Postexercise hypotension in African and Asian populations: a systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Worldwide, raised blood pressure (BP) or hypertension (HT) is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African-origin populations. Post-exercise hypotension (PEH) defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management which can last up to 24 hours. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. Objectives To systematically summarize the acute effects of a single bout of aerobic exercise on blood pressure in a population of African or Asian origin. Methods We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or HT published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random effect models fitted to estimate effect sizes. Results We identified 10 aerobic exercise trials of individuals of Asian origin (n= 156; mean age: 27.05 years: 72% male; baseline SBP/DBP: 114.93 [99,142] / 67.34 [61,74] mmHg) and 11 aerobic exercise trials involving individuals of African origin (n=112; mean age: 41.37 years; 62% male; baseline SBP/DBP: 125.77 [106.6,140.2] / 79.72 [69.9, 84.3] mmHg). Non-significant moderate reductions in office SBP and DBP at 30 minutes postexercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28 / -1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 minutes postexercise (-2.80 [-7.90, 2.28], p = 0.27 / -1.95, [-5.66, 1.75], p = 0.3) were observed compared to control group. No statistically significant differences were found between ethnic groups (p > 0.05). Ambulatory BP was reported only in the African groups. No effect was found on 24h-SBP post-exercise, but 24h-DBP was statistically signficantly reduced (-1.89 [-3.47, -0.31] mmHg, p < 0.01) after a bout of aerobic exercise. Conclusions A single bout of aerobic exercise did not significantly reduce BP immediately in the African and Asian group. In the African group a small though statistically significant lower 24h-DBP was observed. Unfortunately, no data was found on the 24h-BP response in Asians. The low number of studies in both ethnic groups and lack of data on isometric and resistance exercise in African and Asian populations warrant more research to improve quality of evidence.