BACKGROUND: COVID-19 has become a dramatic health problem during this century. In addition to high mortality rate, COVID-19 survivors are at increased risk for cardiovascular diseases 1-year after infection. Explanations for these manifestations are still unclear but can involve a constellation of biological alterations. We hypothesized that COVID-19 survivors compared with controls exhibit sympathetic overdrive, vascular dysfunction, cardiac morpho-functional changes, impaired exercise capacity, and increased oxidative stress. METHODS: Nineteen severe COVID-19 survivors and 19 well-matched controls completed the study. Muscle sympathetic nerve activity (microneurography), brachial artery flow-mediated dilation and blood flow (Doppler-Ultrasound), carotid-femoral pulse wave velocity (Complior), cardiac morpho-functional parameters (echocardiography), peak oxygen uptake (cardiopulmonary exercise testing), and oxidative stress were measured ~3 months after hospital discharge. Complementary experiments were conducted on human umbilical vein endothelial cells cultured with plasma samples from subjects. RESULTS: Muscle sympathetic nerve activity and carotid-femoral pulse wave velocity were greater and brachial artery flow-mediated dilation, brachial artery blood flow, E/e′ ratio, and peak oxygen uptake were lower in COVID-19 survivors than in controls. COVID-19 survivors had lower circulating antioxidant markers compared with controls, but there were no differences in plasma-treated human umbilical vein endothelial cells nitric oxide production and reactive oxygen species bioactivity. Diminished peak oxygen uptake was associated with sympathetic overdrive, vascular dysfunction, and reduced diastolic function in COVID-19 survivors. CONCLUSIONS: Our study revealed that COVID-19 survivors have sympathetic overactivation, vascular dysfunction, cardiac morpho-functional changes, and reduced exercise capacity. These findings indicate the need for further investigation to determine whether these manifestations are persistent longer-term and their impact on the cardiovascular health of COVID-19 survivors.
This study tested the hypothesis that: 1-the exercise training would improve the heart rate recovery (HRR) decline after maximal exercise test in hypertensive patients and; 2-the exercise training would normalize HRR decline when compared to normotensive individuals. Methods: Sixteen hypertensive patients were consecutively allocated into two groups: Exercise-trained (n = 9, 47±2 years) and untrained (n = 7, 42±3 years). An exercise-trained normotensive group (n = 11, 41±2 years) was also studied. Heart rate was evaluated by electrocardiogram. The autonomic function was evaluated based on heart rate changes on the first and the second min of recovery after the maximal exercise test. Exercise training consisted of three 60-minute exercise sessions/week for 4 months. Results: In hypertensive patients, exercise training significantly increased the HRR decline in the first (-19±2 vs.-34±3 bpm, P = 0.001) and second (-33±3 vs.-49±2 bpm, P = 0.006) minutes after the maximal exercise test. In addition, after exercise training, the initial differences in the HRR decline after exercise between hypertensive patients and normotensive individuals were no longer observed (first minute:-34±3 vs.-29±3 bpm, P = 0.52, and second minute:-49±2 vs.-47±4 bpm, P = 0.99). Conclusion: Hypertension causes a delay in HRR after the maximal exercise test yet the exercise training normalizes HRR during the post-exercise period in hypertensive patients.
A hipertensão arterial (HA) é uma doença crônica, caracterizada por elevações persistentes dos níveis pressóricos com implicações clínicas importantes e alta preva - lência em nosso país. No tratamento da HA, são recomendadas modificações do estilo de vida, incluindo maior atividade física. Diversas diretrizes recomendam a realização do exercício físico (EF) para tratamento e prevenção da HA, porém muitos pacientes não aderem a essa prática. Os exercícios mais recomendados são os aeróbicos e os resistidos dinâmicos. Entretanto, outros tipos de exercício têm se mostrado efetivos para a redução dos níveis pressóricos de pacientes hipertensos e indivíduos pré-hipertensos. Além disso, estratégias como o exercício não supervisionado também parecem ter impacto positivo na prevenção e no tratamento dessa comorbidade. Esses tipos de estratégia têm importância maior neste momento em que a pandemia de COVID-19 e o consequente isolamento social impossibilitaram grande parte da população, principalmente dos grupos de risco, como é o caso dos pacientes hipertensos, de realizar EF em academias, grupos de reabilitação presenciais e locais fechados. Curiosamente, a hora do dia em que esses exercícios são realizados, também parece influenciar a magnitude do efeito hipotensor agudo e crônico nesses pacientes. Além disso, sabe-se que a HA tem fatores genéticos/epigenéticos envolvidos em sua fisiopatologia. Assim, a investigação de mecanismos moleculares como o papel dos microRNAs nessa comorbidade é de grande interesse e ganhou destaque nos últimos anos. Esta revisão tem como objetivo destacar os estudos mais atuais sobre temas envolvidos no controle e tratamento da HA com participação do EF.
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