Katia Coelho Ortega

Factors affecting post-exercise hypotension in normotensive and hypertensive humans.

BackgroundPost-exercise hypotension has been extensively described under laboratory conditions. However, studies investigating the persistence of this post-exercise decrease in blood pressure for longer periods have produced controversial results. The present investigation was conducted to verify the effect of a single bout of exercise on ambulatory blood pressure and to identify potential factors that might influence this post-exercise ambulatory blood pressure fall. DesignThe study was a randomized controlled clinical trial. MethodsThirty normotensive and 23 hypertensive subjects were submitted to two ambulatory blood pressure monitorings (using the SpaceLabs 90207, SpaceLabs, Redmond, Washington, USA), which were performed after 45 min of seated rest (control session) or cycling exercise at 50% peak oxygen uptake (exercise session). ResultsNormotensive subjects demonstrated a lower 24 h blood pressure level in the exercise session. Hypertensive patients showed no significant difference in ambulatory blood pressure level between the two experimental sessions. Further data analysis revealed that approximately 65% of the subjects in both groups experienced a fall in blood pressure after exercise. Moreover, in the normotensive subjects, this blood pressure fall was significantly and positively correlated with clinic and ambulatory blood pressure, and negatively correlated with weight and body mass index. The blood pressure response to exercise was also greater in women. In the hypertensive patients, the post-exercise blood pressure decrease was significantly and positively correlated with clinic and ambulatory blood pressure as well as with the peak oxygen uptake, and negatively correlated with age and body mass index. ConclusionsThe post-exercise ambulatory blood pressure fall observed in normotensive and hypertensive humans depends on individual characteristics. Moreover, in both normotensive and hypertensive humans, post-exercise ambulatory hypotension is greater in subjects with a higher initial blood pressure level.

Home blood pressure monitoring in blood pressure control among haemodialysis patients: an open randomized clinical trial

BACKGROUND It is not known if the adjustment of antihypertensive therapy based on home blood pressure monitoring (HBPM) can improve blood pressure (BP) control among haemodialysis patients. METHODS This is an open randomized clinical trial. Hypertensive patients on haemodialysis were randomized to have the antihypertensive therapy adjusted based on predialysis BP measurements or HBPM. Before and after 6 months of follow-up, patients were submitted to ambulatory blood pressure monitoring (ABPM) for 24 h, HBPM during 1 week and echocardiogram. RESULTS A total of 34 and 31 patients completed the study in the HBPM and predialysis BP groups, respectively. At the end of study, the systolic (SBP) and diastolic (DBP) blood pressure during the interdialytic period measured by ABPM were significantly lower in the HBPM group in relation to the predialysis BP group (mean 24-h BP: 135 +/- 12 mmHg/76 +/- 7 mmHg versus 147 +/- 15 mmHg/79 +/- 8 mmHg; P < 0.05). In the HBPM analysis, the HBPM group showed a significant reduction only in SBP compared to the predialysis BP group (weekly mean: 144 +/- 21 mmHg versus 154 +/- 22 mmHg; P < 0.05). There were no differences between the HBPM and predialysis BP groups in relation to the left ventricular mass index at the end of the study (108 +/- 35 g/m(2) versus 110 +/- 33 g/m(2); P > 0.05). CONCLUSIONS Decision making based on HBPM among haemodialysis patients has led to a better BP control during the interdialytic period in comparison with predialysis BP measurements. HBPM may be a useful adjuvant instrument for blood pressure control among haemodialysis patients.

Sympathetic nerve activity is decreased during device-guided slow breathing.

It is known that slow breathing (<10 breaths min–1) reduces blood pressure (BP), but the mechanisms involved in this phenomenon are not completely clear. The aim of this study was to evaluate the acute responses of the muscle sympathetic nerve activity, BP and heart rate (HR), using device-guided slow breathing (breathe with interactive music (BIM)) or calm music. In all, 27 treated mild hypertensives were enrolled. Muscle sympathetic nerve activity, BP and HR were measured for 5 min before the use of the device (n=14) or while subjects listened to calm music (n=13), it was measured again for 15 min while in use and finally, 5 min after the interventions. BIM device reduced respiratory rate from 16±3 beats per minute (b.p.m) to 5.5±1.8 b.p.m (P<0.05), calm music did not affect this variable. Both interventions reduced systolic (−6 and −4 mm Hg for both) and diastolic BPs (−4 mm Hg and −3 mm Hg, respectively) and did not affect the HR (−1 and −2  b.p.m respectively). Only the BIM device reduced the sympathetic nerve activity of the sample (−8 bursts min–1). In conclusion, both device-guided slow breathing and listening to calm music have decreased BP but only the device-guided slow breathing was able to reduce the peripheral sympathetic nerve activity.

Dietary salt restriction increases plasma lipoprotein and inflammatory marker concentrations in hypertensive patients

BACKGROUND Dietary salt restriction has been reported to adversely modify the plasma lipoprotein profile in hypertensive and in normotensive subjects. We investigated the effects of the low sodium intake (LSI) on the plasma lipoprotein profile and on inflammation and thrombosis biomarkers during the fasting and postprandial periods. METHODS Non-obese, non-treated hypertensive adults (n=41) were fed strictly controlled diets. An initial week on a control diet (CD, Na=160 mmol/day) was followed by 3 weeks on LSI (Na=60 mmol/day). At admission and on the last day of each period, the 24-h ambulatory blood pressure was monitored and blood was drawn after an overnight fasting period and after a fat-rich test meal. RESULTS The dietary adherence was confirmed by 24-h urinary sodium excretion. Fasting triglyceride (TG), chylomicron-cholesterol, hsC-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) concentrations, renin activity, aldosterone, insulin, and homeostasis model assessment insulin resistance (HOMA-IR) values were higher, but non-esterified fatty acids (NEFA) were lower on LSI than on CD. For LSI, areas under the curve (AUC) of TG, chylomicron-cholesterol, apoB and the cholesterol/apoB ratio were increased, whereas AUC-NEFA was lowered. LSI did not modify body weight, hematocrit, fasting plasma cholesterol, glucose, adiponectin, leptin, fibrinogen and factor VII (FVII), and AUC of lipoprotein lipase and of lipoprotein remnants. CONCLUSION LSI induced alterations in the plasma lipoproteins and in inflammatory markers that are common features of the metabolic syndrome.

Profile of hypertensive patients: biosocial characteristics, knowledge, and treatment compliance

OBJECTIVE: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. METHODS: The data were collected by interviewing hypertensive outpatients. RESULTS: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. CONCLUSION: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.Objective: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. Methods: The data were collected by interviewing hypertensive outpatients. Results: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. Conclusion: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.

Perfil de um grupo de hipertensos: aspectos biossociais, conhecimentos e adesão ao tratamento

OBJECTIVE: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. METHODS: The data were collected by interviewing hypertensive outpatients. RESULTS: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. CONCLUSION: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.Objective: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. Methods: The data were collected by interviewing hypertensive outpatients. Results: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. Conclusion: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.

Post-resistance exercise hemodynamic and autonomic responses: Comparison between normotensive and hypertensive men

To compare post‐resistance exercise hypotension (PREH) and its mechanisms in normotensive and hypertensive individuals, 14 normotensives and 12 hypertensives underwent two experimental sessions: control (rest) and exercise (seven exercises, three sets, 50% of one repetition maximum). Hemodynamic and autonomic clinic measurements were taken before (Pre) and at two moments post‐interventions (Post 1: between 30 and 60 min; Post 2: after 7 h). Ambulatory blood pressure (BP) was monitored for 24 h. At Post 1, exercise decreased systolic BP similarly in normotensives and hypertensives (−8 ± 2 vs −13 ± 2 mmHg, P > 0.05), whereas diastolic BP decreased more in hypertensives (−4 ± 1 vs −9 ± 1 mmHg, P < 0.05). Cardiac output and systemic vascular resistance did not change in normotensives and hypertensives (0.0 ± 0.3 vs 0.0 ± 0.3 L/min; −1 ± 1 vs −2 ± 2 U, P > 0.05). After exercise, heart rate (+13 ± 3 vs +13 ± 2 bpm) and its variability (low‐ to high‐frequency components ratio, 1.9 ± 0.4 vs +1.4 ± 0.3) increased whereas stroke volume (−14 ± 5 vs −11 ± 5 mL) decreased similarly in normotensives and hypertensives (all, P > 0.05). At Post 2, all variables returned to pre‐intervention, and ambulatory data were similar between sessions. Thus, a session of resistance exercise promoted PREH in normotensives and hypertensives. Although this PREH was greater in hypertensives, it did not last during the ambulatory period, which limits its clinical relevance. In addition, the mechanisms of PREH were similar in hypertensives and normotensives.

Amlodipine 2.5 mg once daily in older hypertensives: a brazilian multi-centre study

ObjectivesThe use of low-dose amlodipine has not yet been well established in the elderly. This study therefore aimed to evaluate the efficacy and tolerability of low-dose amlodipine in elderly patients with Joint National Committee VI stage I or II hypertension. Patients and methodsSixty-five hypertensive individuals (aged 66.3±5.3 years) received amlodipine 2.5 mg per day for 12 weeks before and after two periods of 4 weeks of placebo. At weeks 0, 12 and 16, patients were submitted to office, 24 h ambulatory blood pressure monitoring and home blood pressure measurement. ResultsOffice systolic and diastolic blood pressure showed decreases at weeks 8 (153±17, 90±9 mmHg) and 12 (152±16, 90±9 mmHg) compared with weeks 0 (164±16, 99±6 mmHg) and 16 (162±19, 95±9 mmHg). During ambulatory monitoring, a decrease was observed in the average 24 h systolic and diastolic pressure at week 12 (143±13, 86±7 mmHg) compared with weeks 0 (155±15, 93±6 mmHg) and 16 (152±16, 92±8 mmHg). A daytime and night-time reduction in systolic and diastolic pressure was observed on home blood pressure monitoring at week 12 (146±16/88±8, 144±16/93±8 mmHg) compared with weeks 0 (159±17/94±8, 161±19/93±8 mmHg) and 16 (153±16/93±8, 154±17/92±8 mmHg). Adverse reactions were infrequent. ConclusionsAmlodipine at a dose of 2.5 mg per day showed efficacy and good tolerability in elderly hypertensives.

Finger Blood Pressure During Leg Resistance Exercise

Blood pressure (BP) assessment during resistance exercise can be useful to avoid high BP, reducing cardiovascular risk, especially in hypertensive individuals. However, non-invasive accurate technique for this purpose is not available. The aim of this study was to compare finger photoplethysmographic (FPP) and intra-arterial BP values and responses during resistance exercise. Eight non-medicated hypertensive subjects (5 males, 30-60 years) were evaluated during pre-exercise resting period and during three sets of the knee extension exercise performed at 80% of 1RM until fatigue. BP was measured simultaneously by FPP and intra-arterial methods. Data are mean+/-SD. Systolic BP was significantly higher with FPP than with intra-arterial: at pre-exercise (157+/-13 vs. 152+/-10 mmHg; p<0.01) and the mean (202+/-29 vs. 198+/-26 mmHg; p<0.01), and the maximal (240+/-26 vs. 234+/-16 mmHg; p<0.05) values achieved during exercise. The increase in systolic BP during resistance exercise was similar between FPP and intra-arterial (+73+/-29 vs. +71+/-18 mmHg; p=0.59). Diastolic BP values and increases were lower with FPP. In conclusion, FPP provides similar values of BP increment during resistance exercise than intra-arterial method. However, it overestimates by 2.6+/-6.1% the maximal systolic BP achieved during this mode of exercise and underestimates by 8.8+/-5.8% the maximal diastolic BP.

Atenolol blunts blood pressure increase during dynamic resistance exercise in hypertensives

AIMS This study was conducted to determine whether atenolol was able to decrease BP level and mitigate BP increase during dynamic resistance exercise performed at three different intensities in hypertensives. METHODS Ten essential hypertensives (systolic/diastolic BP between 140/90 and 160/105mmHg) were blindly studied after 6 weeks of placebo and atenolol. In each phase, volunteers executed, in a random order, three protocols of knee-extension exercises to fatigue: (i) one set at 100% of 1RM; (ii) three sets at 80% of 1RM; and (iii) three sets at 40% of 1RM. Intra-arterial radial blood pressure was measured throughout the protocols. RESULTS Atenolol decreased systolic BP maximum values achieved during the three exercise protocols (100% = 186 ± 4 vs. 215 ± 7, 80% = 224 ± 7 vs. 247 ± 9 and 40% = 223 ± 7 vs. 252 ± 16mmHg, P < 0.05). Atenolol also mitigated an increase in systolic BP in the first set of exercises (100% =+38 ± 5 vs.+54 ± 9; 80% =+68 ± 11 vs. +84 ± 13 and 40% =+69 ± 7 vs.+84 ± 14, mmHg, P < 0.05). Atenolol decreased diastolic BP values and mitigated its increase during exercise performed at 100% of 1RM (126 ± 6 vs. 145 ± 6 and +41 ± 6 vs.+52 ± 6, mmHg, P < 0.05), but not at the other exercise intensities. CONCLUSIONS Atenolol was effective in both reducing systolic BP maximum values and mitigating BP increase during resistance exercise performed at different intensities in hypertensive subjects.