DISPARATE EFFECTS OF EXERCISE TRAINING ON GLUCOSE-TOLERANCE AND INSULIN LEVELS AND ON AMBULATORY BLOOD-PRESSURE IN HYPERTENSIVE PATIENTS

Objective: To assess the relationship of insulin levels and glucose tolerance to blood pressure in hypertension. Design: An open, prospective trial of exercise training with ambulatory blood pressure monitoring and intravenous glucose tolerance testing before and after a 14-week training programme. Patients: Twenty sedentary, untreated, non-obese, normoglycaemic individuals of both sexes with uncomplicated essential hypertension, of whom 16 completed the study. Intervention: Fourteen weeks of supervised, low-intensity, group exercise of three 1-h sessions per week. Main outcome measures: Ambulatory and clinic blood pressure, and glucose and insulin responses to an intravenous glucose tolerance test. Results: Maximal work capacity on a bicycle ergometer increased by 20% (P < 0.001); 24-h ambulatory blood pressure was 143 +/- 12/87 +/- 5 mmHg before and 142 +/- 13/87 +/- 7 mmHg after training. Clinic blood pressure decreased from 166 +/- 14/103 +/- 5 mmHg to 157 +/- 12/99 +/- 6 mmHg (P < 0.03). Two-way analysis of variance indicated significant decreases in both glucose (P < 0.04) and insulin (P < 0.03), fasting and throughout the intravenous glucose tolerance test. Conclusions: Although mild exercise reduced clinic blood pressure significantly, it did not affect ambulatory blood pressure despite a marked reduction in glucose and insulin levels. This finding argues against a determinant role of insulin in the 24-h maintenance of blood pressure in hypertensive patients under the conditions of the study.