Aerobic Training Boosts the Power of Antihypertensive Drugs

Fran Lowry

June 08, 2021

Aerobic exercise augments the blood pressure-lowering effect of antihypertensive medication in hypertensive individuals with metabolic syndrome.

In a small study, these patients experienced a greater reduction in their ambulatory blood pressure when they added aerobic exercise to their therapeutic regimen, compared with when they just took antihypertensive meds alone.

The average reduction in mean arterial blood pressure when exercise was added to medication was 10 mm Hg, compared with 6 mm Hg with medication alone.

The findings were presented at the virtual 2021 American College of Sports Medicine (ACSM) Annual Meeting and World Congress.

"The combination of antihypertensive medication with aerobic exercise training reduces blood pressure beyond the effects of medication alone," first author Miguel Ramirez-Jimenez, PhD, an exercise physiologist at the University of Castilla-La Mancha, Toledo, Spain, told Medscape Medical News.

Dr Miguel Ramirez-Jimenez

"And so, if the goal is to reduce the blood pressure as close as possible to normal — 120/80 mm Hg for systolic and diastolic blood pressure — the combination of both medication and exercise is recommended," Ramirez-Jimenez said.

Hypertension ranks as the leading preventable cause of premature death, affecting some 30% of the adult population worldwide, and costing an estimated $370 billion per year. In addition, there is a tendency to reduce blood pressure only by means of blood pressure-lowering drugs rather than using scientific, evidence-based lifestyle interventions.

The current study included 36 overweight and obese adults, (BMI 29 to 33 kg/m2) who did less than 120 minutes of physical activity per week. Their mean age was 59 years (range 53 to 65 years), and 22% were postmenopausal women. They had been on their antihypertensive medications for an average of 8 ± 5 years and all had at least 3 criteria for metabolic syndrome, including elevated blood glucose, triglycerides, and large waist circumference.

Before they began their exercise training, participants were randomly assigned to receive either placebo, in which their usual antihypertensive medication was stopped, or to continue with their usual antihypertensive for 3 days. Their 24-hour ambulatory blood pressure was then measured.

All participants then completed a 4-month training intervention that consisted of supervised indoor cycling sessions 3 times per week.

After the intervention, a similar trial of placebo vs hypertension medication for 3 days was done, and ambulatory blood pressure was again measured.

The researchers found that before the exercise intervention, antihypertensive drugs reduced ambulatory blood pressure by 5 ± 5 mm Hg.

After 4 months of aerobic training, the antihypertensive drugs reduced ambulatory blood pressure by an additional 3 ± 5 mm Hg (92 ± 9 before exercise; 89 ± 8 after exercise).

When the exercise stopped, its antihypertensive effect also stopped.

"One might think that, if a medicated hypertensive patient engages in an exercise training program, this patient could be taken off [the medicine] if the blood pressure is normalized after completing the program," Ramirez-Jimenez said. "But our study shows that when we withdrew the antihypertensive medication after the exercise program, the blood pressure increased again, so this finding indicates to us that, in order to see the benefits of exercise in treated hypertensive [patients], antihypertensive medication must be present, and that exercise training cannot substitute for pharmacological treatment.

"In addition, it is very important to note that after a single bout of exercise, there is a phenomenon named 'post-exercise hypotension' that reduces your blood pressure for up to 24 hours afterwards. Therefore, it is very important to exercise regularly, 3 to 5 times per week, in order to take advantage of this acute effect of exercise.

"We also hope these results will promote the creation of exercise training units in each primary care center to facilitate and promote adherence to this kind of lifestyle intervention," he added.

Encouraging News

Dr Amanda Zaleski

"Treatment guidelines reinforce that individuals with a clinical indication for antihypertensive therapy initiate pharmacological intervention, in addition to, but never instead of, lifestyle interventions," Amanda L. Zaleski, PhD, director of exercise physiology research at Hartford Hospital, Hartford, Connecticut, commented to Medscape Medical News.

"High-intensity interval training is often touted as an attractive alternative to more time-intensive modalities. However the benefit-to-risk ratio among individuals at heightened risk for CVD is not fully understood," said Zaleski, who was not involved in the study.

"This analysis extends the literature to suggest that both antihypertensive therapy and high-intensity interval training confer favorable blood pressure reductions among individuals with metabolic syndrome, without any obvious deleterious effects," she said.

"This is encouraging because we know that patients who are willing and able to perform moderate- to high-intensity aerobic exercise will likely experience additional pleiotropic benefits that were not assessed in this study, such as improved insulin sensitivity and body composition, which would translate to a greater risk reduction, the ultimate goal of treatment of patients with metabolic syndrome."

The study was supported by a grant from the Spanish Government. Ramirez-Jimenez and Zaleski have disclosed no relevant financial relationships.

American College of Sports Medicine (ACSM) Annual Meeting and World Congresses: Abstract 1347. Presented June 1, 2021.

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