Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare

a randomized controlled trial

Authors

Keywords:

Hypertension, Resistance training, Primary health care, Blood pressure

Abstract

BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

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Author Biographies

Aline Cabral Palmeira, Primary healthcare units within the Family Health Program

MSc. Professor, Physiotherapy and Nursing Departments, Faculdade São Francisco de Juazeiro (FASJ), Juazeiro (BA), Brazil.

Breno Quintella Farah, Primary healthcare units within the Family Health Program

PhD. Professor, Physical Education Department, Universidade Federal Rural de Pernambuco, Recife (PE), Brazil; Associate Researcher, Postgraduate Program on Physical Education, Universidade Federal do Pernambuco (UFPE), Recife (PE), Brazil.

Gustavo Oliveira da Silva, Primary healthcare units within the Family Health Program

MSc. Doctoral Student, Postgraduate Program on Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo (SP), Brazil.

Sérgio Rodrigues Moreira, Primary healthcare units within the Family Health Program

PhD. Professor, Postgraduate Program on Physical Education, Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina (PE), Brazil.

Mauro Virgílio Gomes de Barros, Primary healthcare units within the Family Health Program

PhD. Professor, Postgraduate Program on Physical Education, Universidade de Pernambuco (UPE), Recife (PE), Brazil.

Marilia de Almeida Correia, Primary healthcare units within the Family Health Program

PhD. Professor, Postgraduate Program on Medicine, Universidade Nove de Julho (UNINOVE), São Paulo (SP), Brazil.

Gabriel Grizzo Cucato, Primary healthcare units within the Family Health Program

PhD. Professor, Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom.

Raphael Mendes Ritti-Dias, Primary healthcare units within the Family Health Program

PhD. Professor, Postgraduate Program on Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo (SP), Brazil.

References

Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217-23. PMID: 15652604; https://doi.org/10.1016/S0140-6736(05)17741-1

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535; https://doi.org/10.1016/j.jacc.2017.11.006 Erratum in: J Am Coll Cardiol. 2018;71(19):2275-9.

Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-13. PMID: 12493255; https://doi.org/10.1016/s0140-6736(02)11911-8 Erratum in: Lancet. 2003;361(9362):1060.

Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473. PMID: 23525435; https://doi.org/10.1161/JAHA.112.004473

Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc. 2014;89(3):327-34. PMID: 24582191; https://doi.org/10.1016/j.mayocp.2013.10.030

Inder JD, Carlson DJ, Dieberg G, et al. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertens Res. 2016;39(2):88-94. PMID: 26467494; https://doi.org/10.1038/hr.2015.111

Jin YZ, Yan S, Yuan WX. Effect of isometric handgrip training on resting blood pressure in adults: a meta-analysis of randomized controlled trials. J Sports Med Phys Fitness. 2017;57(1-2):154-60. PMID: 26558836; https://doi.org/10.23736/S0022-4707.16.05887-4

Bentley DC, Nguyen CH, Thomas SG. Resting blood pressure reductions following handgrip exercise training and the impact of age and sex: a systematic review and narrative synthesis. Syst Rev. 2018;7(1):229. PMID: 30541603; https://doi.org/10.1186/s13643-018-0876-5

Smart NA, Way D, Carlson D, et al. Effects of isometric resistance training on resting blood pressure: individual participant data meta-analysis. J Hypertens. 2019;37(10):1927-38. PMID: 30889048; https://doi.org/10.1097/HJH.0000000000002105

Carey RM, Whelton PK; 2017 ACC/AHA Hypertension Guideline Writing Committee. Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann Intern Med. 2018;168(5):351-8. PMID: 29357392; https://doi.org/10.7326/M17-3203

Farah BQ, Rodrigues SLC, Silva GO, et al. Supervised, but Not Home-Based, Isometric Training Improves Brachial and Central Blood Pressure in Medicated Hypertensive Patients: A Randomized Controlled Trial. Front Physiol. 2018;9:961. PMID: 30083107; https://doi.org/10.3389/fphys.2018.00961

Pagonas N, Vlatsas S, Bauer F, et al. Aerobic versus isometric handgrip exercise in hypertension: a randomized controlled trial. J Hypertens. 2017;35(11):2199-206. PMID: 28622156; https://doi.org/10.1097/HJH.0000000000001445

Stiller-Moldovan C, Kenno K, McGowan CL. Effects of isometric handgrip training on blood pressure (resting and 24 h ambulatory) and heart rate variability in medicated hypertensive patients. Blood Press Monit. 2012;17(2):55-61. PMID: 22322195; https://doi.org/10.1097/MBP.0b013e32835136fa

Farah BQ, Germano-Soares AH, Rodrigues SLC, et al. Acute and Chronic Effects of Isometric Handgrip Exercise on Cardiovascular Variables in Hypertensive Patients: A Systematic Review. Sports (Basel). 2017;5(3):55. PMID: 29910415; https://doi.org/10.3390/sports5030055

Gordon BDH, Thomas EV, Warren-Findlow J, et al. A comparison of blood pressure reductions following 12-weeks of isometric exercise training either in the laboratory or at home. J Am Soc Hypertens. 2018;12(11):798-808. PMID: 30342777; https://doi.org/10.1016/j.jash.2018.09.003

Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8(18). https://doi.org/10.1186/1741-7015-8-18

Farah BQ, Vianna LC, Rodrigues SLC, et al. Effects of isometric handgrip training in patients with cardiovascular disease: rationale and design of the ISOPRESS network. Motriz: Rev Educ Fís. 2017;23(4):e101719. http://dx.doi.org/10.1590/s1980-6574201700040011

Harriss DJ, Macsween A, Atkinson G. Standards for Ethics in Sport and Exercise Science Research: 2018 Update. Int J Sports Med. 2017;38(14):1126-31. PMID: 29258155; https://doi.org/10.1055/s-0043-124001

Malachias MV. 7th Brazilian Guideline of Arterial Hypertension: Presentation. Arq Bras Cardiol. 2016;107(3 Suppl 3):0. PMID: 27819379; https://doi.org/10.5935/abc.20160140

Gerage AM, Benedetti TR, Farah BQ, et al. Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients. PLoS One. 20150;10(12):e0146078. PMID: 26717310; https://doi.org/10.1371/journal.pone.0146078

Parati G, Stergiou G, O’Brien E, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32(7):1359-66. PMID: 24886823; https://doi.org/10.1097/HJH.0000000000000221

Farah BQ, Lima AH, Cavalcante BR, et al. Intra-individuals and inter- and intra-observer reliability of short-term heart rate variability in adolescents. Clin Physiol Funct Imaging. 2016;36(1):33-9. PMID: 25216444; https://doi.org/10.1111/cpf.12190

Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-65. PMID: 8598068.

McGowan CL, Levy AS, McCartney N, MacDonald MJ. Isometric handgrip training does not improve flow-mediated dilation in subjects with normal blood pressure. Clin Sci (Lond). 2007;112(7):403-9. PMID: 17140398; https://doi.org/10.1042/CS20060195

Millar PJ, McGowan CL, Cornelissen VA, Araujo CG, Swaine IL. Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Med. 2014;44(3):345-56. PMID: 24174307; https://doi.org/10.1007/s40279-013-0118-x

Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288(15):1882-8. PMID: 12377087; https://doi.org/10.1001/jama.288.15.1882

Peters PG, Alessio HM, Hagerman AE, et al. Short-term isometric exercise reduces systolic blood pressure in hypertensive adults: possible role of reactive oxygen species. Int J Cardiol. 2006;110(2):199-205. PMID: 16239039; https://doi.org/10.1016/j.ijcard.2005.07.035

Taylor AC, McCartney N, Kamath MV, Wiley RL. Isometric training lowers resting blood pressure and modulates autonomic control. Med Sci Sports Exerc. 2003;35(2):251-6. PMID: 12569213; https://doi.org/10.1249/01.MSS.0000048725.15026.B5

Millar PJ, Bray SR, McGowan CL, MacDonald MJ, McCartney N. Effects of isometric handgrip training among people medicated for hypertension: a multilevel analysis. Blood Press Monit. 2007t;12(5):307-14. PMID: 17890969; https://doi.org/10.1097/MBP.0b013e3282cb05db

Farah BQ, Christofaro DGD, Correia MA, et al. Effects of isometric handgrip training on cardiac autonomic profile: A systematic review and meta-analysis study. Clin Physiol Funct Imaging. 2020;40(3):141-7. PMID: 31971353; https://doi.org/10.1111/cpf.12619

Cahu Rodrigues SL, Farah BQ, Silva G, et al. Vascular effects of isometric handgrip training in hypertensives. Clin Exp Hypertens. 2020;42(1):24-30. PMID: 30626217; https://doi.org/10.1080/10641963.2018.1557683

McGowan CL, Visocchi A, Faulkner M, et al. Isometric handgrip training improves local flow-mediated dilation in medicated hypertensives. Eur J Appl Physiol. 2007;99(3):227-34. PMID: 17106718; https://doi.org/10.1007/s00421-006-0337-z Erratum in: Eur J Appl Physiol. 2008;103(2):251.

Salles GF, Cardoso CR, Muxfeldt ES. Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med. 2008;168(21):2340-6. PMID: 19029499; https://doi.org/10.1001/archinte.168.21.2340

Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-62. PMID: 33239350; https://doi.org/10.1136/bjsports-2020-102955

Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADdM, et al. Brazilian Guidelines of Hypertension – 2020. Arq Bras Cardiol. 2021 116(3): 516-658.

de Sousa ASA, Correia MA, Farah BQ, et al. Barriers and Levels of Physical Activity in Patients With Symptomatic Peripheral Artery Disease: Comparison Between Women and Men. J Aging Phys Act. 2019;27(5):719-24. PMID: 30747555; https://doi.org/10.1123/japa.2018-0206

Cavalcante BR, Farah BQ, dos A Barbosa JP, et al. Are the barriers for physical activity practice equal for all peripheral artery disease patients? Arch Phys Med Rehabil. 2015;96(2):248-52. PMID: 25281872; https://doi.org/10.1016/j.apmr.2014.09.009

Teixeira AL, Ritti-Dias R, Antonino D, et al. Sex Differences in Cardiac Baroreflex Sensitivity after Isometric Handgrip Exercise. Med Sci Sports Exerc. 2018;50(4):770-7. PMID: 29135601; https://doi.org/10.1249/MSS.0000000000001487

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Published

2021-11-04

How to Cite

1.
Palmeira AC, Farah BQ, Silva GO da, Moreira SR, Barros MVG de, Correia M de A, Cucato GG, Ritti-Dias RM. Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial. Sao Paulo Med J [Internet]. 2021 Nov. 4 [cited 2025 Mar. 9];139(6):648-56. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/534

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