Exercise vs. Heat Therapy Effects on Kidney Function in Adults with Untreated Hypertension

项目总结/摘要 高血压是慢性肾脏病（CKD）的主要危险因素。最近出版的30年 前瞻性队列研究显示，估计肾小球滤过率（eGFR）的年下降率 在成年高血压患者中会加重。此外，如果尿中存在白蛋白（即，白尿症 eGFR的年下降在高血压成人中进一步加剧。血管紧张素转换酶 血管紧张素Ⅱ抑制剂（ACEi）和血管紧张素Ⅱ 1型受体阻滞剂（ARB）被推荐用于治疗高血压 以及减少蛋白尿的能力。然而，约54%的成年高血压患者 白蛋白尿分类的患者目前未接受ACEi/ARB治疗。因此， 巨大的机会，更好地开发非药物方法，有效地降低血液 血压和减少蛋白尿。然而，不幸的是，运动可能并不理想，因为只有45%的人 高血压患者坚持体力活动的建议，有些人可能 不愿意或有局限性的地方行使是不太可行的。在研究中， 热疗对健康的巨大益处热疗法是指使用频繁的发作性增加核心 暴露于热环境（如桑拿浴或热水浸泡）引起的温度， 最终导致有益的健康适应。在健康的成年人中，短期热疗法已被证明 降低蛋白尿的发生率。然而，一个关键的知识差距仍然存在，如果热疗法提供 对高血压成年人的肾脏进行有益的适应，包括减少蛋白尿，这将 降低CKD的风险。目前的研究旨在调查热疗法是否能有效降低血液中的 高血压患者的血压和蛋白尿。我们将比较30次被动热疗 使用热水浸泡8-10周可减少未经治疗的成人升高或1期白蛋白尿 高血压在更大程度上超过30届运动训练在同一时间段。此外，本发明还 我们将确定30次被动热疗是否能在更大程度上减少尿NGAL， 对未经治疗的高血压或1期高血压患者进行运动训练。证明热疗法 可用作高血压和1期高血压的新治疗方法， 明确需要替代运动训练和药物方法。

PROJECT SUMMARY/ABSTRACT Hypertension is the leading risk factor for chronic kidney disease (CKD). A recently published 30-year prospective cohort study revealed that the annual rate of decline in estimated glomerular filtration rate (eGFR) is exacerbated in adults with hypertension. Moreover, if albumin is present in the urine (i.e., albumuria), the annual reductions in eGFR are further exacerbated in adults with hypertension. Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II type 1 receptor blockers (ARBs) are recommended to treat hypertension and for their ability to reduce albuminuria. However, ~54% of adults with hypertension with the highest classification of albuminuria are not currently undergoing treatment with ACEi/ARBs. Thus, there is tremendous opportunity to better develop non-pharmacological approaches that are effective at lowering blood pressure and reducing albuminuria. Unfortunately, however, exercise may not be ideal because only ~45% of patients with hypertension adhere to recommendations for physical activity and some individuals may be unwilling or have limitations where exercise is less feasible. There has been an uptick in research investigating the vast health benefits of heat therapy. Heat therapy refers to the use of frequent episodic increases in core temperature induced by exposures to hot environments, such as sauna bathing or hot water immersion, that ultimately induces beneficial health adaptations. In healthy adults, short-term heat therapy has been shown to reduce the incidence of albuminuria. However, a critical knowledge gap remains if heat therapy provides beneficial adaptations for the kidneys in adults with hypertension, including reducing albuminuria which would lower the risk for CKD. The current study aims investigate whether heat therapy is effective at lowering blood pressure and albuminuria in adults with hypertension. We will compare if 30 sessions of passive heat therapy using hot water immersion over 8-10 weeks reduces albuminuria in adults with untreated Elevated or Stage 1 Hypertension to a greater extent than 30 sessions of exercise training over the same time period. Additionally, we will determine whether 30 sessions of passive heat therapy reduces urinary NGAL to a greater extent than exercise training in adults with untreated Elevated or Stage 1 Hypertension. Demonstrating that heat therapy can be used as a novel treatment for Elevated and Stage 1 Hypertension is timely and important as there is a clear need for alternatives to exercise training and pharmacological approaches.