Cruz Lais Galvani de Barros, Bocchi Edimar Alcides, Grassi Guido, Guimaraes Guilherme Veiga
Laboratory of Physical Activity and Health Heart Institute, Clinical Hospital, Department of Medicine, Sao Paulo University.
Circ J. 2017 Feb 24;81(3):339-345. doi: 10.1253/circj.CJ-16-0870. Epub 2016 Dec 29.
The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water-based exercise (HEx) in resistant hypertension (HT) patients remain undefined.
We investigated these in 44 true resistant HT patients (age 53.3±0.9 years, mean±SEM). They were randomized and allocated to 2 groups, 28 to a HEx training protocol, which consisted of callisthenic exercises and walking in a heated pool for 1 h, three times weekly for 12 weeks and 16 patients to a control group maintaining their habitual activities. Measurements made before and after 12 weeks of HEx included clinic and 24-h BP, plasma levels of nitric oxide, endothelin-1, aldosterone, renin, norepinephrine and epinephrine, as well as peak V̇O, and endothelial function (reactive hyperemia). After 12 weeks of HEx patients showed a significant decrease in clinic and 24-h systolic and diastolic BPs. Concomitantly, nitric oxide increased significantly (from 25±8 to 75±24 μmol/L, P<0.01), while endothelin-1 (from 41±5 to 26±3 pg/mL), renin (from 35±4 to 3.4±1 ng/mL/h), and norepinephrine (from 720±54 to 306±35 pg/mL) decreased significantly (P<0.01). Plasma aldosterone also tended to decrease, although not significantly (from 101±9 to 76±4 pg/mL, P=NS). Peak V̇Oincreased significantly after HEx (P<0.01), while endothelial function was unchanged. No significant change was detected in the control group.
The BP-lowering effects of HEx in resistant HT patients were accompanied by a significant reduction in the marked neurohumoral activation characterizing this clinical condition.
在顽固性高血压（HT）患者中，神经体液和内皮对基于热水的运动（HEx）降压作用的反应仍不明确。
我们对44例真正的顽固性HT患者（年龄53.3±0.9岁，均值±标准误）进行了研究。他们被随机分为2组，28例接受HEx训练方案，包括健身操和在热水池中行走1小时，每周3次，共12周；16例为对照组，维持其日常活动。在HEx治疗12周前后进行的测量包括诊室血压和24小时血压、血浆一氧化氮、内皮素-1、醛固酮、肾素、去甲肾上腺素和肾上腺素水平，以及峰值摄氧量和内皮功能（反应性充血）。HEx治疗12周后，患者的诊室血压和24小时收缩压及舒张压显著降低。同时，一氧化氮显著增加（从25±8至75±24μmol/L，P<0.01），而内皮素-1（从41±5至26±3pg/mL）、肾素（从35±4至3.4±1ng/mL/h）和去甲肾上腺素（从720±54至306±35pg/mL）显著降低（P<0.01）。血浆醛固酮也有下降趋势，尽管不显著（从101±9至76±4pg/mL，P=无显著性差异）。HEx治疗后峰值摄氧量显著增加（P<0.01），而内皮功能未改变。对照组未检测到显著变化。
HEx对顽固性HT患者的降压作用伴随着该临床病症所特有的明显神经体液激活的显著降低。
