Int J Sports Med 2012; 33(09): 683-690
DOI: 10.1055/s-0032-1304633
Review
© Georg Thieme Verlag KG Stuttgart · New York

Cardiovascular Effects of Exercise in Young Hypertensives

P. Palatini
1   Department of Medicine, University of Padova, Padua, Italy
› Author Affiliations
Further Information

Publication History



accepted after revision 31 January 2012

Publication Date:
04 May 2012 (online)

Abstract

Sedentary habits are largely responsible for the alarming rise in the prevalence of hypertension among young individuals. Regular aerobic exercise has been shown to reduce not only blood pressure (BP) in resting conditions but also BP reactivity to stressors. Much less is known about the long-term effects of physical activity on target organ damage in hypertension. Some studies have documented that exercise is able to decrease rather than increase left ventricular mass and that even competitive athletics have beneficial effects on the heart. In addition, physical activity during leisure has been found to be inversely associated with the progression of subclinical atherosclerosis and to delay aging dependent arterial stiffness. Isolated systolic hypertension in physically active young people is often an innocent clinical condition caused by an elevated pulse pressure amplification and low wave arterial reflection from peripheral sites, due to increased arterial elasticity. The above findings support a strategy of exercise training as an initial approach in the management of young sedentary patients in the early stages of hypertension. Caution should be used in subjects with more severe hypertension and every hypertensive athlete should be thoroughly investigated to exclude target organ damage and coronary artery disease.

 
  • References

  • 1 Adamopoulos S, Parissis J, Kroupis C, Georgiadis M, Karatzas D, Karavolias G, Koniavitou K, Coats AJ, Kremastinos DT. Physical training reduces peripheral markers of inflammation in patients with chronic heart failure. Eur Heart J 2001; 22: 791-797
  • 2 Baglivo HP, Fabregues G, Burrieza H, Esper RC, Talarico M, Esper RJ. Effect of moderate physical training on left ventricular mass in mild hypertensive persons. Hypertension 1990; 15 (Suppl. 01) I-153-I-156
  • 3 Bidlingmeyer I, Burnier M, Bidlingmeyer M, Waeber B, Brunner HR. Isolated office hypertension: a prehypertensive state?. J Hypertens 1996; 14: 327-332
  • 4 Boman K, Gerdts E, Wachtell K, Dahlöf B, Nieminen MS, Olofsson M, Papademetriou V, Devereux RB. Exercise and cardiovascular outcomes in hypertensive patients in relation to structure and function of left ventricular hypertrophy: the LIFE study. Eur J Cardiovasc Prev Rehabil 2009; 16: 242-248
  • 5 Calhoun DA, Mutinga ML, Wyss JM, Oparil S. Muscle sympathetic nervous system activity in black and Caucasian hypertensive subjects. J Hypertens 1994; 12: 1291-1296
  • 6 Casale PN, Devereux RB, Milner M, Zullo G, Harshfield GA, Pickering TG, Laragh JH. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med 1986; 105: 173-178
  • 7 C.O.C.I.S. . Arterial Hypertension. In: Protocolli Cardiologici per il giudizio di idoneità allo sport agonistico 2009. CESI Editor; Rome: 2009: 95-104
  • 8 Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 2005; 46: 667-675
  • 9 Crews DJ, Landers DM. A meta-analytic review of aerobic fitness and reactivity to psychosocial stressors. Med Sci Sports Exerc 1987; 19: S114-S120
  • 10 Dinenno FA, Jones PP, Seals DR, Tanaka H. Age-associated arterial wall thickening is related to elevations in sympathetic activity in healthy humans. Am J Physiol 2000; 278: H1205-H1210
  • 11 Fagard RH, Stolarz K, Kuznetsova T, Kawecka-Jaszcz K. Sympathetic activity, assessed by power spectral analysis of HR variability, in white-coat, masked and sustained hypertension versus true normotension. J Hypertens 2007; 25: 2280-2285
  • 12 Fagard RH. Exercise therapy in hypertensive cardiovascular disease. Prog Cardiovasc Dis 2011; 53: 404-411
  • 13 Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: A rising tide. Hypertension 2004; 44: 398-404
  • 14 Flynn JT. Ambulatory blood pressure monitoring in children: imperfect yet essential. Pediatr Nephrol 2011; 26: 2089-2094
  • 15 Grebla RG, Rodriguez CJ, Borrell LN, Pickering TG. Prevalence and determinants of isolated systolic hypertension among young adults: the 1999-2004 US National Health and Nutrition Examination Survey. J Hypertens 2010; 28: 15-23
  • 16 Hagberg JM. Exercise, fitness and hypertension. In: Bouchard C, Shephard RJ, Stephens T, Sutton JR, Mc Pherson BD. (eds.). Exercise, Fitness and Health. Champaign, Ill: Human Kinetics; 1990: 455-566
  • 17 Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, Schoene N, Schuler G. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med 2000; 342: 454-460
  • 18 Hamer M. Sports and psychological processes. Implications for the primary prevention of coronary heart disease. Sports Med 2006; 36: 829-838
  • 19 Hamer M. The relative influences of fitness and fatness on inflammatory factors. Prev Med 2006; 44: 3-11
  • 20 Hayashi K, Sugawara J, Komine H, Maeda S, Yokoi T. Effects of aerobic exercise training on the stiffness of central and peripheral arteries in middle-aged sedentary men. Jpn J Physiol 2005; 55: 235-239
  • 21 Hayashi K, Sugawara J, Aizawa K, Komine H, Yoshizawa M, Nakamura M, Yokoi T. Arterial elastic property in young endurance and resistance-trained women. Eur J Appl Physiol 2008; 104: 763-768
  • 22 Hinderliter A, Sherwood A, Gullette EC, Babyak M, Waugh R, Georgiades A, Blumenthal JA. Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension. Arch Intern Med 2002; 162: 1333-1339
  • 23 Hull EM, Young SH, Ziegler MG. Aerobic fitness affects cardiovascular and catecholamine responses to stressors. Psychophysiology 1984; 21: 353-360
  • 24 Hulsen HT, Nijdam ME, Bos WJ, Uiterwaal CS, Oren A, Grobbee DE, Bots M. Spurious systolic hypertension in young adults; prevalence of high brachial systolic blood pressure and low central pressure and its determinants. J Hypertens 2006; 24: 1027-1032
  • 25 Indermühle A, Vogel R, Rutz T, Meier P, Seiler C. Myocardial contrast echocardiography for the distinction of hypertrophic cardiomyopathy from athlete’s heart and hypertensive heart disease. Swiss Med Wkly 2009; 139: 691-698
  • 26 Jennings GL, Deakin G, Korner P, Meredith I, Kingwell B, Nelson L. What is the dose-response relationship between exercise training and blood pressure?. Ann Med 1991; 23: 313-318
  • 27 Jennings GL. Noradrenaline spillover and microneurography measurements in patients with primary hypertension. J Hypertens 1998; 16 (Suppl) S35-S38
  • 28 Julius S. The hemodynamic link between insulin resistance and hypertension. J Hypertens 1991; 9: 983-986
  • 29 Julius S, Majahalme S, Palatini P. Antihypertensive treatment of patients with diabetes and hypertension. Am J Hypertens 2001; 14 (11 Pt 2) 310S-316S
  • 30 Kavey RE, Kveselis DA, Atallah N, Smith FC. White coat hypertension in childhood: Evidence for end-organ effect. J Pediatr 2007; 150: 491-497
  • 31 Kjeldsen SE, Zweifler AJ, Petrin J, Weder AB, Julius S. Sympathetic nervous system involvement in essential hypertension: increased platelet noradrenaline coincides with decreased ß-adrenoreceptor responsiveness. Blood Press 1994; 3: 164-171
  • 32 Kohno KH, Matsuoka K, Takenaka K, Miyake Y, Okuda S, Nomura G, Imaizumi T. Depressor effect by exercise training is associated with amelioration of hyperinsulinemia and sympathetic overactivity. Intern Med 2000; 39: 1013-1019
  • 33 Kokkinos PF, Narayan P, Colleran JA, Pittares A, Notargiacomo A, Reda D. Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. N Engl J Med 1995; 333: 1462-1467
  • 34 La Gerche A, Taylor AJ, Prior DL. Athlete’s heart: the potential for multimodality imaging to address the critical remaining questions. JACC Cardiovasc Imaging 2009; 2: 350-363
  • 35 Lakka TA, Laukkanen JA, Rauramaa R, Salonen R, Lakka HM, Kaplan GA, Salonen JT. Cardiorespiratory fitness and the progression of carotid atherosclerosis in middle-aged men. Ann Intern Med 2001; 134: 12-20
  • 36 Lande MB, Carson NL, Roy J, Meagher CC. Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study. Hypertension 2006; 48: 40-44
  • 37 Laterza MC, de Matos LD, Trombetta IC, Braga AM, Roveda F, Alves MJ, Krieger EM, Negrão CE, Rondon MU. Exercise training restores baroreflex sensitivity in never-treated hypertensive patients. Hypertension 2007; 49: 1298-1306
  • 38 Lee J, Cho HS, Park S, Kim WK. Regular exercise produced cardioprotective effects on rat’s heart with hypertension induced by L-NAME administration. Clin Exp Hypertens 2009; 31: 364-375
  • 39 Leon AS, Sanchez OA. Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc 2001; 33 (Suppl. 06) S502-S515
  • 40 Luedemann J, Schminke U, Berger K, Piek M, Willich SN, Döring A, John U, Kessler C. Association between behavior-dependent cardiovascular risk factors and asymptomatic carotid atherosclerosis in a general population. Stroke 2002; 33: 2929-2935
  • 41 Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J, Staessen JA. Prevalence, persistence and clinical significance of masked hypertension in youth. Hypertension 2005; 45: 493-498
  • 42 Madden KM, Lockhart C, Cuff D, Potter TF, Meneilly GS. Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension, and hypercholesterolemia. Diabetes Care 2009; 32: 1531-1535
  • 43 Mahmud A, Feely J. Spurious systolic hypertension of youth: fit young men with elastic arteries. Am J Hypertens 2003; 16: 229-232
  • 44 Mancia G, Grassi G, Giannattasio C, Seravalle G. Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. Hypertension 1999; 34: 724-728
  • 45 Mancia G, Bombelli M, Seravalle G, Grassi G. Diagnosis and management of patients with white-coat and masked hypertension. Nat Rev Cardiol 2011; 8: 686-693
  • 46 Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol 1986; 7: 190-203
  • 47 Matthews KA, Katholi CR, McCreath H, Whooley MA, Williams DR, Zhu S, Markovitz JH. Blood pressure reactivity to psychological stress predicts hypertension in the CARDIA study. Circulation 2004; 110: 74-78
  • 48 Maver J, Strucl M, Accetto R. Autonomic nervous system activity in normotensive subjects with a family history of hypertension. Clin Auton Res 2004; 14: 358-359
  • 49 McCambridge TM, Benjamin HJ, Brenner JS, Cappetta CT, Demorest RA, Gregory AJ, Halstead M, Koutures CG, LaBella CR, Martin S, Rice SG. Athletic participation by children and adolescents who have systemic hypertension. Pediatrics 2010; 125: 1287-1294
  • 50 McEniery CM, Yasmin S, Wallace S, Maki-Petaja K, McDonnell B, Sharman JE, Retallick C, Franklin SS, Brown MJ, Lloyd RC, Cockcroft JR, Wilkinson IB. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension 2005; 46: 221-226
  • 51 Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 2006; 48: 1865-1870
  • 52 Mueller PJ. Exercise training and sympathetic nervous system activity: evidence for physical activity dependent neural plasticity. Clin Exp Pharmacol Physiol 2007; 34: 377-384
  • 53 Neumann SA, Jennings JR, Muldoon MF, Manuck SB. White-coat hypertension and autonomic nervous system dysregulation. Am J Hypertens 2005; 18: 584-588
  • 54 Nordstrom CK, Dwyer KM, Merz CN, Shircore A, Dwyer JH. Leisure time physical activity and early atherosclerosis: the Los Angeles Atherosclerosis Study. Am J Med 2003; 115: 19-25
  • 55 Okada K, Maeda N, Tatsukawa M, Shimizu C, Sawayama Y, Hayashi J. The influence of lifestyle modification on carotid artery intima-media thickness in a suburban Japanese population. Atherosclerosis 2004; 173: 329-337
  • 56 O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson Jr SK. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999; 340: 14-22
  • 57 O’Rourke MF, Vlachopoulos C, Graham RM. Spurious systolic hypertension in youth. Vasc Med 2000; 5: 141-145
  • 58 O’Sullivan SE, Bell C. The effects of exercise and training on human cardiovascular reflex control. J Autonom Nerv Syst 2000; 81: 16-24
  • 59 Otsuki T, Maeda S, Iemitsu M, Saito Y, Tanimura Y, Ajisaka R, Miyauchi T. Vascular endothelium-derived factors and arterial stiffness in strength- and endurance-trained men. Am J Physiol Heart Circ Physiol 2007; 292: H786-H791
  • 60 Palatini P, Graniero G, Mormino P, Nicolosi L, Mos L, Visentin P, Pessina AC. Relation between physical training and ambulatory blood pressure in stage I hypertensive subjects. Results of the HARVEST trial. Circulation 1994; 90: 2870-2876
  • 61 Palatini P, Canali C, Graniero GR, Rossi G, de Toni R, Santonastaso M. Relationship of plasma renin activity with caffeine intake and physical training in mild hypertensive men. HARVEST Study Group. Eur J Epidemiol 1996; 12: 485-491
  • 62 Palatini P, Julius S. Association of tachycardia with morbidity and mortality: pathophysiological considerations. J Hum Hypertens 1997; 11 (S 1) 19-27
  • 63 Palatini P, Majahalme S, Amerena J, Nesbitt S, Vriz O, Michieletto M, Krause L, Julius S. Determinants of left ventricular structure and mass in young subjects with sympathetic over-activity. The Tecumseh Offspring Study. J Hypertens 2000; 18: 769-775
  • 64 Palatini P. Masked hypertension: how can the condition be detected?. Blood Press Monit 2004; 9: 297-299
  • 65 Palatini P, Longo D, Zaetta V, Perkovic D, Garbelotto R, Pessina AC. Evolution of blood pressure and cholesterol in stage 1 hypertension: role of autonomic nervous system activity. J Hypertens 2006; 24: 1375-1381
  • 66 Palatini P, Julius S. The role of cardiac autonomic function in hypertension and cardiovascular disease. Curr Ther Rep 2009; 11: 199-205
  • 67 Palatini P, Visentin P, Dorigatti F, Mos L. Regular physical activity prevents development of left ventricular hypertrophy in hypertension. Eur Heart J 2009; 30: 225-232
  • 68 Palatini P, Bratti P, Palomba D, Saladini F, Zanatta N, Maraglino G. Regular physical activity attenuates the BP response to public speaking and delays the development of hypertension. J Hypertens 2010; 28: 1186-1193
  • 69 Palatini P, Puato M, Rattazzi M, Pauletto P. Effect of regular physical activity on carotid intima-media thickness. Results from a 6-year prospective study in the early stage of hypertension. Blood Press 2011; 20: 37-44
  • 70 Palatini P. Role of elevated heart rate in the development of cardiovascular disease in hypertension. Hypertension 2011; 58: 745-750
  • 71 Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O’Brien E, Ohkubo T, Padfield P, Palatini P, Pickering TG, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens 2010; 24: 779-785
  • 72 Pauletto P, Palatini P, Da Ros S, Pagliara V, Santipolo N, Baccillieri S, Casiglia E, Mormino P, Pessina AC. Factors underlying the increase in carotid intima-media thickness in borderline hypertensives. Arterioscler Thromb Vasc Biol 1999; 19: 1231-1237
  • 73 Pelliccia A. Athlete’s heart and hypertrophic cardiomyopathy. Curr Cardiol Rep 2000; 2: 166-171
  • 74 Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 2004; 35: 533-553
  • 75 Pickering TG, Eguchi K, Kario K. Masked hypertension: a review. Hypertens Res 2007; 30: 479-488
  • 76 Polak JF, Person SD, Wei GS, Godreau A, Jacobs Jr DR, Harrington A, Sidney S, O’Leary DH. Segment-specific associations of carotid intima-media thickness with cardiovascular risk factors: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Stroke 2010; 41: 9-15
  • 77 Puato M, Palatini P, Zanardo M, Dorigatti F, Tirrito C, Rattazzi M, Pauletto P. Increase in carotid intima-media thickness in grade I hypertensive subjects: white-coat versus sustained hypertension. Hypertension 2008; 51: 1300-1305
  • 78 Radák Z, Chung HY, Naito H, Takahashi R, Jung KJ, Kim HJ, Goto S. Age-associated increase in oxidative stress and nuclear factor kappaB activation are attenuated in rat liver by regular exercise. FASEB J 2004; 18: 749-750
  • 79 Rauramaa R, Halonen P, Vaisanen SB, Lakka TA, Schmidt-Trucksäss A, Berg A, Penttilä IM, Rankinen T, Bouchard C. Effects of aerobic physical exercise on inflammation and atherosclerosis in men: the DNASCO Study: a six-year randomized, controlled trial. Ann Intern Med 2004; 140: 1007-1014
  • 80 Reaven PD, Barrett-Connor E, Edelstein S. Relation between leisure-time physical activity and blood pressure in older women. Circulation 1991; 83: 559-565
  • 81 Reid CM, Dart AM, Dewar EM, Jennings GL. Interactions between the effects of exercise and weight loss on risk factors, cardiovascular haemodynamics and left ventricular structure in overweight subjects. J Hypertens 1994; 12: 291-301
  • 82 Rimmele U, Zellweger BC, Marti B, Seiler R, Mohiyeddini C, Ehlert U, Heinrichs M. Trained men show lower cortisol, heart rate and psychological responses to psychosocial stress compared with untrained men. Psychoneuroendocrinology 2007; 32: 627-635
  • 83 Roman MJ, Okin PM, Kizer JR, Lee ET, Howard BV, Devereux RB. Relation of central and brachial blood pressure to left ventricular hypertrophy and geometry: the Strong Heart Study. J Hypertens 2010; 28: 384-388
  • 84 Saladini F, Santonastaso M, Mos L, Benetti E, Zanatta N, Maraglino G, Palatini P. Isolated systolic hypertension of young to middle-age individuals implies a relatively low risk of developing hypertension needing treatment when central blood pressure is low. J Hypertens 2011; 29: 1311-1319
  • 85 Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev 2001; 21: 33-61
  • 86 Schmidt-Trucksass AS, Grathwohl D, Frey I, Schmid A, Boragk R, Upmeier C, Keul J, Huonker M. Relation of leisure-time physical activity to structural and functional arterial properties of the common carotid artery in male subjects. Atherosclerosis 1999; 145: 107-114
  • 87 Staessen J, Amery A, Fagard R. Isolated systolic hypertension in the elderly. J Hypertens 1990; 8: 393-405
  • 88 Steptoe A. Psychophysiological stress reactivity and hypertension. Hypertension 2008; 52: 220-221
  • 89 Thompson PD, Buchner D, Piña IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK. AHA Scientific Statement. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation 2003; 107: 3109-3116
  • 90 Urbina EM, Srinivasan SR, Tang R, Bond MG, Kieltyka L, Berenson GS. Impact of multiple coronary risk factors on the intima-media thickness of different segments of carotid artery in healthy young adults. Am J Cardiol 2002; 90: 953-958
  • 91 Urbina E. Noninvasive assessment of target organ injury in children with the metabolic syndrome. J Cardiometab Syndr 2006; 1: 277-281
  • 92 Verdecchia P, Reboldi GP, Angeli F, Schillaci G, Schwartz JE, Pickering TG, Imai Y, Ohkubo T, Kario K. Short- and long-term incidence of stroke in white-coat hypertension. Hypertension 2005; 45: 203-208
  • 93 Wang KL, Cheng HM, Chuang SY, Spurgeon HA, Ting CT, Lakatta EG, Yin FC, Chou P, Chen CH. Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality?. J Hypertens 2009; 27: 461-467
  • 94 Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002; 136: 493-503
  • 95 White WB. Ambulatory blood pressure monitoring in clinical practice. N Engl J Med 2003; 348: 2377-2378
  • 96 Zanettini R, Bettega D, Agostoni O, Ballestra B, del Rosso G, di Michele R, Mannucci PM. Exercise training in mild hypertension: effects on blood pressure, left ventricular mass and coagulation factor VII and fibrinogen. Cardiology 1997; 88: 468-473
  • 97 Zucker IH, Patel KP, Schultz HD, Li YF, Wang W, Pliquett RU. Exercise training and sympathetic regulation in experimental heart failure. Exerc Sport Sci Rev 2004; 32: 107-111