Physical exercise improves cardiac autonomic modulation in hypertensive patients independently of angiotensin-converting enzyme inhibitor treatment

Abstract

We investigated the influence of angiotensin-converting enzyme inhibitor (ACEi) treatment and physical exercise on arterial pressure (AP) and heart rate variability (HRV) in volunteer patients with hypertension. A total of 54 sedentary volunteers were divided into three groups: normotensive (NT Group), hypertensive (HT Group) and HT volunteers treated with ACEi (ACEi Group). All volunteers underwent an aerobic physical-training protocol for 15 weeks. HRV was investigated using a spectral analysis of a time series of R-R interval (RRi) that was obtained in a supine position and during a tilt test. Physical training promoted a significant reduction in the mean arterial pressure of the HT group (113 ± 3 vs. 106 ± 1 mm Hg) and the ACEi group (104 ± 2 vs. Keywords: aerobic physical training; angiotensin; heart rate variability INTRODUCTION Hypertension is highly prevalent in the adult population and represents one of the leading causes of morbidity and mortality worldwide. 1,2 This condition is directly related to the development of cardiovascular diseases, encephalic vascular accident and renal insufficiency. 3 The risk factors for hypertension are associated with many other factors, including lifestyle. 4 The excessive ingestion of salt and alcohol, obesity, smoking and sedentariness represent the main behavioral factors that contribute to the occurrence and development of hypertension. 5 The treatment of hypertension consists mainly of a pharmacological approach, and the angiotensin-converting enzyme inhibitors (ACEis) are an important class of medications. 6 ACEis reduce arterial pressure (AP) by decreasing the peripheral vascular resistance, and they reduce cardiac hypertrophy and the proliferation of vascular smooth muscle cells. 7-9 Additionally, ACEis have an important role in cardiac autonomic control. Some studies have shown that ACEi treatment of hypertension in experimental animals and humans improves baroreflex

Effects of physical training on autonomic cardiac modulation in hypertension: assessment by heart rate variability analysis

“…Such an approach may provide a more comprehensive analysis of cardiovascular regulation mechanisms than that represented by the separate analysis of BP and HR variability alone. 28 In conclusion, the data by Cozza et al 18 provide further support to the concept, promoted by a number of previous studies, that exercise training in hypertensive patients may carry benefits, not only due to better BP control but also due to improved cardiac autonomic modulation. They also emphasize the usefulness of spectral analysis for dynamically tracking changes in neurally modulated HRV parameters induced by exercise over time.…”

“…[15][16][17] Thus, the analysis of HRV appears to represent a simple means to assess autonomic cardiac modulation and a valuable tool to track the autonomic adjustments in the CV system, induced by a number of pharmacological and non-pharmacological interventions, although its specificity should not be taken for granted. 9 Further information on the clinical applicability of HRV analysis in the assessment of the effects of physical exercise is provided by the paper by Cozza et al 18 published in the current issue of Hypertension Research. This study assessed the effects of a 15-week protocol of aerobic physical training (45-min treadmill exercise, three times a week) on autonomic cardiac modulation (as assessed by means of spectral analysis of HRV) in a group of sedentary, non-treated subjects with mild essential hypertension.…”

Effects of antihypertensive treatment on cardiovascular autonomic control: a prospective study

“…Tilt test is used traditionally for diagnosis of syncope (34,35) and orthostatic hypotension (36), study of sympathetic activity (37), study of the influence of various agents and factors on autonomic control (38), etc. Therefore, the use of tilt test for study of drug influence on autonomic regulation, including baroreflex, is appropriate.…”

The results of rehabilitation of the patients presenting with arterial hypertension: the types of adaptation, the vegetative status, and intracardial hemodynamics

“…Это про-является увеличением HF при спектральном анали-зе ВРС в покое [1]. В другой работе снижение АД после ФТ у пациентов с АГ сопровождалось увели-чением значений SDNN (r=-0,46; p<0,05) и сниже-нием LF (r=0,46; p<0,05) [16].…”

“…Благоприятное влияние реабилитационных программ проявляется изменениями вегетативного баланса с повышением тонуса парасимпатической нервной системы [1], таким же эффектом обладают длительные физические тренировки (ФТ) [2,3]. В то же время неблагоприятные сдвиги в состоянии ор-ганизма сопровождаются симпатической активаци-ей, имеется связь показателей вегетативного балан-са с факторами риска сердечно-сосудистых заболе-ваний [4], поражением органов-мишений при арте-риальной гипертензии (АГ) [5,6].…”