Impact of different exercise modalities on blood pressure in patients with nocturnal hypertension

Nocturnal hypertension is the blood pressure (BP) phenotype most strongly associated with cardiovascular morbidity and mortality, yet no specific therapeutic strategy has been established. Physical activity effectively lowers BP, but the impact of different exercise modalities on nocturnal BP remains unclear. In this randomized clinical trial, 66 patients with nocturnal hypertension were assigned to 12 weeks of supervised high-intensity interval training (HIIT, n = 38) or isometric resistance training (IRT, n = 28). The primary outcome was the change in nocturnal SBP measured by ambulatory blood pressure monitoring (ABPM). Fourteen participants (21%) did not complete the intervention, leaving 52 patients (73% women; mean age 49 ± 12 years; BMI 33 ± 7 kg/m2) for analysis. Exercise training significantly reduced office BP (-5.8 ± 18/-3.6 ± 10 mmHg, P < 0.05) and 24-h ABPM (-4.2 ± 12/-2.9 ± 7 mmHg, P < 0.05), mainly driven by nocturnal BP reductions (-6.9 ± 12/-4.7 ± 7 mmHg, both P < 0.001). The HIIT group showed a significantly greater decrease in nocturnal SBP compared with IRT (-9.8 ± 12.3 vs. -2.7 ± 10.4 mmHg, P < 0.001). After adjustment by sex, BMI, age, and antihypertensive treatment, HIIT lowered nocturnal systolic ABPM by -7.5 ± 3.3 mmHg (95% CI: -14.2 to -0.8; P = 0.030) more than IRT. Supervised exercise training, particularly HIIT, significantly lowers nocturnal BP in patients with nocturnal hypertension, regardless of weight loss. These findings suggest HIIT as a promising nonpharmacological therapeutic option for this high-risk phenotype.