasodilationSmoothMuscle

Leg vascular conductance

What hemodynamic variables are involved in the reduction in blood pressure with physical activity?

Vasoconstrictor systems

Effect of 8 weeks interval cycling training on plasma endothelin -1 levels in essential hypertension

Plasma endothelin-1

Nyberg et al. 2013

Concentrations of dialysate 6-keto-PGF1α (n=7) (A) and TXB2 (n=6) (B) in muscle dialysate during an acute exercise bout before and after 16 weeks of training.

Ane H. Hansen et al. Hypertension. 2011;58:943-949

Copyright © American Heart Association, Inc. All rights reserved.

Levels of vasoconstrictorsMuscle interstitial thromboxane in the muscle interstitium

In mild essential hypertension- effect of training

Thromboxane- Vasoconstrictor

Sample collectionPump

MICRODIALYSIS

What hemodynamic variables are involved in the reduction in blood pressure with physical activity?

Functional sympatholysis

Functional sympatholysis

Joyner & Casey 2014

aARaAR

-Vasoconstriction

aAR

?

REST

NORADRENALINE RESPONSIVENESS/FUNCTIONAL

SYMPATHOLYSIS

Smoothmuscle cell

Tyramine Noradrenaline VASOCONSTRICTION

REST/EXERCISE

Leg vascular conductance

Functional sympatholysis in normotensive and hypertensive subjects- effect of exercise training

Mortensen et al. JPhysiol 2014

Before training

Pre-training Post-training

Norm Hyp Norm Hyp

in normotensive and hypertensive individuals

Reduced noradrenalin responsiveness after exercise training in normotensive and hypertensive individuals

Mortensen et al. JPhysiol 2014

KEY POINTS

Measurements of vasoactive systems show that

• Essential hypertension is associated with an imbalance betweenvasodilators and vasoconstrictor systems

• Physical training leads to an improved vasodilator capacity, a reduced level of vasoconstrictors and improved functionalsympatholysis