Is Low-Intensity Isometric Handgrip Exercise an Efficient Alternative in Lifestyle Blood Pressure Management? A Systematic Review.

CONTEXT: High blood pressure is one of the leading preventable causes of cardiovascular death worldwide. In this regard, several studies have shown interest in the benefits of isometric exercise on blood pressure regulation. OBJECTIVE: To assess whether low-intensity isometric handgrip exercise (LI-IHE) is an effective strategy to lower blood pressure levels in prehypertensive and hypertensive patients. DATA SOURCE: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and registered with PROSPERO. Potentially eligible studies were identified after a systematic search conducted on 4 international databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PEDro, and SPORTDiscus. STUDY SELECTION: We included randomized controlled trials that comprised patients who received LI-IHE. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Data related to patient characteristics, exercise programs, risk-of-bias assessment, and outcomes of interest were systematically reviewed independently by 2 authors. RESULTS: The following reductions (mean differences) were observed after LI-IHE: systolic blood pressure (SBP), (MD) = -5.43 mm Hg; (95% CI, -8.47 to -2.39; P = 0.0005); diastolic blood pressure (DBP), -2.41 mm Hg (95% CI, -4.33 to -0.48; P = 0.01); mean arterial pressure (MAP), -1.28 mm Hg (95% CI, -2.99 to 0.44; P = 0.14). CONCLUSION: LI-IHE seems to lower SBP, DBP, and MAP values in prehypertensive and hypertensive adults. It appears that LI-IHE reduces, in greater magnitude, blood pressure levels in hypertensive patients, specifically in patients aged <45 years, those who are overweight, and those on medications. Nevertheless, substantial heterogeneity in the main results and in the analyses by subgroups generated uncertainty about the real reduction magnitude that LI-IHE can produce on blood pressure.

Continuous and Accumulated Bouts of Cycling Matched by Intensity and Energy Expenditure Elicit Similar Acute Blood Pressure Reductions in Prehypertensive Men.

Fonseca, GF, Farinatti, PTV, Midgley, AW, Ferreira, A, de Paula, T, Monteiro, WD, and Cunha, FA. Continuous and accumulated bouts of cycling matched by intensity and energy expenditure elicit similar acute blood pressure reductions in prehypertensive men. J Strength Cond Res 32(3): 857-866, 2018-This study investigated differences in postexercise hypotension (PEH) after continuous vs. accumulated isocaloric bouts of cycling. Ten prehypertensive men, aged 23-34 years, performed 2 bouts of cycling at 75% oxygen uptake reserve, with total energy expenditures of 400 kcal per bout. One exercise bout was performed continuously (CONTIN) and the other as 2 smaller bouts each expending 200 kcal (INTER1 and INTER2). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and cardiac autonomic control were monitored in a supine position for 10 minutes before and 60 minutes after each exercise bout, and during a control session. Compared with control, blood pressure was significantly reduced after CONTIN (SBP: [INCREMENT] - 3.4 mm Hg, p < 0.001; MAP: [INCREMENT] - 2.5 mm Hg, p = 0.001), INTER1 (SBP: [INCREMENT] - 2.2 mm Hg, p = 0.045), and INTER2 (SBP: [INCREMENT] - 4.4 mm Hg, p < 0.001; DBP: [INCREMENT] - 2.7 mm Hg, p = 0.045; MAP: [INCREMENT] - 3.3 mm Hg, p = 0.001). The PEH was similar in CONTIN and INTER2, whereas INTER2 elicited greater PEH than INTER1 (SBP and MAP: [INCREMENT] - 2.0 and [INCREMENT] - 1.8 mm Hg, respectively, p ≤ 0.05). Increases in sympathovagal balance from baseline were inversely related to changes in SBP and DBP after CONTIN and INTER2 (r = -0.64 to -0.71; p = 0.021-0.047). These findings indicate that similar amounts of PEH are observed when exercise is performed as a single 400-kcal exercise bout or 2 × 200-kcal bouts and that the exercise recovery pattern of cardiac autonomic activity may be important in eliciting PEH.

Resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals: meta-analysis.

The purpose of this study was to evaluate the effects of resistance training alone on the systolic and diastolic blood pressure in prehypertensive and hypertensive individuals. Our meta-analysis, followed the guidelines of PRISMA. The search for articles was realized by November 2016 using the following electronic databases: BIREME, PubMed, Cochrane Library, LILACS and SciELO and a search strategy that included the combination of titles of medical affairs and terms of free text to the key concepts: 'hypertension' 'hypertensive', 'prehypertensive', 'resistance training', 'strength training', and 'weight-lifting'. These terms were combined with a search strategy to identify randomized controlled trials (RCTs) and identified a total of 1608 articles: 644 articles BIREME, 53 SciELO, 722 PubMed, 122 Cochrane Library and 67 LILACS. Of these, five RCTs met the inclusion criteria and provided data on 201 individuals. The results showed significant reductions for systolic blood pressure (-8.2 mm Hg CI -10.9 to -5.5;I2: 22.5% P valor for heterogeneity=0.271 and effect size=-0.97) and diastolic blood pressure (-4.1 mm Hg CI -6.3 to -1.9; I2: 46.5% P valor for heterogeneity=0.113 and effect size=-0.60) when compared to group control. In conclusion, resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive subjects. The RCTs studies that investigated the effects of resistance training alone in prehypertensive and hypertensive patients support the recommendation of resistance training as a tool for management of systemic hypertension.

Acute Hypotensive Response to Continuous and Accumulated Isocaloric Aerobic Bouts.

Evidence indicates that chronic reductions in blood pressure (BP) due to aerobic exercise depend on the ability to induce post-exercise hypotension (PEH) after each training bout. The purpose of this study was to investigate PEH after isocaloric bouts of continuous and accumulated running. 10 healthy pre-hypertensive men (aged 27.6±3.5 years) performed the following bouts of exercise: a) A continuous bout (CONT) expending a total of 400 kcal; and b) An accumulated bout split into 2×200 kcal (INTER1 and INTER2) to total 400 kcal at 75% of oxygen uptake reserve. BP, mean arterial pressure (MAP) and heart rate variability were monitored 10 min before and 60 min after control and all exercise conditions. The decrease in MAP over time after continuous (400 kcal) and accumulated (2×200 kcal) bouts of exercise was more pronounced than during control (mean diff between 1.6 and 5.4 mmHg, P≤0.01), although the magnitude of change was similar between continuous and accumulated bouts (mean diff=0.1 mmHg, P=0.79). Concomitant to the PEH, sympathovagal balance was inversely related to changes in MAP after isocaloric bouts performed continuously and cumulatively (r=- 0.72 and-0.85, P=0.019 and 0.002, respectively). In conclusion, BP decreased to similar levels after continuous and accumulated acute aerobic exercise matched for total energy expenditure. Our findings also indicate that the recovery pattern of cardiac autonomic activity may have an important role in eliciting PEH.

Endothelial Changes in Individuals with Prehypertension.

INTRODUCTION: Prehypertension is considered a precursor of systemic arterial hypertension and a predictor of morbidity-mortality due to cardiovascular diseases, which are the main causes of death in Brazil and the world. Thus, early diagnosis and the adoption of therapeutic measures in cases of prehypertension can reduce cardiovascular risk. The aim of the present study was to perform a selective review of the literature to identify and discuss early endothelial changes in individuals with pre-hypertension. RESULTS AND DISCUSSION: The findings indicate an increase in ET-1-mediated vasoconstrictor tone in prehypertension, with endothelial-dependent vasodilatation impairment. Moreover, significantly high levels of angiotensin, arginine and vasopressin were found in this group of patients. A reduction in endothelial fibrinolytic capacity was another important change found in patients with prehypertention and was associated with an increased risk for atherothrombotic events. CONCLUSION: The present findings demonstrate endothelial changes in individuals with prehypertension that contribute to the development of arterial hypertension as well as a high risk for cardiovascular events, underscoring the importance of the early adoption of optimized therapeutic measures for this population.

[Acceptability of a mobile health based intervention to modify lifestyles in prehypertensive patients in Argentina, Guatemala and Peru: a pilot study]. / Aceptabilidad de una intervención basada en Salud Móvil para modificar estilos de vida en prehipertensos de Argentina, Guatemala y Perú: un estudio piloto.

OBJECTIVES: To evaluate the acceptability and feasibility of an intervention based on mobile health, for the adoption of healthy lifestyles in prehypertensive people living in low-income urban areas in Argentina, Guatemala and Peru. MATERIALS AND METHODS: Prehypertensive people aged 30-60 years were recruited for a pilot study. The intervention included two counseling calls made by a nutritionist followed by a weekly customized text message. An internet-based platform offered support for the implementation of the intervention. Using semi-structured interviews, we evaluated the reach and acceptability of the intervention in the participants and ease of use for the nutritionists. RESULTS: It was possible to contact 43 of the 45 participants (95%). The average number of calls to contact a subject was two, with a range of 1-9 calls. Two participants could not be reached on their cell phone; five did not receive complete exposure to the intervention. Based on semi-structured interviews, the results showed good acceptability for the intervention by the participants. Nutritionists perceived the platform as friendly and easy to use. Barriers to deliver this intervention were related to difficulties in obtaining an adequate cellular signal. CONCLUSIONS: Given the high penetration of mobile phones in developing countries, it is concluded that it is feasible and acceptable to offer a mobile health based intervention oriented towards lifestyle modification in people with prehypertension or high risk of chronic disease intervention.

Diet and exercise training reduce blood pressure and improve autonomic modulation in women with prehypertension.

Despite mortality from heart disease has been decreasing, the decline in death in women remains lower than in men. Hypertension (HT) is a major risk factor for cardiovascular disease. Therefore, approaches to prevent or delay the onset of HT would be valuable in women. Given this background, we investigated the effect of diet and exercise training on blood pressure (BP) and autonomic modulation in women with prehypertension (PHT). Ten women with PHT (39 ± 6 years, mean ± standard deviation) and ten with normotension (NT) (35 ± 11 years) underwent diet and exercise training for 12 weeks. Autonomic modulation was assessed through heart rate (HR) and systolic BP (SBP) variability, using time and frequency domain analyses. At preintervention, women with PHT had higher SBP (PHT: 128 ± 7 vs. NT: 111 ± 6 mmHg, p < 0.05) and lower HR variability [standard deviation of normal-to-normal beats (SDNN), PHT: 41 ± 18 vs. NT: 60 ± 19 ms, p < 0.05]. At post-intervention, peak oxygen consumption and muscular strength increased (p < 0.05), while body mass index decreased in both groups (p < 0.05). However, SBP decreased (118 ± 8 mmHg, p < 0.05 vs. preintervention) and total HR variability tended to increase (total power: 1,397 ± 570 vs. 2,137 ± 1,110 ms(2), p = 0.08) only in the group with PHT; consequently, HR variability became similar between groups at post-intervention (p > 0.05). Moreover, reduction in SBP was associated with augmentation in SDNN (r = -0.46, p < 0.05) and reduction in low-frequency power [LF (n.u.); r = 0.46, p < 0.05]. In conclusion, diet and exercise training reduced SBP in women with PHT, and this was associated with augmentation in parasympathetic and probably reduction in sympathetic cardiac modulation.

The effects of continuous positive airway pressure on prehypertension and masked hypertension in men with severe obstructive sleep apnea.

Obstructive sleep apnea and hypertension are common conditions that frequently coexist. Continuous positive airway pressure (CPAP) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension. However, the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension, conditions associated with increased cardiovascular risk, is unknown. Thirty-six male patients (age, 43 ± 7 years; body mass index, 28.8 ± 3.0 kg/m(2)) with untreated severe obstructive sleep apnea (apnea-hypopnea index, 56 ± 22 events/hr on polysomnography) with diagnostic criteria for prehypertension and/or masked hypertension, based on office and 24-hour ambulatory blood pressure monitoring, respectively, were studied. The patients randomized to no treatment (control; n=18) or CPAP (n=18) for 3 months had similar frequency of prehypertension and masked hypertension at study entry. There were no significant changes in blood pressure in patients randomized to the control group. In contrast, patients randomized to CPAP presented significant reduction in office systolic (from 126 ± 5 to 121 ± 7 mm Hg; P=0.001) and a trend for diastolic blood pressure (from 75 ±7 to 73 ± 8 mm Hg; P=0.08) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure (P<0.05 for each comparison). There was a significant reduction in the frequency of prehypertension (from 94% to 55%; P=0.02) and masked hypertension (from 39% to 5%; P=0.04) only in the CPAP group. In conclusion, effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe obstructive sleep apnea.