Exercise and Resistant Hypertension—Is Exercise Enough?—Reply

In Reply We thank Blumenthal and colleagues for their interest and comments on the Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial.¹ We agree with Blumenthal et al that there has been little research studying the effects of exercise alone or combined with lifestyle interventions among individuals with resistant hypertension (RH). Exercise training is recommended by all professional societies as a key lifestyle strategy to treat, manage, and control blood pressure (BP) in patients with hypertension. However, the effectiveness of exercise training in patients with RH is a topic of debate. The recent favorable results of both the Lifestyle Interventions in Treatment-Resistant Hypertension (TRIUMPH) trial² and EnRicH trial¹ are encouraging. In the TRIUMPH trial, Blumenthal et al² found a 4-month program of lifestyle modification, including dietary counseling, behavioral weight management, and supervised exercise decreased 24-hour ambulatory systolic BP (−7.0 mm Hg) and diastolic BP (−3.9 mm Hg) and office systolic BP (−12.5 mm Hg) and diastolic BP (−5.9 mm Hg) in 90 patients with RH. The exercise training component consisted of 3 sessions of vigorous intensity aerobic exercise per week for 30 to 45 minutes per session. In the EnRicH trial,¹ we used a similar exercise prescription consisting of three 40-minute moderate to vigorous intensity aerobic exercise sessions per week for 3 months. As a result, 24-hour ambulatory systolic BP (−6.2 mm Hg) and diastolic BP (−4.4 mm Hg) and office systolic BP (−10.9 mm Hg) and diastolic BP (−5.9 mm Hg) decreased, BP reductions that are similar in magnitude to the TRIUMPH trial. The participants in the EnRicH trial lost a mean of 1.9 kg; however, further analyses revealed neither the reductions in body weight nor baseline BP altered the BP findings.