physical activity and essential...
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Physical activity and essentialhypertension
Ylva Hellsten
Department of Nutrition, Exercise and Sports
University of Copenhagen, Denmark
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• 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
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How much can we expect to lower bloodpressure by physical activity?
What do cross- sectional studies show?
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The influence of life long physical activity behaviour on blood pressure
Older men (Nyberg et al. JPhysiol. 2012)
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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)
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How much can we expect to lower bloodpressure by physical activity?
Longitudinal studies
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4 months of light to moderate intensity endurance exerciseand resistance training lowers blood pressure in mild hypertension
Hansen et al. 2011
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Category 1
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20
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-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
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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
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8 weeks of endurance versus resistance traininglowers arterial blood pressure in prehypertensives
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140
160
Beck et al. Exp Biol Med 2013
Systolic Diastolic Systolic DiastolicResistance Endurance
Training Training
*
*
*
*
-8 mmHg -7 mmHg
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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?
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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
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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
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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
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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
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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
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What hemodynamic variables are involved in the reduction in blood pressure with physical activity?
Vasodilator systems
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Vascular function assessed by infusion of acetylcholine
AcetylcholineNO
ProstaglandinsEDH
Endothelial cell
R VasodilationSmoothMuscle
Leg vascular conductance
Ultrasound doppler
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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
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Vascular function assessed by infusion of sodium nitroprusside
Nitric oxide donor(Sodium nitro prusside)
NOProstaglandins
EDHF
Endothelial cell
VasodilationSmoothMuscle
Leg vascular conductance
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What hemodynamic variables are involved in the reduction in blood pressure with physical activity?
Vasoconstrictor systems
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Effect of 8 weeks interval cycling training on plasma endothelin -1 levels in essential hypertension
Plasma endothelin-1
Nyberg et al. 2013
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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
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What hemodynamic variables are involved in the reduction in blood pressure with physical activity?
Functional sympatholysis
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Functional sympatholysis
Joyner & Casey 2014
aARaAR
-Vasoconstriction
aAR
?
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REST
NORADRENALINE RESPONSIVENESS/FUNCTIONAL
SYMPATHOLYSIS
Smoothmuscle cell
Tyramine Noradrenaline VASOCONSTRICTION
REST/EXERCISE
Leg vascular conductance
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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
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in normotensive and hypertensive individuals
Reduced noradrenalin responsiveness after exercise training in normotensive and hypertensive individuals
Mortensen et al. JPhysiol 2014
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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