# Introduction vidences show that every year, worldwide9.4 million people deaths die from complications of hypertension, which has become a global public health problem.(1) Hypertension is a major risk factor that contributes to cardiovascular disease, including coronary artery disease, stroke, and heart failure. (2,3)Additionally risk factors increased the prevalence of hypertension include population growth, increased age and behavioral risk factors, such as unhealthy diet, tobacco use, consumption of alcohol, excess weight, exposure to persistent stress, high cholesterol, diabetes mellitus, and lack of physical activity. Furthermore, Strategies implemented to prevent and manage hypertension include reducing exposure to behavioral risk factors and early detection and treatment of hypertension. (4) That found a Prehypertension is characterized by systolic blood pressure of 120-139 mmHg and diastolic blood pressure of 80-89 mmHg, measured at rest. (5)High total peripheral resistance is the most commonly reported mechanism for the mildly increased blood pressure in hypertension, which is often accompanied by decreased arterial compliance. (6) Although it is unclear whether these changes occur in prehypertension. (21) Hypertension is responsible for 45%of cardiovascular deaths owing to heart disease and 51% owing to stroke worldwide.(1) Antihypertensive medications are effective at controlling blood pressure and have minimal side effects; however, only half the people with hypertension reach treatment goals. (38) Current first-line treatment for hypertension is nonpharmacological lifestyle modification including eating healthy diet, cessation of smoking, and increasing physical activity. (2,3,35) Currently, the recommended exercise program me for blood pressure management in adults is dynamic endurance aerobic exercise of at least 150-minute moderate intensity,75-minutevigorous intensity, or an equivalent combination of both each1week, as well as at least 2 days of muscle strengthening. (7)They found one important factor that may impact the effectiveness to lower blood pressure (BP) is the type of exercise performed. Analyses suggest isometric exercise may elicit BP reductions greater than those seen with dynamic aerobic and resistance exercise. (33,34) However, isometric handgrip activity may become a new tool in the nonpharmacological treatment of high BP. (30,32) Isometric exercise involves sustained contraction against an immovable load or resistance with no or minimal change in length of the involved muscle group. Aerobic exercise performance has been shown to be inversely related to hemodynamic measurements. (38) Recent analyses suggest that isometric resistance training (IRT) may elicit blood pressure reductions greater than those seen with dynamic aerobic and resistance exercise.(2,8,9) A recent systematic review and subsequent meta-analysis confirms previous findings that IRT reduces systolic blood pressure (SBP) by almost 7mmHg, whereas diastolic blood pressure (DBP) and mean arterial pressure (MAP) were both lowered by almost 4mmHg. (2) Low-to moderate-intensity isometric handgrip exercise can be performed anywhere, requires relatively inexpensive equipment, and does not elicit the same level of cardiovascular stress as aerobic exercise.( 2 I strength is associated with lower BP. (23,24) Recent work suggests that IRT may become a new tool in the non-pharmacological treatment of high blood pressure. (10,12) males and individuals aged ?45 years, may acquire greater blood pressure reductions from IRT (13). Randomized controlled studies of IRT, for ?4 weeks in duration, have predominately used a 30% maximum voluntary contraction (MVC) and a sedentary control. (9) Ray and Carrasco( 14) utilized a sham group, which held a handgrip dynamometer, but did not generate any force. Previous studies have utilized a low intensity during isometric leg training. (15,16)We have found no reported studies, which have utilized an intensity <10% MVC handgrip exercise with prehypertensive and/or hypertensive participants. In addition, previous studies of 4 to 10 weeks duration have focused on people aged between 20 and 35 years or 60 and 80 years with a sedentary control. In addition isometric handgrip study with 10 participants aged 52±5 over 6 weeks have conduct. (17) II. # Methods This study conduct on Port Said Hospital extended from April 2018 to January 2019. The participants with high normal and pre hypertensive, aged between 50 and 65 years recruited from out Hospital clinic. Participants from males and Females had a resting SBP ?130mmHg and/or a resting DBP?85mmHg, were receiving pharmacotherapy to treat their BP. written informed consent. Participants were excluded if they had known cardiovascular disease or multiple comorbidities, smokers, carpal tunnel, and arthritis which may have been aggravated with handgrip exercise. Participant baseline characteristics are displayed in. Participants trained 3 days per week for 8 weeks non-dominant hand. Participants then completed 4 sets of 2-minute isometric handgrip contractions separated by 3-minute rest periods. # Table 1: Entheroment Pre and post intervention blood pressure was established to assess resting SBP, DBP, heart rate (HR), and MAP. The wrist blood pressure monitor method to enable continuous noninvasive BP measurements. All post tests were conducted 24 hours after the final day of week 8 IRT and within 2 hours of the initial pretesting time of day. Blood pressure was measured in the participants' dominant arm Baseline and 24-hour post-IRT blood pressure measurements were conducted with the participant lying supine, with their arm relaxed by their side. Spss version was used to calculate the mean and standard deviation for the last 15, 30, 60, and the entire 120seconds of baseline and post-IRT recording. # III. Results 20 participants who completed the 2 months study of IRT, to establish the size of reduction in blood pressure, a 120-second resting baseline blood pressure recording was taken before and 24hours post-IRT Paired t test (Table 2). Wrist blood pressure monitor measurements were Paired t test analysis of blood pressure, MAP, and HR. Two months of isometric handgrip training resulted in a significant reductions were 7-mmHg reduction in baseline versus post intervention SBP of (p=0.04*). Paired t test however, there were no significant reductions in DBP. Significant reductions were observed in MAP from baseline to post intervention of 4mmHg (p=0.04*) in (Table 5). Analysis indicated an unchanged (P=0.37). ANOVA measures for 15, 30, 60, and 120seconds of pre-and post-resting SBP, DBP, MAP, and HR showed that the only data with statistically significant variation across the 4 measurements, the SBP and MAP as seen in Table 2 were significant with * P < 0.04, Based on this analysis, it was determined that the 120-second data were more stronger. IV. # Discussion The main finding of this study was that significant reductions in SBP and MAP in individuals conducting IRT for 8 weeks. The reduction in SBP was clinically significant 7mmHg and MAP 4 mmHg. The 5reduction in SBP is considered clinically meaningful (>3mmHg). (24,25) Evidence demonstrated, the effect of isometric handgrip exercise on reducing BP in normotensive and hypertensive populations. (22) In addition, the positive associations between handgrip strength and BP explained the mechanism that Peripheral vascular resistance increases with chronological age due to reduced sympatholytic, which results in an elevated sympathetic tone. (19,18) And vascular resistance increased with morphological changes in the arteriolar network. (11) Furthermore, BP is associated with the age-associated loss of lean mass. (37,36) The results seen in this study reflect those seen in previous IRT studies, which also demonstrated significant reductions in SBP over an 8-week period. (2,35,8,13) When baseline blood pressure was added as a covariate, secondary analysis showed that SBP, DBP, MAP, and HR were all significantly reduced. Although it is unclear whether the size of these reductions is clinically meaningful, it found that the magnitude of blood pressure reductions following IRT is directly related to pre-training blood pressure levels . ( 26 # Conclusion Reduction in SBP after 8 weeks of IRT, indicating that IRT may be an alternative exercise for people who are unable to reach the current recommendations of 2.5 hours of weekly aerobic exercise, to aid in their blood pressure management. IHG exercise training might be a simple, effective, inexpensive and non-pharmacological method in lowering blood pressure. ![) Although most evidence indicates that greater handgrip E](image-2.png "") ![Figure 3](image-3.png "") ![Figure 5](image-4.png "") ![)Which could perhaps be explained by regression to the mean. Mean DBPs at baseline in our study were within the normal range, having population baseline mean <85mmH. Taking into account the limited potential for further reductions in DBP, we did not expect to see much of a reduction in DBP after IRT intervention in either group. No significant reduction in DBP. Some small studies have failed to show DB Preductions; Howden et al(27) who had 8 participants conducting 5 weeks of IRT and Taylor et al.(28) with 9 participants after 10weeks of IRT, saw no statistical reductions in DBP with baseline<85mmHg. In contrast, both single studies (29) and pooled analyses from several studies (2,8,10) have shown significant reductions in DBP after IRT. Although baseline DBP may predict significant responses to IRT, again it is unclear whether the size of these reductions is clinically meaningful. The significant reduction in MAP lowered from 100 to 96mmHg, which is clinically meaningful. Reductions in MAP were also seen by Carlsonet al (2) and Millar et al.(35)No changes in HR, The absence of change in resting HR indicates that IRT has a minimal effect on the parasympathetic nervous system. Other analyses have failed to show a reduction in HR with IRT when conducting an isometric handgrip protocol.(29,31)The results of this study confirmed the overall that IRT lowers SBP, DBP and MAP. The magnitude of effect may belarger in hypertensive males aged ?45 years, using unilateral arm IRT for 48 weeks.(39) ](image-5.png "") 2PreMean, spostPSystolic136±12129±150.04 *Diastolic77±775±90.21MAP100±896±110.04 *HR67±969±110.37IFigure 1 3Systolic( mmHg)15 s30s60s120sANOVA (F)PPre135±13135±13135±13136±120.4820.58Post129±16128±16129±16129±150.4140.67P0.070.060.060.04*Table3exhibits comparisons between 15, 30, and 60-second sampling, against the 120-secondSystolic blood pressure recordingFigure 2 4Diastolic(mmHg)15 s30s60s120sANOVA (F)PPre76±776±777±777±72.2040.13Post75±974±974±975±90.1200.86p0.430.320.270.21 5MAP(mmHg)15 s30s60s120sANOVA (F)PPre99±999±999±9100±81.4660.25Post95±1195±1195±1196±110.1430.87P0.120.070.05*0.04* 5exhibits comparisons between 15, 30, and 60-second sampling, against the 120-secondMAP recordingFigure 4 6HR(bpm)15 s30s60s120sANOVA (F)PPre67±967±967±967±90.2470. 71Post69±1269±1169±1169±110.8140. 42P0.330.340. 430.37 6exhibits comparisons between 15, 30, and 60-second sampling, against the 120-secondHR recording © 2020 Global Journals © 2020 Global JournalsThe Effect of Handgrip Exercises on Blood Pressure * A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions SLim TVos AFlaxman Lancet 380 1990-2010. 2010. 2012 : a systematic analysis for the global burden of disease study * Isometric exercise training for blood pressure management: a systematic review and meta-analysis DCarlson GDieberg N Mayo Clin Proc 89 2014 * Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure AChobanian JWright ERoccella Hypertension 42 2003 * Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the RBrook LAppel MRubenfire American Heart Association. Hypertension 61 2013 * The six-minute walk distance is a marker of hemodynamic-related functional capacity in hypertension: a case control study RARamos FSGuimaraes ICordovil ADe Sa Ferreira Hypertens Res 37 2014 * Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension KEFerrier MHMuhlmann JPBaguet JDCameron GLJennings AMDart J Am Coll Cardiol 39 2002 * Heart disease and strokestatistics-2016 update: a report From the DMozaffarian HJFullerton VJHoward American Heart Association. Circulation 133 2015 * Exercise training for blood pressure: a systematic review and metaanalysis VACornelissen NASmart J Am Heart Assoc 2 2013 * Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions PJMillar CLMcgowan VACornelissen Sports Med 44 2014 * Isometric handgrip exercise and resting blood pressure: a meta-analysis of randomized controlled trials GAKelley KSKelley J Hypertens 28 2010 * Effect v of aging on the structure and function of skeletal muscle microvascular networks SEBearden Microcirculation 13 2006 * Cardiovascular stress reactivity tasks successfully predict the hypotensive response of isometric handgrip training in hypertensives MBBadrov SHorton PJMillar * Psychophysiology 50 2013 * Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit JDInder DJCarlson GDieberg Hypertens Res 39 2015 * Isometric handgrip training reduces arterial pressure at rest without changes in sympathetic nerve activity CARay DICarrasco Am JPhysiol Heart CircPhysiol 279 2000 * Effects of the intensity of leg isometric training on the vasculature of trained and untrained limbs and resting blood pressure in middle-aged men AWBaross JDWiles ILSwaine Int J Vasc Med 2012 2012 * The effects of performing isometric training at two exercise intensities in healthy young males JDWiles DAColeman ILSwaine Eur J ApplPhysiol 108 2010 * Shortterm isometricexercise reduces systolic blood pressure in hypertensive adults: Possiblerole of reactive oxygen species PGPeters HMAlessio AEHagerman Int J Cardiol 110 2006 * Evidence for reduced sympatholysis in leg resistance vasculature of healthy older women BAParker SLSmithmyer SSJarvis SJRidout JAPawelczyk DNProctor Am J Physiol Heart Circ Physiol 292 2007 * Metabolic modulation of sympathetic vasoconstriction in exercising skeletal muscle JHansen MSander GDThomas Acta Physiol Scand 168 2000 * Noninvasive continuous hemodynamic monitoring JTruijen JJVan Lieshout WAWesselink J ClinMonitComput 26 2012 * Large artery stiffness: Implications for exercise capacity and cardiovascular risk BAKingwell Clin Exp Pharmacol Physiol 29 2002 * Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions PJMillar CLMcgowan VACornelissen CGAraujo ILSwaine Sports Med 44 2014 * Clinically meaningful blood pressure reductions with low intensity isometric handgrip exercise. A randomized trial NCHess DJCarlson JDInder EJesulola JRMcfarlane NASmart Physiol Res 65 2016 * Isometric handgrip exercise and resting blood pressure: a meta-analysis of randomized controlled trials GAKelley KSKelley J Hypertens 28 2010 * Blood pressure lowering efficacy of nonselective beta-blockers for primary hypertension GWWong JMWright Cochrane Database Syst Rev2014 * Effects of isometric handgrip training among people medicated for hypertension: a multilevel analysis PJMillar SRBray CLMcgowan Blood Press Monit 12 2007 * The effects of isometric exercise training on resting blood pressure and orthostatic tolerance in humans RHowden JTLightfoot SJBrown Experiment Physiol 87 2002 * Isometric training lowers resting blood pressure and modulates autonomic control ACTaylor NMccartney MVKamath Med Sci SportsExerc 35 2003 * The hypotensive effects of isometric handgrip training using an inexpensive spring handgrip training device PJMillar SRBray MJMacdonald J CardiopulmRehabilPrev 28 2008 * Effect of isometric exercise on resting blood pressure: a meta-analysis AOwen JWiles ISwaine J Hum Hypertens 24 2010 * Cardiovascular reactivity to psychophysiological stressors: association with hypotensive effects of isometric handgrip training PJMillar SRBray MJMacdonald Blood Press Monit 14 2009 * Isometric handgrip exercise and resting blood pressure: A meta analysis of randomized controlled trials GAKelley KSKelley J Hypertens 28 2010 * Isometric exercise training for blood pressure management: a systematic review and metaanalysis DJCarlson GDieberg NHess PMillar NASmart ClinProc2014 89 Mayo * Exercise training for blood pressure: a systematic review and metaanalysis VACornelissen NASmart J Am Heart Assoc 2 e004473 2013 * Isometric handgrip training lowers blood pressure and increases heart rate complexity in medicated hypertensive patients PJMillar ASLevy CLMcgowan Scand J Med Sci Sports 23 2013 * Anthropometric measurements from a cross-sectional survey of Irish free-living elderly subjects with smoothed centile curves CACorish NPKennedy Br J Nutr 89 2003 * Aging of skeletal muscle: a 12-yr longitudinal study WRFrontera VAHughes RAFielding MAFiatarone WJEvans RRoubenoff J Appl Physiol 88 2000 * Cost implications of improving blood pressure management among U.S. adults TKNuckols JEAledort JAdams Health Serv Res 46 2011 * Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit D IJodie J CDeborah GudrunDJames R M NicoleClNeil A Hypertension Research 39 2016