OBJECTIVES: Slow loaded breathing training has been shown to reduce resting blood pressure (BP) in isolated systolic hypertension (ISH), but it is not known whether this also reduces their exaggerated BP responses to exercise. METHODS: The study was a randomized controlled trial with block allocation stratified by sex. Twenty ISH patients (68 +/- 5 yrs, 11 males) were randomized with one group undertaking 8-weeks training with slow loaded breathing (SLB; 25% maximum inspiratory pressure, 6 breaths per minute, 60 breaths every day) or deep breathing control (CON), with 8 weeks follow-up. Outcome measures were home BP and heart rate (HR) with laboratory measures of BP and HR responses to static handgrip and dynamic arm cranking exercise. Data were compared with a two-week run-in baseline. RESULTS: Home systolic BP fell by 22 mmHg (20 to 23; mean (95% CI), diastolic BP by 9 mmHg (7 to 11), and HR by 12 bpm (9 to 15; all p < 0.001) as a result of SLB training. Systolic BP at the end of 2-min isometric handgrip was 189 +/- 10 mmHg (mean, SD) before training and 157 +/- 6 mmHg following SLB training. After 4-min arm exercise, systolic BP, measured at the ankle, was reduced from 243 +/- 8 mmHg during the run-in period to 170 +/- 15 mmHg after SLB training with no change for CON. The reduction in exercise BP, in both types of exercise, was partly due to a reduction in resting BP and to a smaller increase above resting. Systolic and pulse pressures remained below run-in values 8 weeks after the end of SLB training, and BP response to handgrip exercise remained below run-in values at 4 weeks after SLB training. CONCLUSIONS: SLB not only reduces resting BP in ISH but also the responses to both static and dynamic exercise, potentially reducing the negative aspect of exercise for cardiovascular health.

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