title: Effects of exercise on central aortic pressure before and after treatment with renin-angiotensin system blockade in patients with hypertension.
abstract: BACKGROUND
  Brachial blood pressure increases with exercise and an excessive rise predicts increased cardiovascular risk. Measurement of brachial blood pressure alone may exaggerate the true blood pressure elevation due to exercise-induced change to pressure amplification. Whether blood pressure-lowering treatment modulates pressure amplification during exercise is unknown.
  
  
  METHODS
  Thirty-two participants with stage 1-2 hypertension (mean age 59.2 years) received eight weeks' blood pressure lowering with either aliskiren (300mg, n=16) or valsartan (320mg, n=16). Brachial and central aortic pressure (CASP) were measured non-invasively during treadmill exercise (Bruce protocol) at baseline, after eight weeks' treatment and 48 hours following treatment withdrawal.
  
  
  RESULTS
  The rise in brachial blood pressure with exercise exceeded the rise in CASP, indicative of enhanced pressure amplification. Eight weeks' treatment elicited similar reductions in brachial blood pressure and CASP which did not differ between rest and peak exercise (p>0.05). The exercise-induced increase in systolic pressure amplification did not differ between baseline and following eight weeks' treatment (p>0.05). These effects remained unchanged following treatment withdrawal.
  
  
  CONCLUSIONS
  Blood pressure lowering does not directly influence the relationship between aortic and brachial pressure either at rest or during exercise in patients with hypertension, other than through proportionate lowering of both pressures. These effects remained unchanged 48 hours after a simulated missed medication dose.
authors: University College London and the National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK.
authors: Peter S
authors: PS
authors: Lacy
authors: Novartis Pharma AG, Basel, Switzerland.
authors: Patrick
authors: P
authors: Brunel
authors: Novartis Pharma AG, Basel, Switzerland.
authors: Fabio
authors: F
authors: Baschiera
authors: Novartis Pharma AG, Basel, Switzerland.
authors: Jaco
authors: J
authors: Botha
authors: University College London and the National Institute for Health Research University College London Hospitals Biomedical Research Centre, UK bryan.williams@ucl.ac.uk.
authors: Bryan
authors: B
authors: Williams
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012146:Rest; D013599:Systole / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension; angiotensin receptor blocker; central aortic blood pressure; direct renin inhibitor; exercise test