Too Old to Benefit from Sports? The Cardiovascular Effects of Exercise Training in Elderly Subjects Treated for Isolated Systolic Hypertension

Background: Hypertension in the elderly is commonly characterized by an elevation of pulse pressure. With regard to advanced arteriosclerosis and limited physical fitness, doubt was casted whether elderly patients still achieve relevant cardiovascular benefits by physical exercise. 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: 54 patients ≧60 years with systolic 24-hour ambulatory blood pressure (ABP) >140 mm Hg and/or antihypertensive treatment and diastolic ABP ≤90 mm Hg were randomly assigned to sedentary activity or a 12-week treadmill exercise program (target lactate 2.5 ± 0.5 mmol/l). Results: Exercise significantly decreased systolic and diastolic ABP by 8.5 ± 8.2 and 5.1 ± 3.7 mm Hg (p < 0.001 each) and increased physical performance. Arterial compliance remained unchanged, whereas endothelium-dependent vasodilation – measured by flow-mediated dilation – significantly increased from 5.6 ± 1.7 to 7.9 ± 3.0% (p < 0.007). After adjustment for initial systolic ABP, pulse pressure did not affect the change of BP. Conclusion: The exercise-induced reduction of BP, which is mediated by improved endothelial function, is independent of pulse pressure. Thus, physical exercise is a helpful adjunct to control BP even in old hypertensives with markedly increased arterial stiffness.