Evaluating the Therapeutic Potential of Exercise in Hypoxia and Low-Carbohydrate High-Fat Diet in Managing Hypertension in Elderly Type 2 Diabetes Patients: A Novel Intervention Approach

Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by hyperglycemia, which could alter metabolic, vascular and hematological parameters. A low-carbohydrate, high-fat diet (LCHF) diet benefits glycemic and blood pressure control. In turn, exercise in hypoxia (EH) is known to improve insulin sensitivity, erythropoiesis and angiogenesis. LCHF combined with EH seem to be a potential therapeutic strategy for T2DM and hypertension (HTN), but evidence is still scarce. The aim of this study was to evaluate the effects of eight weeks of EH combined with a LCHF on hematological and lipid profiles, inflammation and blood pressure in older patients with T2DM and coexistent HTN. Diabetic patients with HTN (n=42) were randomly assigned to a (1) control group: control diet (high-carbohydrate and low-fat diet) + exercise in normoxia; (2) EH group: control diet + EH; (3) intervention group: LCHF + EH. Baseline and eight-week measurements included systolic, diastolic, and mean blood pressure (SBP, DBP, MAP, respectively), and hematological and lipid profiles and inflammation biomarkers. Blood pressure decreased after interventions (p<0.001), with no differences among groups (SBP: p=0.151; DBP: p=0.124 and MAP: p=0.18). There were no differences in lipid profile and C-reactive protein (p>0.05). Mean corpuscular hemoglobin (MCH) increased in the EH group (p=0.027), while MCH concentration decreased in the EH+LCHF group (p=0.046). In conclusion, there is no additional benefit in adding hypoxia to exercise or restricting carbohydrates, on blood pressure in patients with T2DM and coexisting HTN. Further elucidation of the mechanisms underlying hematological adaptations is imperative. Trial registration number: NCT05094505.