Effects of Different Exercise Training Programs on Short-term Blood Pressure Variability and Atrial Function in Hypertension

This is a prospective randomized two- arms, single-blinded, parallel trial evaluating the effects of two different exercise training modalities on atrial function, assessed by speckle-tracking echocardiography, and shortt-term blood pressure variability in hypertensive patients with coronary artery disease. First endpoint will be: between-groups comparison of changes in short-term BP variability. Secondary endpoints will be: exercise-induced changes in peak atrial longitudinal strain (PALS); diastolic function, left ventricular strain, 24/h blood pressure values, exercise tolerance. We will include 50 patient with hypertension and underlying coronary artery disease, evaluated for entering a cardiac rehabilitation program. Patients that will be judged suitable for the study will be randomized, with a 1:1 ratio, to interval combined training (ICT) or aerobic continuous combined training (CCT) both including aerobic and resistance exercises. Each patient will undergo three visits. At visit 1 in which patients will perform a first echocardiography with evaluation of the acoustic window and a cardiopulmonary test (for excluding myocardial ischemia and for establishing the training intensity); visit 2- acute evaluation- :patients will undergo an echocardiographic assessment before and within 30 minutes after a single exercise session (alternatively interval or combined training according to the randomization code). Visit 3: at 12 weeks all patient will perform a final echocardiography evaluation, a 24/h blood pressure monitoring and a second cardiopulmonary test. Patients of both groups will exercise three times/week for 12 weeks. Each exercise session will last 80 minutes

Inclusion criteria

• Hypertension;
• Coronary artery disease;
• Age over 45 years;
• Male gender

Exclusion criteria

• Secondary hypertension;
• Significant heart valve diseases;
• Hypertrophic cardiomyopathy;
• Signs and/or symptoms of myocardial ischemia during an ergometric test;
• Uncontrolled arrhythmia;
• Neurological and or orthopedic conditions contraindicating or limiting exercises;
• Significant chronic obstructive pulmonary disease (FEV1 <50%),
• Symptomatic peripheral arterial disease