Key result
Eight weeks of blood pressure lowering with aliskiren or valsartan did not alter the exercise-induced increase in systolic pressure amplification compared to baseline (p>0.05).
Why the study?
Does renin-angiotensin system blockade with aliskiren or valsartan modulate pressure amplification during exercise in patients with hypertension?
RCT (n=32)
Does renin-angiotensin system blockade with aliskiren or valsartan modulate pressure amplification during exercise in patients with hypertension?
Blood pressure lowering with renin-angiotensin system blockade reduces both aortic and brachial pressures proportionately without directly influencing their relationship at rest or during exercise.
Antihypertensive effects on exercise pressure amplification remain uncertain; larger trials needed before clinical consideration.
INTRODUCTION: Brachial blood pressure increases with exercise and an excessive rise predicts increased cardiovascular risk. Measurement of brachial blood pressure alone may exaggerate the true blood pressure elevation due to exercise-induced change to pressure amplification. Whether blood pressure-lowering treatment modulates pressure amplification during exercise is unknown. METHODS: Thirty-two participants with stage 1-2 hypertension (mean age 59.2 years) received eight weeks' blood pressure lowering with either aliskiren (300mg, n=16) or valsartan (320mg, n=16). Brachial and central aortic pressure (CASP) were measured non-invasively during treadmill exercise (Bruce protocol) at baseline, after eight weeks' treatment and 48 hours following treatment withdrawal. RESULTS: The rise in brachial blood pressure with exercise exceeded the rise in CASP, indicative of enhanced pressure amplification. Eight weeks' treatment elicited similar reductions in brachial blood pressure and CASP which did not differ between rest and peak exercise (p>0.05). The exercise-induced increase in systolic pressure amplification did not differ between baseline and following eight weeks' treatment (p>0.05). These effects remained unchanged following treatment withdrawal. CONCLUSION: Blood pressure lowering does not directly influence the relationship between aortic and brachial pressure either at rest or during exercise in patients with hypertension, other than through proportionate lowering of both pressures. These effects remained unchanged 48 hours after a simulated missed medication dose.
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Lacy et al. (2014) conducted an RCT in stage 1-2 hypertension (n=32). Aliskiren or Valsartan vs. Baseline was evaluated on exercise-induced increase in systolic pressure amplification (p=>0.05). Eight weeks of blood pressure lowering with aliskiren or valsartan did not alter the exercise-induced increase in systolic pressure amplification compared to baseline (p>0.05).
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