Magnitude da hipotensão pós-exercício aeróbio agudo: Uma revisão sistemática dos estudos randomizados

Abstract

ARTIGO DE REVISÃO | REVIEW ARTICLE RESUMOObjetivou-se revisar sistematicamente estudos randomizados sobre a magnitude da hipotensão pós-exercício (HPE) em adultos. Consultaram-se as bases Pubmed, Scielo e Lilacs, combinando os indexadores "exercise" e "hypotension", sendo encontrados 1336 estudos. Destes, excluíram-se 1268 por títu-los, 37 por resumos, 10 não randomizados, 1 por repetição de dados, restando 20. Estes foram avaliados segundo os itens de randomização, mascaramento, sigilo de alocação, análise por intenção de tratar e quantitativamente pela Escala de Jadad. As reduções das pressões sistólica (PAS) e diastólica (PAD) em normotensos foram inferiores à dos hipertensos (−9±3 vs −11±6 mmHg e −5±2 vs −8±6 mmHg, respetivamente). Em ambos os grupos, os indivíduos ativos apresentaram HPE maior que os sedentários (normotensos: PAS −10±4 vs −8±1 mmHg; PAD −5±1 vs −4±1 mmHg; hipertensos: PAS −16±4 vs −9±2 mmHg; PAD −7±4 vs −5±3 mmHg, respetivamente). Nestes estudos, a magnitude da HPE variou entre −4 a −19 mmHg para PAS e −2 a −9 mmHg para PAD, valores que dependem tanto das características da amostra, seus estágios pressóricos iniciais, sexo e nível de atividade física, como também do protocolo de exercício utilizado, não havendo consenso sobre a influência da sua duração ou da intensidade do exercício. Palavras-chave: exercício, pressão arterial, hipotensão pós-exercício ABSTRACTThe objective was to carry out a systematic review of randomized trials on the magnitude of post exercise hypotension (PEH) in adults. 1336 studies were retrieved from PubMed, Scielo and Lilacs, after searching "exercise" and "hypotension". 1268 papers were excluded by titles, 37 by abstracts, 10 were nonrandomized, 1 by repeating data, leaving 20. These studies were evaluated according to the randomization, blinding, allocation concealment, analysis by intention to treat and quantitatively by the Jadad Scale. The average reductions in systolic (SBP) and diastolic (DBP) of the normotensive were lower than hypertensive (−9±3 vs. −11±6 mmHg and −12±2 vs. −8±6 mmHg, respectively) in both groups, active individuals had greater PEH than sedentary individuals (normotensive SBP −10±4 vs. −8±1 mmHg, PAD −5±1 vs. −4±1; hypertensive SBP −16±4 vs −9±2 mmHg; PAD −7±4 vs. −5±3 mmHg, respectively). In randomized studies the magnitude of PEH ranged from −4 to −19 mmHg for SBP and −2 to −9 mm Hg for DBP values according to the sample characteristics (blood pressure early stages, gender and level of physical activity) and the exercise protocols selected (i.e., there is no consensus on the influence of duration and intensity).

Effect of a pompage protocol on hemodynamic behavior during and on isometric exercise recovery in elderly: randomized and controlled study

“…However, knowing that some patients do not respond adequately to physical exercise, do not show post-exercise hypotension (27) , and are aware of the musculoskeletal limitations that some elderly people may have, studies of other non-pharmacological complementary therapies are necessary to this population.…”

Efeitos agudos e subagudos de uma sessão de montaria a cavalo sobre variáveis cardiovasculares de indiví­duos jovens e saudáveis

“…Apesar de algumas divergências entre autores, de forma geral, a HPE tende a ocorrer tanto em indivíduos hipertensos quanto em normotensos, em diferentes faixas etárias, e parece acontecer após exercícios de curta ou longa duração, independente de sua intensidade e em ambos os sexos. Entretanto, normalmente indivíduos com níveis de PA iniciais mais altos (principalmente hipertensos) apresentam HPE mais significativa [29,30]. Apesar de, aparentemente, não haver diferenças na HPE em relação ao sexo, o presente estudo demonstrou um maior decréscimo da PA nos homens do que nas mulheres, sendo significativo apenas na PAS dos homens.…”

Neural mechanismsand post-exercise hypotension: The importance of experimental studies

“…Post-exercise hypotension (PEH) has been observed in normotensive and hypertensive humans 8,9 , likewise, in animal models of hypertension 7 , being greater in hypertensive than normotensive subjects 24,25,26 . In humans, PEH has been documented following various types of dynamic exercise (walking, running, cycling, and swimming), as well as in resistance exercise 7,25,26,27,28 .…”

“…They concluded that a single bout of resistance exercise could have a blood pressure-lowering effect that lasts up to 24 hours. Marques-Silvestre et al 9 found in their systematic review, relevant reductions of systolic/diastolic blood pressure after a session of dynamic aerobic exercise and it was maintained for several hours. Therefore, these post-exercise blood pressure reductions could have an impact on cardiovascular health, since a 5 mm Hg reduction is clinically significant and is associated with risk reduction for stroke and heart disease of 15%-20% 36 .…”

“…The arterial baroreceptor in hypertensive subjects adapts to high levels of blood pressure, via receptors depolarization reduction, diminishing thus its functional capacity 5,6 . The role of physical exercise in blood pressure reduction has been well documented in animal models 7 and humans 8,9 , and this phenomenon occurs due to adjustments in the neurohumoral mechanisms. Post-exercise hypotension [PEH] is a prolonged decrease in arterial blood pressure after a single bout of exercise 7 .…”