Hypertension is a strong risk factor for cardiovascular disease (CVD) and causes death and disability in our rapidly expanding older population. Although several health organizations recommend exercise for milder forms of hypertension, few older persons were subjects in the research upon which these recommendations are based. Because the hemodynamic causes of hypertension and the cardiovascular (CV) responses to exercise in older persons may differ from those of younger persons, the existing research on exercise and BP may not apply to older persons. Therefore, the specific aim of this study is to determine whether exercise training reduces BP in men and women, ages 55 to 75 years, with high normal BP or mild hypertension. Subjects will be randomized to 6- months of exercise training or to a control group. The type, intensity, duration, and frequency of exercise will follow the American College of Sports Medicine's guidelines for exercise and hypertension. Because so few older women were included in prior exercise studies, an equal number of older men and women will be enrolled to examine gender differences in the response to exercise training. We will also determine whether exercise mitigates detrimental changes in central and peripheral parameters of CV structure and function seen in hypertensive individuals. These parameters are left ventricular (LV) mass, LV filling rate, endothelial-mediated vasoreactivity, and vascular stiffness which will be assessed using a new generation of noninvasive techniques including high resolution ultrasound, doppler echocardiography, and high resolution magnetic resonance imaging (MRI). A finding that changes in BP are explained by any or some of these CV parameters would identify new potential pathophysiological mechanisms by which exercise reduces BP and improves CV health. Because exercise improves fitness and may also improve body composition and regional fat distribution, the associations of change in these parameters to BP change will be analyzed. Dual energy x-ray absorptiometry (DEXA) and MRI will assess total and regional body composition. A follow-up 6 months after treatment will address the practical issues of whether subjects will continue to exercise on their own, residual effects on BP, and if antihypertensive medications can be avoided. The results from this study will expand the scientific knowledge that defines exercise guidelines for older men and women at risk for CVD because of their BP levels.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL059164-03
Application #
6389767
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Cooper, Lawton S
Project Start
1999-04-01
Project End
2003-03-31
Budget Start
2001-04-01
Budget End
2002-03-31
Support Year
3
Fiscal Year
2001
Total Cost
$457,285
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Barone, B B; Wang, N-Y; Bacher, A C et al. (2009) Decreased exercise blood pressure in older adults after exercise training: contributions of increased fitness and decreased fatness. Br J Sports Med 43:52-6
Stewart, K J; Ouyang, P; Bacher, A C et al. (2006) Exercise effects on cardiac size and left ventricular diastolic function: relationships to changes in fitness, fatness, blood pressure and insulin resistance. Heart 92:893-8
Stewart, Kerry J; Bacher, Anita C; Hees, Paul S et al. (2005) Exercise effects on bone mineral density relationships to changes in fitness and fatness. Am J Prev Med 28:453-60
Stewart, Kerry J; Bacher, Anita C; Turner, Katherine et al. (2005) Exercise and risk factors associated with metabolic syndrome in older adults. Am J Prev Med 28:9-18
Lim, Jimmy G; McAveney, Timothy J; Fleg, Jerome L et al. (2005) Oxygen pulse during exercise is related to resting systolic and diastolic left ventricular function in older persons with mild hypertension. Am Heart J 150:941-6
Lim, Jimmy G; Shapiro, Edward P; Vaidya, Dhananjay et al. (2005) Sex differences in left ventricular function in older persons with mild hypertension. Am Heart J 150:934-40
Stewart, Kerry J; Bacher, Anita C; Turner, Katherine L et al. (2005) Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med 165:756-62
Stewart, Kerry J; Sung, Jidong; Silber, Harry A et al. (2004) Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens 17:314-20
Ouyang, Pamela; Sung, Jidong; Kelemen, Mark D et al. (2004) Relationships of insulin sensitivity with fatness and fitness and in older men and women. J Womens Health (Larchmt) 13:177-85
Stewart, Kerry J; DeRegis, James R; Turner, Katherine L et al. (2003) Usefulness of anthropometrics and dual-energy x-ray absorptiometry for estimating abdominal obesity measured by magnetic resonance imaging in older men and women. J Cardiopulm Rehabil 23:109-14

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