Aerobic physical exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Beta-blockade interacts with heart rate, sympathetic tone, maximal workload and local lactate production. In the present randomized-controlled study, we compared the cardiovascular effects of an endurance training programme in elderly hypertensives with or without beta-blockers and developed a first approach to determine a lactate-based training heart rate in presence of beta-blockade. Fifty-two patients (23 with beta-blocker, 29 without beta-blocker) >= 60 years with systolic 24-h ambulatory blood pressure (ABP) >= 140 mmHg and/or antihypertensive treatment were randomly assigned to sedentary activity or a heart-rate controlled 12-week treadmill exercise programme (lactate 2.0 mmol/l). In the exercise group, the training significantly decreased systolic and diastolic 24-h ABP, blood pressure on exertion (100 W) and increased endothelium-dependent vasodilation (flow-mediated vasodilation, FMD) and physical performance both in the presence and absence of beta-blockade (p < 0.05 each). The extent of ABP reduction did not significantly differ in the presence or absence of beta-blockade (delta systolic ABP 10.6 +/- 10.5 versus 10.6 +/- 8.8 mmHg, delta diastolic ABP 5.7 +/- 8.6 versus 5.8 +/- 4.0 mmHg). Mean training heart rate was significantly lower in the patients on beta-blockers (97.2 +/- 7.7 versus 118.3 +/- 7.5 min, p < 0.001). Lactate-based aerobic endurance training evokes comparable cardiovascular benefits in the presence and absence of beta-blockade including a marked improvement of endothelial function. In the present study, target training heart rate with beta-blockers is about 18% lower than without.
Reprinted by permission from Journal of Human Hypertension, Macmillan Publishers Ltd.

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