Sports in Hypertension of the Elderly

April 14, 2006 updated by: Charite University, Berlin, Germany

The Impact of Pulse Pressure on Cardiovascular Effects of Exercise Training in Hypertension of the Elderly

The present work examines the impact of pulse pressure as a footprint of vascular ageing on cardiovascular benefits of endurance training in elderly hypertensives. METHODS AND RESULTS: 54 patients ≥ 60 years with antihypertensive treatment and diastolic 24h-ambulatory blood pressure (ABP) ≤ 90 mmHg are randomly assigned to sedentary activity or a heart-rate controlled 12 week exercise program, consisting of walking on a treadmill at target lactate concentrations of 2.5 ± 0.5 mmol/l. 24h-ambulatory blood pressure, physical performance, arterial elasticity, endothelium-derived vasodilation, quality of life, and weight are assessed at baseline and follow-up.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Based on previous studies on sports in hypertension, we expected the intervention to result in a decrease of systolic 24h-ambulatory BP (systolic ABP) of at least 6 mm Hg in the training group with no changes in the control group.16,17 This difference was considered to be clinically relevant. A sample size of 23 in each group has 80% power to detect a difference in means of 6 mmHg assuming that the common standard deviation is 7 mmHg, a baseline systolic ABP of 140 mmHg and a two-sided p<0.05. We estimated the drop-out rate to be about 15% leading to a sample size of 27 patients per group.

Patients are recruited from our hypertension outpatient clinic. Inclusion criteria are current antihypertensive treatment, diastolic ABP ≤ 90 mmHg, age of ≥ 60 years. Prior to the exercise program, cardiac function is examined by ECG and echocardiogram. Exclusion criteria are regular engagement in physical exercise training in the past 12 weeks prior to inclusion in the study, symptomatic peripheral arterial occlusive disease, aortic insufficiency or stenosis > stage I, hypertrophic obstructive cardiomyopathy (HOCM), congestive heart failure (> NYHA II), uncontrolled cardiac arrhythmia with haemodynamic relevance, systolic office BP ≥ 180 mmHg, signs of acute ischemia in exercise ECG, change of antihypertensive medication in the past 6 weeks prior to inclusion in the study or during follow-up period. According to these criteria 54 patients are enrolled and randomized to exercise and control group.

Physical performance is assessed using a modified Bruce-protocol. Arterial elasticity is measured by pulse-wave analysis of the radial artery. Endothelium-dependent vasodilation is assessed sonographically by flow-mediated vasodilation. 24h-ABP monitoring is performed using Spacelabs 90207 monitors. The follow-up BP and vascular measurements of the training group are conducted within 2 days after the last training session.

The training program, consisting of walking on a treadmill according to an interval-training pattern, is carried out 3 times weekly for 12 weeks. If patients miss a training session, the program is prolonged until 36 workouts are carried out. The initial duration of training sessions is 30 minutes. During the first week, training consists of 5 workloads of 3 min; between workloads patients walk with half-speed for 3 min. Exercise duration is gradually increased to 4 x 5 min a day in the second week, 3 x 8 min in the third, 3 x 10 min in the fourth and 2 x 15 min in the fifth week. In the sixth and further weeks, exercise is progressively increased to 30, 32 and 36 min and is carried out without interruption. Training intensity corresponds to the speed necessary to reach a lactate concentration of 2.5 ± 0.5 mmol/l in capillary blood slightly above the aerobic threshold. Heart rate during training is controlled by a heart-rate monitor. As lactate concentration sinks below 2.0 mmol/l or exercise heart rate decreases by more than 5/min as a result of training adaptation, treadmill speed is increased by 0.5 km/h or elevation is increased by 3% to maintain training intensity. We have previously shown that this training protocol leads to a substantial increase of physical performance in short time. During training patients are continuously supervised by a physician.

Study Type

Interventional

Enrollment

54

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Germany
      • Berlin, Germany, 12200
        • Charite, Campus Benjamin Franklin

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

61 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

≥ 60 years antihypertensive treatment diastolic 24h-ambulatory blood pressure (ABP) ≤ 90 mmHg

Exclusion Criteria:

regular engagement in physical exercise training in the past 12 weeks symptomatic peripheral arterial occlusive disease aortic insufficiency or stenosis > stage I hypertrophic obstructive cardiomyopathy (HOCM) congestive heart failure (> NYHA II) uncontrolled cardiac arrhythmia with haemodynamic relevance systolic office BP ≥ 180 mmHg signs of acute ischemia in exercise ECG change of antihypertensive medication in the past 6 weeks or during follow-up period

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Decrease of 24h-ambulatory systolic blood pressure

Secondary Outcome Measures

Outcome Measure
change of diastolic blood pressure
change of pulse pressure
change of arterial compliance
change of endothelium-derived vasodilation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Charite University, Berlin, Germany

Investigators

  • Principal Investigator: Timm H Westhoff, MD, Charité, Campus Benjamin Franklin, Medizinische Klinik IV, Berlin, Germany

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

February 1, 2005

Study Completion

October 1, 2005

Study Registration Dates

First Submitted

April 14, 2006

First Submitted That Met QC Criteria

April 14, 2006

First Posted (Estimate)

April 18, 2006

Study Record Updates

Last Update Posted (Estimate)

April 18, 2006

Last Update Submitted That Met QC Criteria

April 14, 2006

Last Verified

March 1, 2005

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • EA4/019/2004

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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