Abstract
Concurrent aerobic plus resistance exercise (RAE) and high-intensity interval exercise (HIIE) are both effective at inducing post-exercise hypotension (PEH) in patients with hypertension. However, central hemodynamic changes associated with PEH in hypertensive subjects with underlying ischemic heart disease (IHD) have been poorly investigated. The study aim was to compare the acute effects produced by these two exercise modalities on left ventricular diastolic function and left atrial function. Twenty untrained male patients with a history of hypertension and IHD under stable pharmacological therapy were enrolled. Each patient underwent three exercise sessions: RAE, HIIE and a control session without exercise, each lasting 45 min. An echocardiography examination was performed before and between 30 min and 40 min from the end of the exercise sessions. Following the exercise sessions, BP values decreased in a similar way in RAE and HIIE and were unchanged after the control session. Compared to pre-session, the ratio between early filling velocity (E) and mitral annulus early diastolic velocity (E’). E/E’ increased after HIIE and remained unchanged after both RAE and control sessions (between-sessions p 0.002). Peak atrial longitudinal strain (PALS) increased slightly after RAE (+1.4 ± 1.1%), decreased after HIIE (−4.6 ± 2.4%) and was unchanged after the control session (between-sessions p 0.03). Peak atrial contraction strain (PACS) was mildly increased after RAE, was reduced after HIIE and was unchanged after the control session. Atrial volume was unchanged after both exercise sessions. Left ventricular and left atrial stiffness increased significantly after HIIE, but remained unchanged after the RAE and control sessions. Stroke volume and cardiac output increased after RAE, decreased after HIIE, and were unchanged after the control session. In conclusion, single session of RAE and HIIE brought about similar PEH in hypertensive subjects with IHD, while they evoked different central hemodynamic adjustments. Given its neutral effects on diastolic and atrial functions, RAE seems more suitable for reducing blood pressure in hypertensive patients with IHD.
Highlights
Physical exercise is a well-established non-pharmacological treatment for patients with hypertension and with ischemic heart disease (IHD) [1]
When exercise is used for treating hypertension, the reduction of blood pressure (BP) below resting pre-exercise levels after a single session, called post-exercise hypotension (PEH), is a clinically relevant phenomenon, since it has been suggested that it may be useful to predict individual responsiveness to BP decrease after a training period [7]
Some recent studies comparing the effectiveness of acute high-intensity interval exercise (HIIE) and resistance and aerobic exercise (RAE) to elicit PEH in hypertensive patients showed BP reductions of similar magnitude following these two exercise modalities, at least when they are performed by untrained patients [8,9]
Summary
Physical exercise is a well-established non-pharmacological treatment for patients with hypertension and with ischemic heart disease (IHD) [1]. In previous trials 3–6 months of HIIE and RAE proved to be safe and effective in elderly subjects and in patients with cardiovascular diseases; these patients were able to improve their exercise tolerance without harming the hemodynamic profile [10,11,12,13,14]. Central hemodynamic changes that occur early with PEH after a single session of HIIE or RAE in patients with hypertension and underlying IHD have been poorly investigated. In this group of patients, the concomitant presence of hypertension and myocardial ischemia contributes over time to increase left ventricular (LV) stiffness and to generate diastolic dysfunction. Prescribing physical exercise for reducing BP and improving exercise tolerance without harming diastolic function or even, possibly, improving it could be a desirable goal for these patients
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