Beta-blockers do not impair the cardiovascular benefits of endurance training in hypertensives

Aerobic physical exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Beta-blockade interacts with heart rate, sympathetic tone, maximal workload and local lactate production. In the present randomized- controlled study, we compared the cardiovascular effects of an endurance training programme in elderly hypertensives with or without beta-blockers and developed a first approach to determine a lactate-based training heart rate in presence of beta-blockade. Fifty-two patients (23 with beta-blocker, 29 without beta-blocker) >= 60 years with systolic 24-h ambulatory blood pressure (ABP) >= 140 mm Hg and/or antihypertensive treatment were randomly assigned to sedentary activity or a heart-rate controlled 12-week treadmill exercise programme (lactate 2.0 mmol/l). In the exercise group, the training significantly decreased systolic and diastolic 24-h ABP, blood pressure on exertion (100 W) and increased endothelium-dependent vasodilation (flow-mediated vasodilation, FMD) and physical performance both in the presence and absence of beta-blockade (P < 0.05 each). The extent of ABP reduction did not significantly differ in the presence or absence of beta-blockade (D systolic ABP 10.6 +/- 10.5 vs 10.6 +/- 8.8 mm Hg, D diastolic ABP 5.7 +/- 8.6 vs 5.8 +/- 4.0 mm Hg). Mean training heart rate was significantly lower in the patients on beta-blockers (97.2 +/- 7.7 vs 118.3 +/- 7.5/min, P < 0.001). Lactate-based aerobic endurance training evokes comparable cardiovascular benefits in the presence and absence of beta-blockade including a marked improvement of endothelial function. In the present study, target training heart rate with beta-blockers is about 18% lower than without.