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 VO2) 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 VO2 for 50 to 60 min 5 days per week. The 1 year program resulted in a 41% increase in peak VO2 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 less than .01). After training, maximal SBP was achieved at a faster heart rate (157 +/- 5 vs 132 +/- 6 beats/min; p less than .001) and was 7.4% higher (174 +/- 6 vs 162 +/- 5 mm Hg; p less than .005), while SBP at peak exercise had increased by 21% (171 +/- 6 vs 141 +/- 7 mm Hg; p less than .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 less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)