Aerobic Exercise Training Reduces 24-Hour Ambulatory Blood Pressure In Patients With Resistant Hypertension: A Randomized Controlled Trial (Enrich Trial)

Objective: To assess the effect of aerobic exercise training in 24-hour ambulatory blood pressure (ABPM) in patients with resistant hypertension. Design and method: In this randomized-control trial (ClinicalTrials.gov: NCT03090529), 48 patients with resistant hypertension were allocated to either the exercise (EG, n = 26) or control group (CG, n = 22). Exercise training consisted of 40 min aerobic exercise at 50–70% of VO2peak, 3 sessions per week for 12 weeks. Ambulatory blood pressure (ABPM) was recorded at the same weekday at baseline and 48 hours after the last exercise session. The main outcome was the change in mean 24-hour ABPM. Results: Both groups were similar at baseline for: number of antihypertensive drugs (EG: 4.58 ± 0.86 vs.CG: 4.65 ± 0.56, p = 0.626), age (EG: 59.3 ± 8.3 vs CG: 59.6 ± 9.0 yrs, p = 0.897), body mass index (EG: 30.1 ± 4.9 vs CG:30.0 ± 4.9 kg/m2, p = 0.954), and VO2peak (EG: 34.5 ± 5.7 vs CG: 31.8 ± 6.6 mlO2.Kg-1.min-1, p = 0.138). No differences in ABPM were found between groups at baseline. The EG improved ABPM; there was a significant group∗time interaction in 24-hour mean systolic ABPM (EG: 127.4 ± 12.2 to 121.1 ± 12.6 mmHg vs. CG: 122.7 ± 14.4 to 124.0 ± 14.3 mmHg, p = 0.011), 24-hour mean diastolic ABPM (EG: 75.6 ± 7.8 to 71.4 ± 7.6 mmHg vs. CG: 73.1 ± 9.3 to 72.9 ± 8.6 mmHg, p = 0.015), daytime mean systolic ABPM (EG: 133.0 ± 12.3 to 125.8 ± 13.3 mmHg vs. CG: 128.2 ± 14.5 to 129.2 ± 13.2 mmHg, p = 0.010) and daytime mean diastolic ABPM (EG: 79.4 ± 8.1 to 74.8 ± 8.6 mmHg vs. CG: 77.1 ± 9.8 to 77.0 ± 8.5 mmHg, p = 0.019). No differences between groups were observed for night-time mean systolic (EG: 115.0 ± 15.0 to 111.1 ± 11.2 mmHg vs. CG: 112.0 ± 15.2 to 113.9 ± 17.7 mmHg, p = 0.131) and mean diastolic ABPM (EG: 67.3 ± 9.4 to 64.2 ± 5.6 vs. CG: 65.7 ± 8.6 to 65.4 ± 9.7 mmHg, p = 0.180). Conclusions: Aerobic exercise training decreases 24 h and daytime ABPM in patients with resistant hypertension. This decrease in 24-hour ABP is of the same magnitude as reported for individuals with non-resistant hypertension, suggesting that in patients with resistant hypertension aerobic exercise training may have the same positive effects as in patients with non-resistant hypertension.