Heat Therapy versus Exercise Training in Hypertension

项目摘要/摘要 在美国，高血压(HTN)是心血管疾病(CVD)相关死亡人数最多的疾病。 其他可改变的心血管疾病危险因素，仅次于吸烟，成为任何人可预防的死亡原因 原因嘛。根据最近更新的临床分类，美国HTN的患病率为46%。重要的是，非- 对于大多数患有高血压的成年人，建议进行药物治疗，而不是降压药物 基于新分类的HTN(即以前未被归类为HTN的那些)。生活方式干预，如 由于定期锻炼被认为是预防HTN发展的第一线措施，在 诊断为HTN的治疗。流行病学研究表明， 体力活动和身体素质以及血压和HTN水平。不幸的是，绝大多数 人们对开始运动训练和遵守符合以下条件的运动训练方案持沉默态度 最低标准极低。此外，一些患者组由于 对一些限制或不能获得运动的全部好处，以降低心血管疾病的风险。因此， 迫切需要替代的非药物选择来降低血压和改善心血管疾病风险。 热疗，以热水浴或桑拿浴的形式，是一种古老的做法，最近在 心血管疾病的预防和治疗。最近一项来自芬兰的20多年前瞻性队列研究表明，在芬兰，桑拿的使用 非常普遍，也是文化的一部分，表明经常使用桑拿浴与 减少发生HTN的风险，这可能是全因心血管疾病发生率降低的部分原因 此前在较大的队列中报告了经常使用桑拿的死亡病例。到目前为止，还没有临床上 在人体上进行试验以确定热疗是否是一种有效的治疗方法来降低这些患者的血压 与HTN合作。因此，我们建议进行一项临床试验，以确定热疗是否能有效地降低血液 HTN中的压力。我们会将热疗后的血压降低与标准运动进行比较 训练。我们假设在8-10周内使用热水浸泡的30次被动热疗 与锻炼相比，HTN患者的血压改善程度更大。此外，我们还将评估 HTN的临床措施、关键的血管和自主神经生物标记物与心血管健康风险 在热疗和运动训练之后。我们进一步假设热疗会增加血管 HTN患者的依从性、降低交感神经流出和改善内皮功能。最后，我们将 确定热疗或运动测试后血压的急剧下降是否会 预测热疗或运动训练后静息血压的持续下降 在HTN受试者中。这些发现将提供比基线静息血更重要的预测性信息 压力。证明热疗可以作为一种治疗特发性HTN的新方法是及时和 这一点很重要，因为显然需要替代运动训练和药理学方法。

PROJECT SUMMARY/ABSTRACT In the U.S., hypertension (HTN) accounts for more cardiovascular disease (CVD)-related deaths than any other modifiable CVD risk factor, second only to cigarette smoking as a preventable cause of death for any reason. Based on recently updated clinical classifications, the US prevalence of HTN is 46%. Importantly, non- pharmacological treatment rather than antihypertensive medication is recommended for most adults who have HTN based on the new classifications (i.e., those not previously classified as HTN). Lifestyle interventions such as regular exercise are considered a first-line preventative against the development of HTN and in the treatment of diagnosed HTN. Epidemiological studies have demonstrated an inverse relationship between physical activity and physical fitness and level of blood pressure and HTN. Unfortunately, the vast majority of people are reticent to initiate exercise training and compliance in exercise training regimens that meet the minimum standards are extremely low. Additionally, some patient groups are not able to perform exercise due to a number of limitations or are not able to obtain the full benefits of exercise to reduce CVD risk. Thus, alternative non-pharmacological options to lower blood pressure and improve CVD risk are critically needed. Heat therapy, in the form of hot bath or sauna, is an ancient practice that has recently regained attention in the prevention and treatment of CVD. A recent 20+year prospective cohort study from Finland, where sauna use is extremely common and part of the culture, has demonstrated that regular sauna use was associated with reduced risk of developing HTN, which may explain in part the reduced rates of all-cause cardiovascular deaths with regular sauna use previously reported in the larger cohort. To date, there have been no clinical trials in humans to determine whether heat therapy is an effective treatment to reduce blood pressure in those with HTN. As such, we propose a clinical trial to determine whether heat therapy can effectively reduce blood pressure in HTN. We will compare the blood pressure reductions following heat therapy to standard exercise training. We hypothesize that 30 sessions of passive heat therapy using hot water immersion over 8-10 weeks will improve blood pressure in HTN individuals to a greater extent than exercise. In addition, we will evaluate clinical measures, key vascular and autonomic biomarkers of HTN, and cardiovascular health risk before and following heat therapy and exercise training. We further hypothesize that heat therapy will increase vascular compliance, lower sympathetic outflow, and improve endothelial function in individuals with HTN. Lastly, we will determine whether the acute decreases in blood pressure following a heat therapy session or exercise test will predict the sustained reduction in resting blood pressures following heat therapy treatment or exercise training in HTN subjects. These findings would provide significant predictive information beyond baseline resting blood pressures. Demonstrating that heat therapy can be used as a novel treatment for essential HTN is timely and important as there is a clear need for alternatives to exercise training and pharmacological approaches.