Effect of chronic angiotensin system inhibitor treatment on cardiovascular adaptations to exercise training in adults with metabolic syndrome.

Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are commonly prescribed alongside exercise to manage hypertension in individuals with metabolic syndrome (MetS). However, whether chronic renin-angiotensin system (RAAS) inhibition modifies exercise-induced physiological adaptations remains unclear. In this prospective parallel-group study, 62 sedentary adults with MetS completed a 16-week supervised high-intensity interval training (HIIT) program. Participants were either chronically treated with ACEi or ARBs (antihypertensive medication group, AHM, n = 27) or not receiving pharmacological treatment (CONTROL, n = 35). Primary outcomes included changes in resting and exercise blood pressure (BP), MetS components, and cardiorespiratory fitness (CRF). Both groups showed significant improvements over time in cardiometabolic health (MetS Z-score: AHM -0.22 ± 0.42; CONTROL -0.30 ± 0.33; p < 0.001) and CRF (VO2MAX: AHM 3.9 ± 2.1; CONTROL 5.0 ± 3.1 mL·kg⁻¹·min⁻¹; p = 0.003), with no significant time × group interactions (all p > 0.05). Resting blood pressure decreased similarly in both groups (mean arterial pressure [MAP]: AHM -4.2 ± 8.7; CONTROL -6.5 ± 6.3 mmHg; p = 0.005; interaction p > 0.05). Exercise blood pressure responses also improved, with significant time effects for maximal MAP (p = 0.008) and submaximal diastolic BP (p = 0.047), without between-group differences (interaction p > 0.05). Chronic treatment with ACEi or ARBs does not appear to attenuate improvements in cardiometabolic health, BP, or CRF by 16 weeks of supervised HIIT in adults with MetS. These findings suggest that RAAS inhibition is compatible with structured exercise training, supporting HIIT as an effective adjunct therapy in individuals receiving antihypertensive medication. However, the absence of significant interactions should be interpreted in the context of limited power to detect small-to-moderate differences.