Reversal of exertional hypotension by prolonged exercise training in selected patients with ischemic heart disease

The effect of prolonged intense endurance exercise training on exertional hypotension was investigated in 16 patients with coronary artery disease who had a 10 mm Hg or greater fall in systolic blood pressure (SBP) during progressive exercise testing. Training consisted of walking, running, or cycling at 50% to 60% of peak oxygen uptake (peak V̇O₂) for 30 min 3 days per week for an initial 3 months and was followed by an additional 9 months of similar exercise performed at 70% to 90% of peak V̇O₂ for 50 to 60 min 5 days per week. The 1 year program resulted in a 41% increase in peak V̇O₂ and lower heart rate and blood pressure responses to submaximal work. Before conditioning, SBP attained a maximal value of 162 ± 5 mm Hg but fell 21 ± 3 mm Hg,, to 141 ± 7 mm Hg, at peak effort (p < .01). After training, maximal SBP was achieved at a faster heart rate (157 ± 5 vs 132 ± 6 beats/min; p < .001) and was 7.4% higher (174 ± 6 vs 162 ± 5 mm Hg; p < .005), while SBP at peak exercise had increased by 21% (171 ± 6 vs 141 ± 7 mm Hg; p < .001) and ST segment depression was slightly reduced. Left ventricular ejection fraction (LVEF) before training declined from 56 ± 4% at rest to 52 ± 3% at peak exercise (p < .05). After the exercise program, LVEF at peak effort was higher (56 ± 4 vs 52 ± 3%; p < .02) despite attainment of a greater peak supine exercise SBP (195 ± 6 vs 165 ± 6 mm Hg; p < .0001). Peak exercise stroke work and cardiac output increased 19% and 13%, respectively (both p < .005). No changes in exercise capacity, hemodynamics, or LVEF were observed in 10 nonexercising control patients with similar clinical and physiologic characteristics. These data suggest that prolonged intense endurance exercise training can normalize the SBP response to exercise for selected patients with coronary artery disease and exertional hypotension in conjunction with an improvement in indexes of myocardial ischemia.