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