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Central and peripheral mechanisms underlying postexercise hypotension: a scoping review.

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Postexercise hypotension (PEH) lowers blood pressure after exercise. While linked to autonomic control, local vasodilators may be more critical. Further research is needed to clarify PEH mechanisms.

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Area of Science:

  • Exercise Physiology
  • Cardiovascular Health
  • Hypertension Management

Background:

  • Postexercise hypotension (PEH) is a significant blood pressure reduction following exercise.
  • PEH holds clinical importance for chronic blood pressure lowering and predicting exercise training response.
  • The precise physiological mechanisms driving PEH remain incompletely understood.

Purpose of the Study:

  • To conduct a scoping review of existing literature reviews on the mechanisms of postexercise hypotension.
  • To synthesize current knowledge on central and peripheral physiological systems contributing to PEH.
  • To identify gaps in understanding and guide future research directions for PEH mechanisms.

Main Methods:

  • A comprehensive literature search was performed across major scientific databases (PubMed, Web of Science, Scopus, CINAHL, Cochrane, SportDiscus) up to January 2023.
  • The review included 21 literature reviews: 13 narrative, 4 systematic (102 primary trials), and 4 meta-analyses (75 primary trials, 1566 participants).
  • Mechanisms were classified into central (autonomic nervous system, baroreflex, cardiac) and peripheral (vascular, hemodynamic, humoral, renal) categories.

Main Results:

  • PEH is generally associated with altered autonomic control, leading to reduced cardiac output or vasodilation.
  • Evidence suggests a potential shift in emphasis from autonomic control to local vasodilator factors in eliciting PEH.
  • The specific contributions of various physiological factors to PEH are unclear, particularly across different exercise types and populations.

Conclusions:

  • While autonomic nervous system changes are implicated, local vasodilator mechanisms may play a more significant role in PEH.
  • Further integrated research is necessary to elucidate the complex mechanisms of PEH.
  • Understanding PEH mechanisms is crucial for optimizing exercise as an antihypertensive therapy, especially for clinically relevant blood pressure reductions.