Can postexercise hypotension also be observed in African and Asian populations: a systematic review and meta-analysis of randomized controlled trials.

Worldwide, raised blood pressure (BP) or hypertension is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African origin populations. Post-exercise hypotension (PEH), defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. We systematically summarized the acute effects of a single bout of aerobic exercise on BP in a population of African or Asian origin. We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or hypertension published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random-effect models fitted to estimate effect sizes. We identified 10 aerobic exercise trials performed in individuals of Asian origin (n = 136; mean age: 29.51 (21.2-69) years: 78% male; baseline systolic BP/diastolic BP: 118.9 ± 9.64/68.9 ± 2.69 mmHg) and 11 aerobic exercise trials involving individuals of African origin (n = 157; mean age: 41.05 (29.9-49) years; 59% male; baseline systolic BP/diastolic BP: 134.5 ± 8.65 mmHg/82.2 ± 3.24 mmHg). Non-significant reductions in office systolic BP and diastolic BP at 30 min post exercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28/-1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 min post exercise (-2.80 [-7.90, 2.28], p = 0.27/-1.95, [-5.66, 1.75], p = 0.3) were observed compared to the control intervention. No statistically significant differences were found between both ethnic groups (p > 0.05). Ambulatory BP was reported only in a few African groups. No effect was found on 24h-systolic BP post exercise, but 24h-diastolic BP was statistically significantly reduced (-1.89 [-3.47, -0.31] mmHg, p < 0.01) after a bout of aerobic exercise compared to the control intervention. The available evidence is insufficient to recommend a single session of aerobic exercise as an efficient tool to lower BP in African and Asian populations. Though, the paucity of data in non-Caucasian populations underscores the need for additional efforts to establish the efficacy of single bouts of exercise, including isometric and dynamic resistance exercise, as a potential non-pharmacological adjunct to help lowering BP in the daily life of descendants of Asian or African origin.

ST elevation in recovery post exercise with normal coronary arteries.

We present the case of a 45-year-old healthy man who successfully completed three stages of the Bruce protocol but developed inferolateral ST segment elevation in the recovery phase. The ECG change was associated with a marked drop in blood pressure. He underwent emergency coronary angiography which revealed normal coronary arteries. It is likely that post-exercise hypotension triggered coronary spasm which caused the ST segment elevation. Alternatively, coronary spasm may have been the primary event, inducing sufficient myocardial ischaemia to cause a marked drop in blood pressure. Exercise tolerance testing is often a reliable test to rule out reversible myocardial ischaemia. While the physician is focused on ischaemic changes or rhythm abnormalities developing during the exercise phase, the recovery period is just as important and requires as much vigilance. Coronary vasospasm can result in significant ST changes and haemodynamic compromise at any point during the test, and the ECG traces can be indistinguishable from a classic ST elevation myocardial infarction, as in the present case.

Efecto hipotensor agudo del ejercicio de oclusión vascular sobre adultos mayores / Acute hypotensor effect of the vascular occlusion exercise on elderly adults

Objetivo: El objetivo de este estudio fue evaluar la respuesta cardíaca aguda después de realizar una sesión de ejercicio con oclusión vascular en adultos mayores (AM). Sujetos y método: 22 participantes voluntarios, fueron sometidos al protocolo experimental de ejercicio dinámico de prensión manual con un 30% de presión de oclusión (PO), después de registrar los valores basales y en reposo de presión arterial sistólica (PAS), presión arterial diastólica (PAD) y frecuencia cardíaca (FC). Evaluadas en condiciones basales y entre los 5 y 30 minutos post-oclusión. Resultados: Al finalizar el protocolo se observó una reducción significativa en la PAS y FC a los 15', 20' y 25' (p<0,05) y para la PAD a los 10' y 20' (p<0,05). Conclusión: El efecto agudo del ejercicio con oclusión vascular genera una reducción significativa de PAS, PAD y FC hasta 25 minutos post-oclusión, en los AM analizados

The objective of this study was to evaluate the acute cardiac response after performing an exercise session with vascular occlusion in elderly adults (EA). Twenty-two volunteer participants underwent the experimental protocol of dynamic manual grip exercise with 30% occlusion pressure (OP), after recording the baseline values and resting systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). All measures were taken in basal conditions and between 5 and 30 minutes' post-occlusion. At the end of the protocol, there was a significant reduction in SBP and HR at 15 ', 20' and 25 '(p <0.05) and for DBP at 10' and 20 '(p <0.05).). The acute effect of exercise with vascular occlusion generates a significant reduction of SBP, Basal Diastolic Pressure (BDP) and HR up to 25 minutes' post-occlusion, in the EA analyzed

Efecto agudo hipotensivo de la combinación de ejercicios basados en caminar y de resistencia en mujeres mayores de 65 años no institucionalizadas / Hypotensive acute effect of a combined resistance and walk-based exercise among over 65-year old community-dwelling women

Objective. The aim of this study was to test the effects on blood pressure of a single bout of low-intensity resistance exercise combined with moderate aerobic walk-based exercise performed by active, controlled hypertensive elderly women. Method. Forty-two participants were randomized in two types of sessions: exercise session (n = 21), that performed a single bout of combined exercise and control session (n = 21) that keep in rest during the bout. Pre-session, post-session and post-24-hour systolic, diastolic and mean pressure values were evaluated and compared between groups. Results. Statistical significant reductions were achieved just after the performed bout (7% of reduction) and 24 hours after the bout (9% of reduction) on the diastolic blood pressure values in the exercise session group. Conclusions. In this population, a single bout of combined session is feasible and safe and has a hypotensive effect on diastolic blood pressure in both immediately and after 24 hours post exercise(AU)

Objetivo. Comprobar el efecto hipotensivo que una sola sesión de ejercicio combinado puede tener sobre la presión arterial de mujeres hipertensas controladas y mayores de 65 años. Método. Cuarenta y dos participantes fueron asignadas aleatoriamente a dos grupos de sesiones: sesión de entrenamiento (n = 21) que realizó una sola sesión de ejercicios combinados y sesión control (n = 21) que mantuvo reposo durante la misma. Antes, después y tras 24 horas desde la sesión, los valores de presión sistólica, diastólica y medios fueron evaluados y comparados entre grupos. Resultados. Se encontraron diferencias estadísticamente significativas entre los grupos tras la realización de la sesión (7% de reducción) y tras 24 horas (9% de reducción) en los valores de presión arterial diastólica media del grupo experimental. Conclusiones. En esta población una sola sesión de ejercicio combinado se propone como aplicable y segura y tiene un efecto hipotensivo en la presión diastólica tanto inmediatamente después como pasadas 24 horas de la intervención(AU)

Resistance exercise training does not affect postexercise hypotension and wave reflection in women with fibromyalgia.

The purpose of this study was to assess the effects of resistance exercise training (RET) on aortic wave reflection and hemodynamics during recovery from acute resistance exercise in women with fibromyalgia (FM) and healthy women (HW). Nine women with FM (aged 42 ± 5 years; mean ± SD) and 14 HW (aged 45 ± 5 years) completed testing at baseline and after 12 weeks of whole-body RET that consisted of 3 sets of 5 exercises. Heart rate (HR), digital blood pressure (BP, plethysmography), aortic BP, and wave reflection (radial tonometry) were assessed before and 20 min after acute leg resistance exercise. Aortic and digital diastolic blood pressure (DBP) were significantly decreased (p < 0.05) and aortic and digital pulse pressures (PP) were significantly increased (p < 0.05) after acute exercise before RET. Acute resistance exercise had no effect on HR, wave reflection (augmentation index and reflection time), digital, or aortic systolic BP. RET improved muscle strength without affecting acute DBP and PP responses. Acute resistance exercise produces postexercise diastolic hypotension without affecting systolic blood pressure, HR, and wave reflection responses in women with and without FM. RET does not alter resting and postexercise hemodynamics and aortic wave reflection in premenopausal women.