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Short-term aerobic exercise in the elderly promotes blood pressure reduction.



Hypertension (HTN) is a widely prevalent risk factor for cardiovascular disease, affecting well over 50 million men and women in the United States alone. Secondary to progressive arterial wall injury and remodeling, HTN significantly increases the risk for developing coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. , myocardial infarction, sudden death, cerebrovascular disease and stroke, peripheral arterial disease, retinopathy, aortic aneurysms, left ventricular hypertrophy left ventricular hypertrophy Cardiology Enlargement of the left ventricle often linked to the prolonged hemodynamic stress of CHF, characterized by myocardial cell hypertrophy, ↑ left ventricular wall thickness, ↓ ventricular compliance, ↑  and congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. , and nephropathy among other clinical sequelae sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention . The etiology of HTN is multifactorial and its severity is impacted significantly by genetic background as well as environmental and lifestyle factors.

The incidence of HTN increases in both men and women as a function of age. (1,2) Elderly patients are also vulnerable to the development of isolated systolic hypertension, a clinical entity also associated with significant elevations in cardiovascular disease. Despite the availability of a plethora of antihypertensive agents with a broad range of mechanistic utility, only approximately one-third of hypertensive patients achieve nationally defined targets for blood pressures. (3) The percentage of controlled hypertensive patients declines progressively with advancing age. (4) This is unfortunate. Both the Systolic Hypertension in the Elderly Program (5) and the Systolic Hypertension in Europe Trial (6) demonstrated that elderly patients experience significant reductions in cardiovascular morbidity and mortality Morbidity and Mortality can refer to:
  • Morbidity & Mortality, a term used in medicine
  • Morbidity and Mortality Weekly Report, a medical publication
See also
  • Morbidity, a medical term
  • Mortality, a medical term
 when treated with antihypertensive medications.

According to the most recent Joint National Commission guidelines for hypertension, lifestyle modifications such as exercise, weight loss, and salt an dietary restriction play important roles in blood pressure management. (7) As patients age, they tend to gain weight and engage in lower levels of exercise, augmenting risk for HTN development. Instituting sustained lifestyle modifications in populations of any age range is challenging with relatively poor long-term adherence. Among more elderly patients, there is also the issue of whether or not instituting an exercise regimen may constitute an intervention best described as "too little, too late."

In this issue of the Journal of Applied Research, Huang and coworkers explore the effect of moderate and intense aerobic exercise on blood pressure in sedentary patients aged 75 years and older. After only 10 weeks of exercise, systolic blood pressure Systolic blood pressure
Blood pressure when the heart contracts (beats).

Mentioned in: Hypertension
 (SBP SBP Spontaneous bacterial peritonitis, see there ) reductions were observed relative to the group that did not exercise. Among patients in the high-intensity exercise group, resting SBP was significantly reduced by 7.8 mmHg (148.3 [+ or -] 22.8 mmHg vs 140.5 [+ or -] 27.2 mmHg; P<0.05). In the moderate-intensity group, the SBP showed a nonsignificant trend toward reduction of approximately 5.2 mmHg (145.8 [+ or -] 17.7 mmHg vs 140.6 [+ or -] 23.6 mmHg). These differences were observed independent of changes in weight. Importantly, the SBP in the control group increased by 2.6 mmHg (133.1 [+ or -] 23.9 mmHg vs 135.7 [+ or -] 14.8 mmHg). There were no differences noted in diastolic blood pressure Diastolic blood pressure
Blood pressure when the heart is resting between beats.

Mentioned in: Hypertension
 in the exercise groups relative to the control group over the time course studied.

This study provides an important demonstration of the capacity of exercise to meaningfully impact SBP in sedentary octogenarians. These data support the contention that pharmacologic intervention should be coupled with exercise and other lifestyle modification even in our more elderly patients, assuming there are no contraindications to the institution of aerobic exercise. Huang et al show that, when it comes to introducing exercise as a therapeutic modality, it is never too late. The vasculature of these patients remains apt to respond to this intervention in a clinically meaningful manner. It will be of interest to determine if longer term exercise impacts blood pressure progressively more over time and if patients reach a point when DBP is also impacted significantly. In addition to its effects on blood pressure, exercise would also be expected to reduce insulin resistance and the development of metabolic syndrome and diabetes mellitus. This study warrants replication in a larger sample size over a longer follow-up period.

REFERENCES

(1.) Fields LE, Burt VL, Cutler JA, et al. The burden of adult hypertension in the United States 1999 to 2000, a rising tide, Hypertension. 2004;44:398-404.

(2.) Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-1913.

(3.) Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med. 2001;345:479-486.

(4.) Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA. 2005;294:466-472.

(5.) SHEP SHEP Cardiology A clinical trial–Systolic Hypertension in the Elderly Program–that evaluated efficacy of antihypertensives–with diuretics or β-blockers on M&M and stroke in Pts with isolated systolic HTN.  Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255-3264.

(6.) Staessen JA, Fagard R, This L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators Lancet. 1997;350:757-764.

(7.) Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;289:1206-1252.

Editor-in-Chief Peter P Toth, MD, PhD Director of Preventive Cardiology Sterling Rock Falls Clinic, Ltd Chief of Medicine, CGH Medical Center Clinical Associate Professor University of Illinois University of Illinois may refer to:
  • University of Illinois at Urbana-Champaign (flagship campus)
  • University of Illinois at Chicago
  • University of Illinois at Springfield
  • University of Illinois system
It can also refer to:
 School of Medicine E-mail: Peter.Toth@JARCET.com
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Title Annotation:Editorial
Author:Toth, Peter P.
Publication:Journal of Applied Research
Article Type:Clinical report
Date:Sep 1, 2006
Words:884
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