Influence of cardiac rehabilitation on blood pressure in patients with coronary artery disease
Authors: Senesael E , Pardaens S , Cuypers S , Brouwers S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
One of the main goals of cardiac rehabilitation is the optimalisation of the cardiovascular risk to prevent the progression of heart disease. Arterial hypertension is one of the most important risk factors that however remains often undertreated.

Purpose
We analysed the patient data from our cardiac rehabilitation center over the last 3 years to assess the evolution in exercise capacity and blood pressure before and after the rehabilitation program.

Methods
Patients diagnosed with coronary artery disease (acute coronary syndrome, elective percutaneous coronary intervention or coronary artery bypass graft) between October 2019 and September 2022 were retrospectively included if they followed at least 50% of the total training sessions. Mean blood pressure at the beginning and end of the cardiac revalidation was derived from the mean values of the first 5 sessions and of the last 5 sessions. A change in 5 mmHg was investigated.

Results
The study enrolled 378 patients, of which 17 % female, with a mean age of 65.3 ± 9.68 years. Every patient followed an average of 42 training sessions (over &lt; 6 months) and 149 patients (41%) had a systolic blood pressure drop of at least 5 mmHg. This decrease was more prevalent in men (133 of 149 (89%) in this group vs. 171 of 218 (78%) in the group with no difference in blood pressure (p &lt;0,05)). These 149 patients had higher systolic blood pressure at the beginning of the sessions (mean systolic blood pressure of 132 ± 9,64 mmHg, p &lt;0,05) and a significant difference in the number of patients who stopped smoking (86 of 129 (58%) vs. 98 of 218 (45%) (p&lt; 0.05)) and were more likely to have no acute coronary syndrome (i.e. more elective procedures) (107 of 149 (72%) vs. 133 of 218 (61%) (p &lt;0,05)).
There was no difference in the antihypertensive treatment between the 2 groups at the beginning of the cardiac rehabilitation.
The evolution in exercise capacity between the beginning and the end of the rehabilitation sessions showed in both groups together an increase in exercise capacity of 3ml/min/kg in peak VO2 (=18% improvement in peak VO2). In the group with a decrease of 5 mmHg in blood pressure, the exercise capacity improved on average with 1,6 METS (32%) vs. 1,1 METS (19%) in the group with no change in blood pressure. In other words, a positive trend could be observed for a drop in the systolic blood pressure with at least 5 mmHg in relation with an improvement in exercise capacity (p=0,06). The mean systolic blood pressure for all patients at the end of the cardiac rehabilitation was 124 ± 8.36 mmHg.

Conclusion
Following cardiac rehabilitation in patients with coronary artery disease, a decrease in blood pressure was seen in 41% of the participants. This decrease was mainly seen in males that stopped smoking and had no acute coronary disease. A trend towards a significant relation between improved exercise capacity (in METS) and improved blood pressure was observed.