Estilo de vida fisicamente ativo e adaptações hemodinâmicas na hipertensão arterial resistente

Abstract

INTRODUCTION: Patients diagnosed with resistant hypertension are directly related to worse prognosis for mortality. On the other hand, it has been reported that physical training is effective in lowering the blood pressure in these patients. However, the guiding mechanisms of blood pressure reduction caused by physical exercise are not yet known. In this sense, the objectives of this study were: 1) Check in resistant hypertension patients to regular physical and / or exercise activities interfere in the values of heart rate, stroke volume, or total peripheral resistance. 2) To test the hypothesis that physically active resistant hypertensive patients have a lower peripheral vascular resistance when compared to sedentary resistant hypertensive patients. MATERIALS AND METHODS: Fourteen patients with hypertension physically active resistant (active group; 66 ± 7 years) and fourteen patients with hypertension resistant sedentary (Sedentary group; 57 ± 8 years), similar in BMI (29.5 ± 3.3 vs. 29.4 ± 2.7 kg / m2, p = 0.99), use of medications and comorbidities. Blood pressure (auscultation - Unitec®), heart rate (electrocardiogram - Dixtal® 2022), stroke volume (beat to beat - Finometer Pro®) and forearm blood flow (venous occlusion plethysmography - Hokanson®) were recorded for 5 minute at rest. Peripheral vascular resistance was calculated by dividing average blood pressure by forearm blood flow. It was considered significant P value less than or equal to 0.05. RESULTS: Patients with resistant hypertension physically active had lower systolic blood pressure (133 ± 14 vs. 153 ± 19 mmHg, p <0.01) and diastolic blood pressure (72 ± 6 vs. 83 ± 12 mmHg, p = 0.01). Contemplating the first goal, the significant reduction in heart rate in the active group (64 ± 5 vs 72 ± 12 bpm, p = 0.03) was the mechanism responsible for reducing blood pressure in this group. That's because there was no significant difference between the active and Sedentary groups for systolic volume measures (98 ± 26 vs. 108 ± 25 ml, respectively, p = 0.32) and total peripheral resistance (17 ± 6 vs. 16 ± 6 units, respectively, p = 0.53). Regarding the second objective, the forearm blood flow was similar between the active groups and Sedentary (2.9 ± 0.9 vs. 2.4 ± 0.9 ml / min / 100 ml, respectively, p = 0.14) . However, when evaluated peripheral vascular resistance forearm, physically resistant hypertension showed significantly lower asset values compared to sedentary resistant hypertension (38 ± 14 vs. 52 ± 18 units, respectively, p = 0.03). In addition, by calculating the Cohen d, it was considered high effect size for the variables: systolic blood pressure, diastolic and mean, by auscultation; systolic blood pressure and average at oscillometry; diastolic blood pressure 24 hours, diastolic blood pressure during the wakefulness period and systolic and diastolic blood pressure during sleep, the outpatient method; heart rate and peripheral vascular resistance. CONCLUSION: Patients diagnosed with resistant hypertension in physically active have lower blood pressure value and heart rate when compared to their sedentary peers. Furthermore, peripheral vascular function in these forearm is best physically active patients.