Abstract

Hypertension (HTN) is a public health concern and a major preventable cause of cardiovascular disease (CVD). When uncontrolled, HTN may lead to adverse cardiac remodeling, left ventricular hypertrophy, and ultimately, heart failure. Regular aerobic exercise training exhibits blood pressure protective effects, improves myocardial function, and may reverse pathologic cardiac hypertrophy. These beneficial effects depend at least partially on improved mitochondrial function, decreased oxidative stress, endothelial dysfunction, and apoptotic cell death, which supports the general recommendation of moderate exercise in CVD patients. However, most of these mechanisms have been described on healthy individuals; the effect of moderate exercise on HTN subjects at a cellular level remain largely unknown. We hypothesized that hypertension in adult spontaneously hypertensive rats (SHRs) reduces the mitochondrial response to moderate exercise in the myocardium.Methods: Eight-month-old SHRs and their normotensive control—Wistar-Kyoto rats (WKYR)—were randomly assigned to moderate exercise on a treadmill five times per week with a running speed set at 10 m/min and 15° inclination. The duration of each session was 45 min with a relative intensity of 70–85% of the maximum O2 consumption for a total of 8 weeks. A control group of untrained animals was maintained in their cages with short sessions of 10 min at 10 m/min two times per week to maintain them accustomed to the treadmill. After completing the exercise protocol, we assessed maximum exercise capacity and echocardiographic parameters. Animals were euthanized, and heart and muscle tissue were harvested for protein determinations and gene expression analysis. Measurements were compared using a nonparametric ANOVA (Kruskal-Wallis), with post-hoc Dunn's test.Results: At baseline, SHR presented myocardial remodeling evidenced by left ventricular hypertrophy (interventricular septum 2.08 ± 0.07 vs. 1.62 ± 0.08 mm, p < 0.001), enlarged left atria (0.62 ± 0.1 mm vs. 0.52 ± 0.1, p = 0.04), and impaired diastolic function (E/A ratio 2.43 ± 0.1 vs. 1.56 ± 0.2) when compared to WKYR. Moderate exercise did not induce changes in ventricular remodeling but improved diastolic filling pattern (E/A ratio 2.43 ± 0.1 in untrained SHR vs. 1.89 ± 0.16 trained SHR, p < 0.01). Histological analysis revealed increased myocyte transversal section area, increased Myh7 (myosin heavy chain 7) expression, and collagen fiber accumulation in SHR-control hearts. While the exercise protocol did not modify cardiac size, there was a significant reduction of cardiomyocyte size in the SHR-exercise group. Conversely, titin expression increased only WYK-exercise animals but remained unchanged in the SHR-exercise group. Mitochondrial response to exercise also diverged between SHR and WYKR: while moderate exercise showed an apparent increase in mRNA levels of Ppargc1α, Opa1, Mfn2, Mff, and Drp1 in WYKR, mitochondrial dynamics proteins remained unchanged in response to exercise in SHR. This finding was further confirmed by decreased levels of MFN2 and OPA1 in SHR at baseline and increased OPA1 processing in response to exercise in heart. In summary, aerobic exercise improves diastolic parameters in SHR but fails to activate the cardiomyocyte mitochondrial adaptive response observed in healthy individuals. This finding may explain the discrepancies on the effect of exercise in clinical settings and evidence of the need to further refine our understanding of the molecular response to physical activity in HTN subjects.

Highlights

  • Exercise is a key element of optimal cardiovascular health: physical activity and exercise training improves cardiovascular fitness and reduces the risk of cardiovascular disease (CVD)

  • Blood Pressure and Heart Rate Measurements. Both SBP and DBP were higher in Spontaneously Hypertensive Rat (SHR) than Wistar–Kyoto rats (WKYR) at baseline and after completing the study protocol (Figure 1A), irrespective of the allocated branch (SBP: WYKR 155 ± 15.67 vs. SHR 230 ± 14.04 mmHg, p < 0.0001; DBP: WYKR 107.8 ± 12.42 vs. SHR 188 ± 21.06 mmHg, p < 0.0001)

  • We evaluated the expression of genes related to mitochondrial dynamics, including genes involved in mitochondrial fusion (Opa1 and Mfn2) and fission (Drp1 and Mff) [15]

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Summary

Introduction

Exercise is a key element of optimal cardiovascular health: physical activity and exercise training improves cardiovascular fitness and reduces the risk of cardiovascular disease (CVD). Several clinical trials have probed the antihypertensive effect of exercise: in hypertensive adults, aerobic exercise training lowers blood pressure 5–7 mmHg, rivaling the effect of the first-line antihypertensives [5]. Based on these results, exercise is recommended as a lifestyle modification for hypertension prevention and treatment; the type of exercise, as well as the optimal frequency, intensity, and duration is based on expert opinion and not on substantial evidence. This lack of agreement reflects a concerning fact: the robustness of epidemiologic evidence regarding the beneficial effect of exercise contrasts with our poor understanding of the mechanisms underlying its effects in specific conditions such as hypertension [6]

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