Blood Flow Restriction Training And A Mechanistic Approach To Explaining Hypertension
Get your textbooks and notebooks out because today we’re going in on the physiology of blood pressure. For you millennials out there, back when I was in school, a “textbook” was a large paper book with pages of words and “taking notes” meant opening a “notebook” made of “paper” and using a “pen” to “write” on said pages of paper. Sometimes we would even use a “highlighter” to help emphasize certain words or phrases. I also, in order to talk to my first girlfriend, I had to look up her home phone number in the school phone directory. I called, her father answered the phone, and I said, “I’m sorry, I have the wrong number.” Then I crawled into the fetal position and went to bed…
Ok. Here, we, go!
The renin-angiotensin axis (RAA) is the main pharmacological target for reducing hypertension due to its role in inducing increases in systemic vascular resistance. However, there is a counter-axis known as the ACE2/Angiotensin-(1-7)/MAS axis (AAA) that exists to counter-regulate the systemic changes produced by the RAA axis. Unfortunately, this axis has been shown to be inhibited in chronic diseases such as hypertension and diabetes. Non-pharmacological interventions like exercise may help restore the balance between axes to help reduce blood pressure and reduce reliance on pharmacology.
A recent study (Joshi, 2020) provides preliminary in-vivo evidence to suggest that an acute bout of low-load (10% 1RM) BFR leg extension exercise provides the acute cellular signaling required to stimulate recruitment of specialized cells known as hematopoeitic stem/progenitor cells through ACE2 activation. These cells are responsible for increasing vasculogenesis (creation of new vascular beds) and facilitating anti-hypertensive effects. In fact, regional hypoxia was negatively correlated to the expression of growth factors like vascular endothelial growth factor (VEGF) (-0.88) and stromal-derived factor-1a (SDF) (-0.85) and higher levels of hypoxia showed a favorable increase in ACE2/ACE levels (-0.92), suggesting an effect that may act to reduce inhibition of the RAA axis over time.
Providing non-pharmacological means to enhance quality of life is crucial and it appears that the hypoxia provided through BFR training may provide a novel therapeutic target for individuals with chronic disease that have an altered RAA.
SOURCE:
Joshi S, Mahoney S, Jahan J, Pitts L, Hackney KJ, Jarajapu YP. Blood flow restriction exercise stimulates mobilization of hematopoietic stem/progenitor cells and increases the circulating ACE2 levels in healthy adults. J Appl Physiol (1985). 2020 May 1;128(5):1423-1431. doi: 10.1152/japplphysiol.00109.2020. Epub 2020 Apr 23. PMID: 32324479; PMCID: PMC7272753.
Adapted from: https://www.instagram.com/p/CQXF0XbjxQr/
****Remember, the decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.
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