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