Importance Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy.

Objective To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension.

Design, Settings, and Participants The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals’ hypertension outpatient clinic.

Interventions Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care.

Main Outcomes and Measures The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness.

Results A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, −12.8 to −1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (−5.1 mm Hg; 95% CI, −7.9 to −2.3; P = .001), daytime systolic BP (−8.4 mm Hg; 95% CI, −14.3 to −2.5; P = .006), and daytime diastolic BP (−5.7 mm Hg; 95% CI, −9.0 to −2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (−10.0 mm Hg; 95% CI, −17.6 to −2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group.

Conclusions and Relevance A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population.

Trial Registration ClinicalTrials.gov Identifier: NCT03090529

重要性 有限的证据表明，运动可降低顽固性高血压患者的血压 (BP)，这是对药物治疗反应低的临床人群。

目的 确定有氧运动训练干预是否能降低难治性高血压患者的动态血压。

设计、设置和参与者 运动训练治疗顽固性高血压 (EnRicH) 试验是一项前瞻性、2 中心、单盲随机临床试验，于 2017 年 3 月至 2019 年 12 月在葡萄牙的 2 个医院中心进行。前瞻性招募了 60 名诊断为 40 至 75 岁的顽固性高血压患者，并在医院的高血压门诊进行观察。

干预 患者以 1:1 的比例被随机分配到为期 12 周的中等强度有氧运动训练计划（运动组）或常规护理对照组。除了常规护理外，锻炼组每周进行 3 次 40 分钟的监督训练。

主要结果和测量 有动力的主要功效测量是从基线开始的 24 小时动态收缩压变化。次要结局包括白天和夜间动态血压、办公室血压和心肺健康。

结果 共53例患者完成研究，其中运动组26例，对照组27例。其中，24 人 (45%) 为女性，平均 (SD) 年龄为 60.1 (8.7) 岁。与对照组相比，在运动组中，24 小时动态收缩压降低了 7.1 mm Hg（95% CI，-12.8 至 -1.4；P  = .02）。此外，24 小时动态舒张压（-5.1 mm Hg；95% CI，-7.9 至 -2.3；P  = .001），日间收缩压（-8.4 mm Hg；95% CI，-14.3 至 -2.5；P = .006）， 与对照组相比，运动组的 日间舒张压（-5.7 mm Hg；95% CI，-9.0 至 -2.4；P = .001）降低。诊室收缩压（-10.0 mm Hg；95% CI，-17.6 至 -2.5；P = .01）和心肺健康（每分钟耗氧量 5.05 mL/kg；95% CI，3.5 至 6.6；P  < .001）在运动组中也比对照组有所改善。

结论和相关性 一项为期 12 周的有氧运动计划可降低顽固性高血压患者的 24 小时和日间动态血压以及诊室收缩压。这些发现为临床医生提供了将中等强度有氧运动作为针对该患者群体的标准辅助治疗的证据。

试验注册 ClinicalTrials.gov 标识符：NCT03090529