Physical Activity and the Acute Hemodynamic Response to ACE Inhibition in Hypertension

Stephen A Maris; Kayla M Meyer; Gillian Murray; Jonathan S Williams

doi:10.1177/1559827620935367

Physical Activity and the Acute Hemodynamic Response to ACE Inhibition in Hypertension

Am J Lifestyle Med. 2020 Jul 7;16(4):538-545. doi: 10.1177/1559827620935367. eCollection 2022 Jul-Aug.

Authors

Stephen A Maris^{1

2}, Kayla M Meyer^{1

2}, Gillian Murray^{1

2}, Jonathan S Williams^{1

2}

Affiliations

¹ Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts (SAM, KMM, GM, JSW).
² Department of Exercise Science and Athletic Training, Springfield College, Springfield, Massachusetts (SAM).

Abstract

Introduction. Physical activity (PA) can reduce blood pressure (BP) in hypertensives through possibly interacting with the renin-angiotensin-aldosterone system (RAAS). We conducted a nested-cohort analysis to determine if self-reported PA was associated with BP responsiveness to acute angiotensin converting enzyme inhibition (ACEi). Methods. Data were extracted from the HyperPATH dataset, a cohort designed to identify mechanisms of cardiometabolic risk. Hypertensives that completed a self-assessed PA questionnaire, hormonal assessments (aldosterone [ALDO]), and BP to a single dose of an ACEi (captopril, 25 mg) were included. All participants (n = 144) were studied on a controlled diet for 7 days. PA was recorded as no PA, or little, moderate, or high amounts of exercise. Analyses were adjusted for age, sex, race, and body mass index. Results. Individuals who reported high amounts of PA displayed a greater BP lowering effect from ACEi compared to those who reported moderate (-14.8 ± 8.1 vs -8.4 ± 9.9 mm Hg, P < .01) or no additional PA (-14.8 ± 8.1 vs -2.6 ± 9.9 mm Hg, P < .001). Exploratory analyses indicated high amounts of PA were associated with a reduced heart rate (54 ± 8 vs 66 ± 10 bpm, P < .001) and blunted ALDO (β = 0.44, 95% confidence interval = 0.19-0.70). Conclusions. Higher self-reported PA was associated with an augmented BP lowering effect to acute ACEi in hypertensive patients.

Keywords: ACE inhibitor; blood pressure; exercise; renin-angiotensin-aldosterone system.