Kokkinos PF, Narayan P, Colleran JA, Pittaras A, Notargiacomo A, Reda D, Papademetriou V
Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension

N Engl J Med (Nov) 333:1462-1467 1995

A large body of evidence supports the conclusion that the African American population is particularly at risk for the development and sequelae of hypertension. Exercise has long been held to be beneficial for the hypertensive patient and this study adds an important piece of foundation to that argument. The investigators recruited 46 adult black men with severe hypertension (SBP>180 or DBP>110) and divided them equally into an exercise group (45 minutes three times a week at 75% max heart rate) and a sedentary group and followed them for the next 16 to 32 weeks. The drop out rate by the end of the study was greater than 50%. Antihypertensive medications were administered in a stepped approach (indapamide, then verapamil followed by enalapril) and patients were "frequently reminded" not to alter their diet or physical activity level. By the end of 16 weeks the groups did not differ in weight but a statistical, though clinically minor, improvement was noted in peak oxygen uptake. Most notable, however, was an improvement by over 5 mmHg in both systolic and diastolic blood pressure in the exercise group associated with an impressive 40 gm reduction in LV mass. These effects persisted through 32 weeks despite a reduction in antihypertensive medications.

Comment:Unfortunately, only males were included in this study and little concrete evidence is provided to suggest control of confounding variables such as sodium intake, number in each group on ACE inhibitors, and outcome of the large number of men who dropped out of the exercise group. In any case, it appears that moderate prolonged three time a week aerobic exercise has clear cut benefits on blood pressure, LVH, and number of antihypertensive medications used in this population and will hopefully curtail some of the long-term morbidity and mortality of severe hypertension in motivated patients. (Narsipur)

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H: Non drug therapy : Role of exercise
H: Pathophysiology : Heart in hypertension