There is increasing evidence that blood pressure variability (BPV, variation of blood pressure over time) constitutes a strong and independent marker of cardiovascular risk. The all-cause mortality is > 50% greater in subjects with a standard deviation of inter-visit blood pressure > 5 mmHg. Regular aerobic exercise reduces blood pressure and is recommended by current hypertension guidelines as a basic lifestyle modification. It remains elusive, however, whether aerobic exercise is able to reduce BPV as well. In total, 72 hypertensive subjects were randomly assigned to an 8- to 12-week treadmill exercise program (target lactate 2.0 +/- 0.5 mmol/l) or sedentary control. Blood pressure was measured by 24 h-ambulatory blood pressure monitoring (ABP). Two aspects of BPV were assessed: the variability of ABP and the variability of blood pressure on exertion. The coefficient of variation (CV) was used as a statistical measure of BPV. The CV of systolic daytime ABP was defined as primary outcome. The exercise program significantly decreased systolic and diastolic daytime ABP by 6.2 +/- 10.2 mmHg (p < 0.01) and 3.0 +/- 6.3 mmHg (p = 0.04), respectively. Moreover, it reduced blood pressure on exertion and increased physical performance (p < 0.05 each). Exercise had no impact, however, on the CV of daytime (10.2 +/- 2.7 versus 9.8 +/- 2.6%, p = 0.30) and night-time systolic (8.9 +/- 3.2 versus 10.5 +/- 4.1%, p = 0.10) and diastolic ABP (daytime 11.5 +/- 3.3 versus 11.5 +/- 3.1%, night-time 12.0 +/- 4.3 versus 13.8 +/- 5.2%; p > 0.05 each). Regular aerobic exercise is a helpful adjunct to control blood pressure in hypertension, but it has no effect on 24 h BPV, an independent predictor of cardiovascular risk.
Reprinted by permission from Journal of Human Hypertension, Macmillan Publishers Ltd.

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