Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: A randomized controlled trial (HEx trial)

Guimarães, Guilherme Veiga; Cruz, Lais Galvani de Barros; Fernandes-Silva, Miguel Morita; Dórea, Egı́dio Lima; Bocchi, Edimar Alcides

doi:10.1016/j.ijcard.2014.01.100

Cited by 79 publications

(102 citation statements)

References 33 publications

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“…Entre estes estudos, cinco apresentaram abordagem aguda [24][25][26]28, 37 e 10 apresentaram abordagem crônica 23,27,29,[30][31][32][33][34][35][36] . Destes estudos, 20,0% apresentaram randomização adequada; em nenhum estudo foi relatada ocultação da alocação; assim como nenhum realizou cegamento de pacientes e pesquisadores; 20% tinham cegamento dos avaliadores dos desfechos; 80% descreveram perdas no acompanhamento e exclusões, e 33,3% dos estudos utilizaram o princípio de intenção de tratar para análises estatísticas.…”

Section: Resultsunclassified

“…Dos estudos incluídos, nove foram realizados no Brasil, dois nos Estados Unidos, um na China, um no Irã, um na Austrália e um na África do Sul. A hidroginástica foi a intervenção mais recorrente, aparecendo em 10 estudos [23][24][25][26][27][28][29][30][31][32] . A natação apareceu em cinco estudos 27,[33][34][35][36] , sendo que um deles realizou treinamento combinado com a hidroginástica 27 e apenas um estudo utilizou corrida aquática como forma de exercício 37 .…”

Section: Resultsunclassified

“…Em sete dos estudos foi referida a utilização de medicação anti-hipertensiva 23,25,26,28,29,31,32 , em três foi referida a não utilização 24,33,37 , em um estudo apenas quatro sujeitos do grupo controle faziam utilização de medicação 27 , em outro, apenas um sujeito utilizava 36 e em outro, dos 116 sujeitos, apenas 14 utilizavam fármaco 35 . Para os dois estudos restantes, os autores não apresentaram informações a respeito 30,34 .…”

Section: Resultsunclassified

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Efeitos de exercícios aeróbicos aquáticos sobre a pressão arterial em adultos hipertensos: revisão sistemática

Santos¹,

Costa²,

Kruel³

2014

Rev Bras Ativ Fís Saúde

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ResumoA hipertensão arterial é um importante fator de risco cardiovascular, sendo o exercício fí-sico reconhecido como tratamento não farmacológico de sujeitos com esta morbidade. No entanto, ainda são escassos estudos realizados no meio aquático. Dessa forma, o objetivo do presente estudo foi revisar sistematicamente os efeitos agudos e crônicos de exercícios aeróbicos aquáticos sobre a pressão arterial de indivíduos hipertensos. A busca incluiu as bases de dados PubMed, Embase, Lilacs e Scielo, sem restrição de idioma e com data de publicação até janeiro de 2014, além da revisão das referências nos estudos incluídos. Ensaios clínicos randomizados, não randomizados, estudos comparativos e casos-controles, verificando os efeitos dos exercícios aquáticos no tratamento da hipertensão, foram incluídos. Dos 83 artigos elegíveis, 15 foram incluídos. Os estudos foram publicados entre 1997 e 2014. No total, participaram dos estudos 377 sujeitos, com frequência de duas semanas a 12 meses nas intervenções crônicas e uma ou duas sessões nas intervenções agudas. A intensidade dos protocolos de treinamento variou de moderada a alta. Dos 5 estudos com intervenção aguda, 80% demonstraram redução da pressão arterial sistólica após a sessão de exercícios. Após o período de intervenção crônica, 80% dos 10 estudos incluídos demonstraram redução da pressão arterial, sendo 50,0% somente para a sistólica, 10% somente para a diastólica e 20% para ambas. Os resultados permitem concluir que exercícios aquáticos, sobretudo a hidroginástica, atuam positivamente na redução da pressão arterial, sendo uma alternativa eficiente para auxiliar no tratamento de adultos hipertensos. PalavRas-chaveHipertensão; Exercícios aquáticos; Natação; Hidroginástica; Corrida aquática.

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Section: Resultsunclassified

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Efeitos de exercícios aeróbicos aquáticos sobre a pressão arterial em adultos hipertensos: revisão sistemática

Santos¹,

Costa²,

Kruel³

2014

Rev Bras Ativ Fís Saúde

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“…1 Briefly, a cardiopulmonary exercise test was performed to exclude patients with coronary artery disease and to assess the training effect. Before the test perfomance all patients followed the strict behavioral criteria previously described.…”

Section: Exercise Test and Bp Evaluationmentioning

confidence: 99%

“…1 Whether and to what extent these BP-lowering effects are associated with, and presumably triggered by, modifications in the behavior of the neurohumoral systems that participate in the homeostatic control of BP and are activated in resistant HT, such as the sympathetic nervous system and the renin-angiotensin-aldosterone axis, 2-5 is largely unknown. In addition, no information is available on whether and to what extent HEx training is capable of exerting favorable effects on the endothelial dysfunction that characterizes resistant HT patients.…”

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confidence: 99%

Neurohumoral and Endothelial Responses to Heated Water-Based Exercise in Resistant Hypertensive Patients

Cruz¹,

Bocchi²,

Guimarães³

2017

Circ J

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155 patients with a diagnosis of resistant HT were screneed for the HEx trial in the HT outpatient clinic of the University Hospital of São Paulo, Brasil. We excluded 111 patients, with the remaining 44 patients included in the present study. They were sedentary, aged between 40 and 65 years, diagnosed as affected by resistant HT for more than 5 years, and who in the previous 6 months had unchanged and regular use of at least 3 optimally dosed antihypertensive drugs, including a diuretic, and displayed office systolic BP >140 mmHg, and/or diastolic BP >90 mmHg. 7 We used medical records to exclude patients with a history of secondary HT [e.g., chronic kidney disease (creatinine W e recently showed that heated water-based exercise (HEx) training exerts blood pressure (BP) lowering effects in patients with true resistant hypertension (HT) by significantly reducing office as well as ambulatory BP values recorded during a 24-h period. 1 Whether and to what extent these BP-lowering effects are associated with, and presumably triggered by, modifications in the behavior of the neurohumoral systems that participate in the homeostatic control of BP and are activated in resistant HT, such as the sympathetic nervous system and the renin-angiotensin-aldosterone axis, 2-5 is largely unknown. In addition, no information is available on whether and to what extent HEx training is capable of exerting favorable effects on the endothelial dysfunction that characterizes resistant HT patients. 5, 6 The present study was designed to provide information on the neurohumoral mechanisms of the BP-lowering effects of HEx training in resistant HT patients by assessing the sympathetic and renin-angiotensin as well as the Guido Grassi, MD; Guilherme Veiga Guimaraes, PhDBackground: The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water-based

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Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension

et al. 2021

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IMPORTANCE Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy. OBJECTIVE To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension. DESIGN, SETTINGS, AND PARTICIPANTS The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals' hypertension outpatient clinic. INTERVENTIONS Patients were randomly assigned in a 1:1 ratio to a 12-week moderateintensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care. MAIN OUTCOMES AND MEASURESThe powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness.RESULTS A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, −12.8 to −1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (−5.1 mm Hg; 95% CI, −7.9 to −2.3; P = .001), daytime systolic BP (−8.4 mm Hg; 95% CI, −14.3 to −2.5; P = .006), and daytime diastolic BP (−5.7 mm Hg; 95% CI, −9.0 to −2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (−10.0 mm Hg; 95% CI, −17.6 to −2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group.CONCLUSIONS AND RELEVANCE A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population.

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Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: A randomized controlled trial (HEx trial)

Abstract: HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.

Cited by 79 publications

References 33 publications

Efeitos de exercícios aeróbicos aquáticos sobre a pressão arterial em adultos hipertensos: revisão sistemática

Efeitos de exercícios aeróbicos aquáticos sobre a pressão arterial em adultos hipertensos: revisão sistemática

Neurohumoral and Endothelial Responses to Heated Water-Based Exercise in Resistant Hypertensive Patients

Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension

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