Endurance Exercise Training reduces Blood Pressure according to the Wilder’s Principle

Abstract

The effect of antihypertensive medicine (AHM) is larger the higher the pre-treatment blood pressure level. It is unknown whether this Wilder’s principle, also applies for the exercise-training blood pressure (BP) lowering effect. One hundred seventy-eight (n=178) middle-aged individuals (55±8 y) with metabolic syndrome (MetS), underwent high intensity interval training (3 days·week^–1) for 16 weeks. Participants were divided into medicated (Med; n=103) or not medicated (No Med; n=75) with AHM. Office BP was evaluated before and after the exercise-training. Correlations and stepwise regression analysis were used to determine which variable better predicted the reductions in systolic BP (SBP) with training. After training, participants with hypertension lowered SBP by a similar magnitude regardless of if they were in the Med (–15 mmHg, 95% CI–12,–19; P<0.001) or No Med group (–13 mmHg, 95% CI–9,–16; P<0.001). However, SBP did not decrease among normotensive groups (P=0.847 for Med and P=0.937 for No Med). Pre-treatment SBP levels was the best predictor of exercise-training lowering effect (r=–0.650; β=–0.642; P<0.001). For each 10 mmHg higher pre-training SBP there were a 5 mmHg deeper SBP reduction (Wilder principle). Furthermore, AHM does not interfere with exercise-training BP-lowering effect.

Key words

aerobic interval training - cardiovascular diseases - hypertension - metabolic syndrome - office blood pressure - Wilder’s principle

Publication History

Received: 02 January 2021

Accepted: 30 June 2021

Article published online:
24 September 2021

• References

• 1 Wilder J. Zeitschrift fur die gesamte. Neurologie und Psychiatrie 1931; 137: 317-338
• 2 Dixon GT, Johnson ES. Efficacy of antihypertensive drugs. Lancet 1976; 1: 515-518
• 3 Wilson AL, Schumacher GE. Test of a novel method for analysis of the efficacy of antihypertensive drugs. Lancet 1979; 1: 656-658
• 4 Law MR, Wald NJ, Morris JK. et al Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003; 326: 1427
• 5 Molmen-Hansen HE, Stolen T, Tjonna AE. et al Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. Eur J Prev Cardiol 2012; 19: 151-160
• 6 MacDonald HV, Johnson BT, Huedo-Medina TB. et al Dynamic resistance training as stand-alone antihypertensive lifestyle therapy: A meta-analysis. J Am Heart Assoc 2016; 5: e003231
• 7 Schjerve IE, Tyldum GA, Tjonna AE. et al Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults. Clin Sci (Lond) 2008; 115: 283-293
• 8 Pescatello LS, Buchner DM, Jakicic JM. et al Physical activity to prevent and treat hypertension: A systematic review. Med Sci Sports Exerc 2019; 51: 1314-1323
• 9 Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc 2013; 2: e004473
• 10 Mora-Rodriguez R, Ortega JF, Hamouti N. et al Time-course effects of aerobic interval training and detraining in patients with metabolic syndrome. Nutr Metab Cardiovasc Dis 2014; 24: 792-798
• 11 Morales-Palomo F, Ramirez-Jimenez M, Ortega JF. et al Effects of repeated yearly exposure to exercise-training on blood pressure and metabolic syndrome evolution. J Hypertens 2017; 35: 1992-1999
• 12 Mancia G, Bombelli M, Corrao G. et al Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension 2007; 49: 40-47
• 13 Mora-Rodriguez R, Ortega JF, Morales-Palomo F. et al Weight loss but not gains in cardiorespiratory fitness after exercise-training predicts improved health risk factors in metabolic syndrome. Nutr Metab Cardiovasc Dis 2018; 28: 1267-1274
• 14 Dimeo F, Pagonas N, Seibert F. et al Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension 2012; 60: 653-658
• 15 Alberti KG, Eckel RH, Grundy SM. et al Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645
• 16 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
• 17 Whelton PK, Carey RM, Aronow WS. et al 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension 2018; 71: 1269-1324
• 18 Moreno-Cabanas A, Ortega JF, Morales-Palomo F. et al The use of a graded exercise test may be insufficient to quantify true changes in Vo₂MAX following exercise training in unfit individuals with metabolic syndrome. J Appl Physiol (1985) 2020; 129: 760-767
• 19 Mora-Rodriguez R, Fernandez-Elias VE, Morales-Palomo F. et al Aerobic interval training reduces vascular resistances during submaximal exercise in obese metabolic syndrome individuals. Eur J Appl Physiol 2017; 117: 2065-2073
• 20 O'Brien E, Waeber B, Parati G. et al Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ 2001; 322: 531-536
• 21 Craig CL, Marshall AL, Sjostrom M. et al International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381-1395
• 22 Messerli FH, Bangalore S, Schmieder RE. Wilders principle: pre-treatment value determines post-treatment response. Eur Heart J 2015; 36: 576-579
• 23 Mora-Rodriguez R, Ramirez-Jimenez M, Fernandez-Elias VE. et al Effects of aerobic interval training on arterial stiffness and microvascular function in patients with metabolic syndrome. J Clin Hypertens (Greenwich) 2018; 20: 11-18
• 24 Azevedo LF, Brum PC, Mattos KC. et al Effects of losartan combined with exercise training in spontaneously hypertensive rats. Braz J Med Biol Res 2003; 36: 1595-1603
• 25 Brito LC, Pecanha T, Fecchio RY. et al Morning versus evening aerobic training effects on blood pressure in treated hypertension. Med Sci Sports Exerc 2019; 51: 653-662
• 26 Pescatello LS, Wu Y, Gao S. et al Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review. BMJ Open Sport Exerc Med 2021; 7: e000895
• 27 Baptista LC, Machado-Rodrigues AM, Verissimo MT. et al Exercise training improves functional status in hypertensive older adults under angiotensin converting enzymes inhibitors medication. Exp Gerontol 2018; 109: 82-89
• 28 Guimaraes GV, Cruz LG, Tavares AC. et al Effects of short-term heated water-based exercise training on systemic blood pressure in patients with resistant hypertension: a pilot study. Blood Press Monit 2013; 18: 342-345
• 29 Moreira SR, Cucato GG, Terra DF. et al Acute blood pressure changes are related to chronic effects of resistance exercise in medicated hypertensives elderly women. Clin Physiol Funct Imaging 2016; 36: 242-248
• 30 Di Raimondo D, Tuttolomondo A, Miceli S. et al Aerobic physical activity based on fast walking does not alter blood pressure values in non-dipper essential hypertensives. Int Angiol 2012; 31: 142-149
• 31 Maruf FA, Akinpelu AO, Salako BL. et al Effects of aerobic dance training on blood pressure in individuals with uncontrolled hypertension on two antihypertensive drugs: a randomized clinical trial. J Am Soc Hypertens 2016; 10: 336-345
• 32 Miller ER, Erlinger TP, Young DR. et al Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension 2002; 40: 612-618
• 33 Westhoff TH, Franke N, Schmidt S. et al Beta-blockers do not impair the cardiovascular benefits of endurance training in hypertensives. J Hum Hypertens 2007; 21: 486-493
• 34 Radaelli A, Piepoli M, Adamopoulos S. et al Effects of mild physical activity, atenolol and the combination on ambulatory blood pressure in hypertensive subjects. J Hypertens 1992; 10: 1279-1282
• 35 Clement DL, De Buyzere ML, De Bacquer DA. et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003; 348: 2407-2415