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CLINICAL STUDY: HYPERTENSION

Postexercise blood pressure reduction in elderly hypertensive patients

Maria Urbana P. Brandão Rondon, PhD^*, Maria Janieire N. N. Alves, MD^*, Ana Maria F. W. Braga, MD, PhD^*, Odila Tomoko U. N. Teixeira, MD, Antonio Carlos P. Barretto, MD, PhD^*, Eduardo M. Krieger, MD, PhD and Carlos Eduardo Negrão, PhD^*,*

^* Unit of Cardiovascular Rehabilitation and Exercise Physiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
Unit of General Clinic of Cardiopathies, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
Unit of Hypertension, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil

Manuscript received April 13, 2001; revised manuscript received November 7, 2001, accepted November 29, 2001.

^* Reprint requests and correspondence: Dr. Carlos Eduardo Negrão, InCor, Instituto do Coração, Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Av. Dr. Enéas de Carvalho Aguiar 44, Cerqueira César, São Paulo, SP CEP 05403-000, Brazil.
cndnegrao{at}incor.usp.br

OBJECTIVES: We sought to study: 1) the impact of hemodynamic and left ventricular function on short-term postexercise blood pressure reduction in elderly hypertensive patients; and 2) the 22-h postexercise effects on ambulatory blood pressure in elderly hypertensive patients.

BACKGROUND: Although early exercise provokes postexercise blood pressure reduction, the mechanisms underlying this response are not completely understood. Besides, it is unclear whether the reduction in blood pressure after exercise lasts long enough to have clinical relevance in elderly hypertensive patients.

METHODS: We studied 24 elderly hypertensive patients (age 68.9 ± 1.5 years) and 18 age-matched normotensive control subjects (age 68.1 ± 1.2 years). Cardiac output (carbon dioxide rebreathing) and blood pressure (auscultatory) were measured at rest and after a 45-min period of low-intensity bicycle exercise (50% maximal oxygen uptake) and at 15, 30, 60 and 90 min after exercise. Left ventricular function (by Doppler echocardiography) was also evaluated. Ambulatory blood pressure monitoring was evaluated after 45 min of exercise or 45 min of rest, in a randomized order.

RESULTS: In the hypertensive patients, exercise provoked a significant reduction in blood pressure, cardiac output, stroke volume and left ventricular end-diastolic volume. It also provoked a significant reduction in systolic, mean and diastolic blood pressure during a 22-h period, at daytime and nighttime.

CONCLUSIONS: The short-term reduction in blood pressure after exercise in elderly hypertensive patients is associated with a decrease in stroke volume and left ventricular end-diastolic volume. The 22-h postexercise reduction in blood pressure demonstrates the clinical relevance of low-intensity exercise in elderly hypertensive patients.

Abbreviations and Acronyms   Vo2peak   a-vO2   arterial-venous oxygen difference   CO   cardiac output   DBP   diastolic blood pressure   MBP   mean blood pressure   SBP   systolic blood pressure   SV   stroke volume   TPR   total peripheral resistance   VCO2   carbon dioxide production   VO2   oxygen uptake   VO2peak   peak oxygen uptake