BACKGROUND: The effect of inspiratory muscle training (IMT) applied along with function in Hypertension (HT) patients is uncertain. In this study, it was to determine the effectiveness of functional IMT (F-IMT) on functional lower and upper exercise capacity, mobility, peripheral and respiratory muscle strength, blood pressure, fatigue, physical activity, and quality of life (HRQoL) in HT patients. METHODS: Prospective, randomized controlled, assessor-blinded, parallel three-armed trial. Forty-five patients with HT were divided into F-IMT group (IMT with 50% maximal inspiratory pressure (MIP)/4 weeks plus exercise and IMT with 50% MIP/4 weeks, n = 15), IMT group (MIP 50%, n = 15) and control group (CG, breathing exercises, n = 15). 6-min walking test (6-MWT), 6-min pegboard ring test (6PBRT), 1-min sit to stand test (1STS), mobility, peripheral muscle strength, MIP, maximal expiratory pressure (MEP), systolic and diastolic blood pressure (SBP, DBP), fatigue, physical activity, and HRQoL were evaluated before and after 8 weeks of training. RESULTS: Increases in 6-MWT were higher in F-IMT (p < 0.001). 6PBRT, 1STS, quadriceps femoris strength were improved and SBP reduced in F-IMT and IMT than CG (p < 0.001). Mobility, handgrip, HRQoL, and physical activity level increased within groups (p < 0.05). MIP increased within F-IMT and IMT; MEP, fatigue, DBP improved only within F-IMT (p < 0.05). CONCLUSIONS: F-IMT is more effective in enhancing exercise capacity, reducing fatigue and DBP, and improving MEP. Both IMT and F-IMT show similar benefits for upper extremity exercise capacity, quadriceps femoris strength, SBP, and MIP. Mobility, HRQoL, and physical activity levels are increased with F-IMT, IMT, and breathing exercises. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06343246 (03/29/2024).

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