Research Article
Effects of aerobic dance training on blood pressure in individuals with uncontrolled hypertension on two antihypertensive drugs: a randomized clinical trial

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Abstract

There is a dearth of reports on possible additive blood pressure (BP)–reducing effect of aerobic exercise on antihypertensive drug in humans. This study investigated the additive BP-reducing effect of aerobic exercise on BP in individuals with uncontrolled hypertension. In this 12-week double-blind study, 120 new-diagnosed individuals with mild-to-moderate hypertension were randomized to receive coamilozide + 5/10 mg of amlodipine + aerobic dance or coamilozide + 5/10 mg of amlodipine alone. Forty-five and 43 participants in exercise and control groups, respectively, completed the 12-week intervention. Addition of aerobic exercise to antihypertensive drug therapy significantly reduced systolic BP (7.1 mm Hg [95% confidence interval: 5.0, 9.3]; P < .001) and diastolic BP (1.7 mm Hg [95% confidence interval: 0.4, 3.0]; P = .009) at 12 weeks. BP control rate differed significantly between exercise (53.9%) and control (35.3%) groups, P < .001. Postintervention, proportion of participants in exercise group who had their number of antihypertensive drug reduced to one (20.3%) differed from that in control group (11.1%); (χ2 = 11.0; P = .001). Combination of aerobic dance and antihypertensive drugs reduces number of antihypertensive drugs needed to achieve BP control and enhances BP control in individuals with hypertension on two antihypertensive drugs.

Introduction

Hypertension is the leading risk factor for cardiovascular disease mortality worldwide.1 About 26% (972 million) of the world adult population was estimated to have hypertension.2 Two-thirds of this hypertension population were from economically developing countries.2 Uncontrolled hypertension is a major public health concern.3 It is associated with various degrees of target organ damages.4

Medication adherence is a major factor in hypertension management.3 One of the factors identified to contribute to medication adherence is number of daily antihypertensive tablets >2.5 Indeed, no less than 75% of individuals with hypertension require more than one antihypertensive agent to reach the recommended blood pressure (BP) goal.6, 7 Any individual with hypertension who either discontinues his medications or is nonadherent to the prescribed drug therapy is at risk of developing cardiovascular complications through uncontrolled BP.8 Thus, the best adherence to drug therapy is achieved with fewer drugs prescribed with the least possible frequency.9 In addition, multiple pharmacological treatment strategy is beset with problems of adverse drug reactions and interactions, unfavorable effects on comorbid conditions, and financial burden on the patient.10 Thus, a nonpharmacological antihypertensive management may be required as adjunct to antihypertensive drug therapy such that adequate BP control is attained with the minimum number of drugs possible.

Exercise is widely recommended as one of the key nonpharmacological agents to manage hypertension.11 A recent meta-analysis indicated that aerobic exercise reduced systolic BP by 6.9 mm Hg and diastolic BP by 4.9 mm Hg.12 These modest reductions in BP are clinically important in reducing risks of coronary artery disease, stroke, and all-cause mortality.13 Two previous studies had investigated the additive effects of antihypertensive drug on BP-reducing effects of physical exercise in individuals with moderate hypertension.14, 15 Furthermore, two laboratory studies investigated the additive effects of physical exercise on BP-reducing effects of antihypertensive drug in spontaneously hypertensive rats.16, 17 To our knowledge, no human study has investigated the possible additive BP-lowering effect of physical exercise on antihypertensive drug in individuals with hypertension. However, we have reported no significant additive BP-reducing effects of aerobic exercise on antihypertensive drugs in a pilot study.18 The current report presents findings from an adequately sampled study on effect of aerobic dance training on BP in individuals with uncontrolled hypertension after being on two antihypertensive drugs.

Section snippets

Study Design

This randomized controlled trial was part of a larger study on effect of aerobic exercise on cardiovascular health indices and health-related QoL in individuals with essential hypertension. It used aerobic dance training combined with antihypertensive drug therapy more than 12 weeks to determine whether the exercise will have additive BP-reducing effects on the drug therapy. The participants were randomly assigned to either the exercise group or the control group using a computer-generated

Results

The participants in this study comprised 60 participants (13 males and 47 females) in exercise group and 60 participants (22 males and 38 females) in control group, most of whom were married (exercise: 80.0%; control: 71.1%). Eighty-eight (45 in exercise group and 43 in control group) of the 120 participants randomly assigned to groups completed the study. BMI classified 64.4% of participants in exercise group and 55.4% of participants in control group as overweight or obese (Table 1). The mean

Discussion

The additive-reducing effects of aerobic dance on BP in individuals with uncontrolled hypertension on two antihypertensive drugs were investigated in this study. The findings of more reductions of systolic and diastolic BP in exercise group than in control group in this study indicate that aerobic exercise training is effective in achieving systolic and diastolic BP control in individuals with uncontrolled hypertension on two antihypertensive drugs. This implies that aerobic exercise training

Conclusions

Thus, combination of aerobic dance and antihypertensive drugs reduces number of antihypertensive drugs needed to achieve BP control and enhances BP control in individuals with hypertension on two antihypertensive drugs.

Acknowledgments

The authors thank the patients and the physicians who volunteered to sacrifice their times for this study, in particular, Late Dr. Ilori of Adeoyo Hospital, Ibadan. The authors also appreciate the inestimable assistance and support of the staff of Chronic Disease Research Project (CDRP), University College Hospital, Ibadan. The authors thank the African Population and Health Research Centre (APHRC), Nairobi, Kenya, in partnership with the International Development Research Centre (IDRC) and

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    Conflict of interest: None of the authors has any conflict of interest to declare regarding this manuscript.

    Neimeth Pharmaceutical Plc, Lagos, Nigeria, provided some of the drugs given to the participants in this study, and African Population and Health Research Centre (APHRC), Nairobi, Kenya, in partnership with the International Development Research Centre (IDRC) and Ford Foundation (ADDRF Award – 2010 ADDRF- 022), through African Doctoral Dissertation Research Fellowship, provided funds for this study.

    Trial Registration Number: ISRCTN81952488; http://www.controlled-trials.com/ISRCTN81952488/.

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