Effects of exercise and stress management training on nighttime blood pressure dipping in patients with coronary heart disease: A randomized, controlled trial

Andrew Sherwood, Patrick J. Smith, Alan L. Hinderliter, Anastasia Georgiades, James A. Blumenthal

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Abstract

Introduction Blunted nighttime blood pressure (BP) dipping is prognostic of cardiovascular morbidity and mortality. Patients with coronary heart disease (CHD) are often characterized by a blunted nighttime BP dipping pattern. The present study compared the effects of 2 behavioral intervention programs, aerobic exercise (EX) and stress management (SM) training, with a usual care (UC) control group on BP dipping in a sample of CHD patients. Methods This was a secondary analysis of a randomized, controlled trial with allocation concealment and blinded outcome assessment in 134 patients with stable CHD and exercise-induced myocardial ischemia. Nighttime BP dipping was assessed by 24-hour ambulatory BP monitoring, at prerandomization baseline and after 16 weeks of one of the following treatments: usual medical care; UC plus supervised aerobic EX for 35 minutes, 3 times per week; UC plus weekly 1.5-hour sessions of SM training. Results The EX and SM groups exhibited greater improvements in systolic BP dipping (P = .052) and diastolic BP dipping (P = .031) compared with UC. Postintervention systolic BP percent-dipping means were 12.9% (SE = 1.5) for SM, 11.1% (SE = 1.4) for EX, and 8.6% (SE = 1.4) for UC. Postintervention diastolic BP percent-dipping means were 13.3% (SE = 1.9) for SM, 14.1% (SE = 1.8) for EX, and 8.8% (1.8) for UC. Conclusions For patients with stable CHD, EX or SM training resulted in improved nighttime BP dipping compared with usual medical care. These favorable effects of healthy lifestyle modifications may help reduce the risk of adverse clinical events.

LanguageEnglish (US)
Pages85-90
Number of pages6
JournalAmerican heart journal
Volume183
DOIs
StatePublished - Jan 1 2017

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Coronary Disease
Randomized Controlled Trials
Exercise
Blood Pressure
Ambulatory Blood Pressure Monitoring
Myocardial Ischemia
Outcome Assessment (Health Care)
Morbidity
Control Groups
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Effects of exercise and stress management training on nighttime blood pressure dipping in patients with coronary heart disease : A randomized, controlled trial. / Sherwood, Andrew; Smith, Patrick J.; Hinderliter, Alan L.; Georgiades, Anastasia; Blumenthal, James A.

In: American heart journal, Vol. 183, 01.01.2017, p. 85-90.

Research output: Contribution to journalArticle

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abstract = "Introduction Blunted nighttime blood pressure (BP) dipping is prognostic of cardiovascular morbidity and mortality. Patients with coronary heart disease (CHD) are often characterized by a blunted nighttime BP dipping pattern. The present study compared the effects of 2 behavioral intervention programs, aerobic exercise (EX) and stress management (SM) training, with a usual care (UC) control group on BP dipping in a sample of CHD patients. Methods This was a secondary analysis of a randomized, controlled trial with allocation concealment and blinded outcome assessment in 134 patients with stable CHD and exercise-induced myocardial ischemia. Nighttime BP dipping was assessed by 24-hour ambulatory BP monitoring, at prerandomization baseline and after 16 weeks of one of the following treatments: usual medical care; UC plus supervised aerobic EX for 35 minutes, 3 times per week; UC plus weekly 1.5-hour sessions of SM training. Results The EX and SM groups exhibited greater improvements in systolic BP dipping (P = .052) and diastolic BP dipping (P = .031) compared with UC. Postintervention systolic BP percent-dipping means were 12.9{\%} (SE = 1.5) for SM, 11.1{\%} (SE = 1.4) for EX, and 8.6{\%} (SE = 1.4) for UC. Postintervention diastolic BP percent-dipping means were 13.3{\%} (SE = 1.9) for SM, 14.1{\%} (SE = 1.8) for EX, and 8.8{\%} (1.8) for UC. Conclusions For patients with stable CHD, EX or SM training resulted in improved nighttime BP dipping compared with usual medical care. These favorable effects of healthy lifestyle modifications may help reduce the risk of adverse clinical events.",
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