The cardiovascular effects of upper-limb aerobic exercise in hypertensive patients

Background Aerobic exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Several hypertensive patients, however, are limited by musculoskeletal complaints or vascular occlusive disease from lower-limb exercise such as jogging or cycling. In the present randomized-controlled study, we evaluate whether an aerobic arm-cycling program provides a measurable cardiovascular benefit. Methods Twenty-four probands were randomly assigned to sedentary activity or a heart rate controlled 12 week exercise program, consisting of arm-cycling at target lactate concentrations of 2.0 +/- 0.5 mmol/l. Endothelial function was assessed by flow-mediated dilation of the brachial artery. Augmentation index and large/small artery compliance (C-1 and C-2) were measured by computerized pulse-wave analysis of the radial artery. Results The exercise program led to a significant reduction in systolic (134.0 +/- 20.0 to 127.0 +/-16.4 mmHg; P=0.03) and diastolic blood pressure (73.0 +/- 21.6 to 67.1 +/- 8.2 mmHg; P=0.02) accompanied by a significant improvement in C-2 (3.5 +/- 1.6 to 4.8 +/- 2.0 ml/mmHg x 100; P=0.004). Flow-mediated dilation, augmentation index, and C-2 were not significantly affected (P>0.05). Physical performance as derived from lactate and heart rate curves of lower-limb stress tests was unchanged, whereas maximal workload in an upper-limb ergometry significantly increased (P=0.005). Blood pressure and vascular parameters remained unchanged in the control group. Conclusion Regular arm aerobic exercise leads to a marked reduction in systolic and diastolic blood pressures and an improvement in small artery compliance. Arm-cycling is a reasonable option for hypertensive patients who want to support blood pressure control by sports despite having coxarthrosis, gonarthrosis, or intermittent claudication.