Effect of exercise on ambulatory supine blood pressure in patients with resistant hypertension and peripheral artery disease with claudication

This retrospective study examines the effects of a 6-month home-based walking low-intensity interval training (LIIT) program on systolic blood pressure (SBP) in a cohort of patients with peripheral artery disease (PAD) and controlled (HT) or resistant hypertension (RH). From a cohort of 1011 PAD patients who completed the 6-month LIIT program, the data of those with hypertension without intercurrent therapy changes were analyzed. LIIT included eight bouts of in-home interval walking (walk:rest ratio of 1:1) at slow speed, progressively increased speed, and was maintained by a metronome. Office blood pressure was measured at baseline and after 5, 12, and 26 weeks by the same operator, with the patient lying in supine position. The ankle‒brachial index (ABI) and performance of the 6-min walking test (6MWD) were also assessed. Program updates were performed during visits, and adherence to exercise was verified and classified into tertiles according to the sessions executed. Among the 793 patients studied, 597 had HT, and 196 had RH. All patients safely completed the LIIT sessions (84 ± 11%). Both subgroups had significantly decreased SBP (RH: - 13 ± 15 mmHg; HT: - 10 ± 14 mmHg; between-group p = 0.052). Significant group-per-factor interactions (p < 0.001) for the decrease in the SBP were obtained according to adherence to exercise in both the RH and HT groups. The ABI of the worst limb significantly increased (RH: + 0.10 ± 0.13; HT: + 0.09 ± 0.12), as did the 6MWD (RH: + 35 ± 44 m; HT: + 39 ± 45 m). In PAD patients with claudication and hypertension, structured low-intensity in-home exercise, in addition to improving mobility, significantly reduced SBP values in RH patients, reinforcing the effect of medical therapy.