title: Lifestyle change diminishes a hypertensive response to exercise in type 2 diabetes.
abstract: OBJECTIVE
  A hypertensive response to exercise (HRE) is common in patients with type 2 diabetes and is associated with increased left ventricular (LV) mass and mortality. This study aimed to determine whether lifestyle modification would improve exercise blood pressure (BP) and reduce LV mass in patients with type 2 diabetes.
  
  
  METHODS
  One hundred and eighty-five patients with type 2 diabetes were randomized to 1 yr of lifestyle intervention (n=97, mean ± SD age=54.7 ± 11.3 yr, 51% men) or usual care (control; n=88, age=53.8 ± 8.1 yr, 61% men). Brachial BP was measured at rest and during a graded maximal exercise test at baseline and 1 yr. Patients also underwent two-dimensional echocardiography to determine LV dimensions. A subgroup of 61 patients had resting and exercise central BP estimated from radial tonometry. An HRE was defined as a maximal exercise systolic BP of ≥210 mm Hg for men and ≥190 mm Hg for women.
  
  
  RESULTS
  At study entry, there were 101 patients (55%) with an HRE (n=51 controls). Compared with controls, lifestyle intervention significantly reduced the propensity to develop an HRE in those participants who did not have HRE at baseline (29.8% vs 59.5%, P=0.006). However, absolute values of exercise and resting (brachial and central) BP and LV mass were not significantly changed (all P values >0.05). There were significant (all P values <0.05) improvements in V˙O2max, body mass index, plasma glucose, insulin resistance, and HDL cholesterol after lifestyle intervention compared with control.
  
  
  CONCLUSIONS
  Lifestyle intervention significantly attenuates the development of an HRE but does not reduce cardiac size after 1 yr in patients with type 2 diabetes.
authors.affiliation: Menzies Research Institute, Hobart, Australia.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Schultz
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Hordern
authors.forename: Rodel
authors.initials: R
authors.lastname: Leano
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Coombes
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.forename: James E
authors.initials: JE
authors.lastname: Sharman
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004452:Echocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D040242:Risk Reduction Behavior; D055815:Young Adult