Arquivos suplementares
Palavras-chave
lifestyle
arterial stiffness
pre-hypertension
dash diet
Como Citar
Resumo
Introduction: Lifestyle changes (LC) influence peripheral blood pressure (BP) in pre-hypertensive (PH) individuals; the behavior of central systolic BP (CBP) in respect to LC is not fully known. However, pre-hypertension cardiovascular risk is similar to mild hypertension and can be associated with changes in the endothelial function thereby altering the CBP.
Objective: Thus, to demonstrate the influence of LC on the peripheral and the central blood pressure in PH individuals.
Methods: Fifty-six PH patients were studied before and after three months of LC (Dash diet and aerobic exercises). The CBP was measured by tonometry of the radial artery before and after LC.
Results: The mean age of the study population was 48 ± 10.8 years. There were significant reductions in peripheral systolic pressure (127±8.1 vs. 122 ± 9.2, P=0.003), in the body mass index (29.0±4.6 vs. 28.5±4.6, P=0.001) and the waist-hip ratio(0.91 ± 0.07 vs. 0.89 ± 0.06, P=0.0007) and also in the central systolic pressure (113±10.7 vs. 107±10.9, P=0.0001) after three months of LC.
Conclusion: Lifestyle changes promote improvement in peripheral and central BP in PH individuals.
Aconselhamento sobre mudanças no estilo de vida reduz a pressão arterial central em indivíduos pré-hipertensos: um estudo de intervençãoIntrodução: Aconcselhamento para Modificação no estilo de vida (MEV) influencia diretamente a pressão arterial periférica em indivíduos pré-hipertensos. O comportamento da pressão sistólica central (PSC) em relação à MEV não está plenamente conhecido. Além disso, a pré-hipertensão (PH) oferece risco cardiovascular semelhante ao de um hipertenso leve e pode estar associado com alterações da função endotelial alterando a PSC.
Objetivo: Demonstrar a influência da MEV com exercício físico e dieta alimentar em parâmetros antropométricos e hemodinâmicos, incluindo a PSC, em indivíduos pré-hipertensos.
Métodos: Foram estudados 56 pacientes com PH antes e após 3 meses de MEV. A PSC foi avaliada utilizando-se um sistema de tonometria da artéria radial antes e após a MEV.
Resultados: A média de idade da população estudada foi 48±10,8 anos. Houve redução significativa na PAS (127±8,1 para 122±9,2; p=0,003), PAD (75±7,4 para 72±7,7; p=0,003), PAM (92±7,0 para 89±7,6; p=0,002), IMC (29,0±4,6 para 28,5±4,6; p=0,001) e na relação C/Q (0,91±0,07 para 0,89±0,06; p=0,0007) após 03 meses de MEV. Também se observou redução da PSC (113±10,7 para 107±10,9; p=0,0001) após três meses de MEV.
Conclusão: A MEV promoveu melhora pressão arterial periférica e central de indivíduos pré-hipertensos.
Referências
Prospective Studies Collaboration: Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360:1903-1913. Available from: DOI:10.1016/s0140-6736(02)11911-8
Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. VII Brazilian Guidelines on Hypertension. Arquivos Brasileiros de Cardiologia. 2016;107(3supl. 3):1-83. Available from: DOI: 10.5935/abc.20160151
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics-2015 Update: A Report from the American Heart Association. Circulation. 2015;131: e29-e322. Available from: DOI: 10.1161/CIR.0000000000000219
Hughes JW, Fresco DM, Myerscough R, Van Dulmen MHM, Carlson LE, Josephson R. Randomized Controlled Trial of Mindfulness-Based Stress Reduction for Prehypertension. Psychosomatic Medicine. 2013;75:721-728. Available from: DOI:10.1097/PSY.0b013e3182a3e4e5.
Moreira LB, Fuchs SC, Wiehe M, Gus M, Moraes RS, Fuchs FD: Incidence of hypertension in Porto Alegre, Brazil: a population-based study. Journal of Human Hypertension. 2008; 22:48-50. Available from: DOI: 10.1038/sj.jhh.1002252
Roman MJ, Devereux RB, Kizer JR, et al. High central pulse pressure is independently associated with adverse cardiovascular outcome the strong heart study. Journal of the American College of Cardiology.2009;54(18):1730-4. Available from: DOI: 10.1016/j.jacc.2009.05.070
Protogerou AD, Papaioannou TG, Blacher J, et al. Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target? Journal of Hypertension.2007;25(2):265-72. Available from: DOI: 10.1097/HJH.0b013e3280114f23
Vaz-de-Melo RO, Giollo-Junior LT, Martinelli DD, Moreno-Junior H, Mota-Gomes MA, Cipullo JP, et al. Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study. São Paulo Medical Journal. 2014; 132(5):288-94. Available from: DOI:10.1590/1516-3180.2014.1325704
Willians B, Lacy PS, Thom SM, Cruikshanki K, Stanton A, Collier D, et al. The CAFE Investigators, for the Anglo-Scandinavian Cardiac Outcomes Trail (ASCOT) Investigators – Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) Study. Circulation. 2006;113:1213-1225. Available from: DOI: 10.1161/CIRCULATIONAHA.105.595496
Durier S, Fassot C, Laurent S, Boutouyrie P, Couetil JP, Fine E, et al. Physiological genomics of human arteries: quantitative relationship between gene expression and arterial stiffness. Circulation. 2003;108:1845-1851. Available from: DOI: 10.1161/01.CIR.0000091407.86925.7A
Trudeau L. Central Blood Pressure as an Index of Antihypertensive Control: Determinants and Potential Value. Canadian Journal of Cardiology. 2014;30(5 Suppl): S23-8. Available from: DOI: 10.1016/j.cjca.2014.03.010
Gkaliagkousi E, Douma S – The pathogenesis of arterial stiffness and its prognostic value in essential hypertension and cardiovascular diseases. Hippokratia Journal. 2009; 13:70-75.
Wassertheurer S, Kropf J, Weber T, Van der Giet M, Baulmann J, Ammer M, et al. A new oscillometric method for pulse wave analysis: Comparison with common tonometric method. Journal of Human Hypertension. 2010;24:498-504. Available from: DOI:10.1038/jhh.2010.27
Mitchell GF, Conlin PR, Dunlap ME, et al. Aortic diameter, wall stiffness, and wave reflection in systolic hypertension. Hypertension. 2008;51:105-111. Available from: DOI: 10.1161/HYPERTENSIONAHA.107.099721
Wilkinson IB, McEniery CM, Cockcroft JR. Central blood pressure estimation for the masses moves a step closer. Journal of Human Hypertension. 2010;24:495-497. Available from: DOI: 10.1038/jhh.2010.47
Maldonado J, Pereira T, Polónia J, Silva JA, Morais J, Marques M. Arterial stiffness predicts cardiovascular outcome in a low to moderate cardiovascular risk population: the EDIVA (Estudo de Distensibilidade Vascular) Project. Journal of Hypertension. 2011; 29(4):669–75. Available from: DOI:10.1097/HJH.0b013e3283432063.
Lien LF, Brown AJ, Ard JD, Loria C, Erlinger TP, Feldstein AC, et al. Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome. Hypertension. 2007; 50:609-616. Available from: DOI: 10.1161/HYPERTENSIONAHA.107.089458
Pal GK, Chandrasekaran A, Hariharan AP, Dutta TK, Pal P, Nanda N, Venugopal L. Body mass index contributes to sympathovagal imbalance in prehypertensives. BMC Cardiovascular Disorders. 2012;12:54. Available from: DOI:10.1186/1471-2261-12-54
Munir S, Jiang B, Guilcher A, Brett S, Redwood S, Marber M, Chowienczyk P. Exercise reduces arterial pressure augmentation through vasodilation of muscular arteries in humans. American Journal of Physiology Heart Circulatory Physiology. 2008;294:H1645–50. Available from: DOI:10.1152/ajpheart.01171.2007H1650.
Sociedade Brasileira de Cardiologia. V Brazilian Guidelines for Dyslipidemia and Prevention of Atherosclerosis. Arquivos Brasileiros Cardioliogia. 2013;101(4) supl.1. Available from: DOI:10.5935/abc.2013S010
21.Sacre JW, Jennings GLR, Kingwell BA. Exercise and Dietary Influences on Arterial Stiffness in Cardiometabolic Disease. Hypertension. 2014;63(5):888-93. Available from: DOI:10.1161/HYPERTENSIONAHA.113.02277:00-00.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. American Heart Association. Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association. Journal of the American College of Cardiology. 2011; 57:1404–1423. Available from: DOI: 10.1016/j.jacc.2011.02.005
Cipullo JP, Martin JFV, Ciorlia LAS, Pereira de Godoy MR, Cação JC, Loureiro AAC, et al. Hypertension prevalence and risk factors in a Brazilian urban population. Arquivos Brasileiros Cardiologia. 2010;94(4):519-26. Available from: DOI: 10.1590/s0066-782x2010005000014
Zhu S, Wang Z, Heshka S, Heo M, Faith MS, Heymsfield SB. Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds. American Journal of Clinical Nutrition. 2002;76: 743-9. Available from: DOI: 10.1093/ajcn/76.4.743
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Annals of Internal Medicine. 2006;145(4):247-54. Available from: DOI: 10.7326/0003-4819-145-4-200608150-00004
Levey AS, Stevens LA, Schmid CH, et al. Anew equation to estimate glomerular filtration rate. Annals of Internal Medicine. 2009;150(9):604-12. Available from: DOI:10.7326/0003-4819-150-9-200905050-00006
Myint PK, Kwok CS, Luben RN, Wareham NJ, Khaw KT. Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease. Heart. 2014;100(20):1613-9. Available from: DOI: 10.1136/heartjnl-2014-305816
Després JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscleris, Thrombisis, and Vascular Biology.2008; 28:1039-1049. Available from: DOI:10.1161/ATVBAHA.107.159228.
Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obesity Reviews. 2011; 12:680-7. Available from: DOI:10.1111/j.1467-789X.2011.00879.x
Fonseca LJ, Nunes-Souza V, Guedes Gda S, Schettino-Silva G, Mota-Gomes MA, Rabelo LA. Oxidative status imbalance in patients with metabolic syndrome: role of the myeloperoxidase/hydrogen peroxide axis. Oxidative Medicine and Cellular Longevity. 2014; 2014:898501. Available from: DOI:10.1155/2014/898501
Juraschek SP, Blaha MJ, Whelton SP, Blumenthal R, Jones SR, Keteyian SJ, et al. Physical fitness and hypertension in a population at risk for cardiovascular disease: The Henry Ford Exercise Testing (FIT) Project. Journal of the American Heart Association. 2014;3(6): e001268. Available from: DOI:10.1161/JAHA.114.001268
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Europen Heart Journal. 2013;34(28):2159-219. Available from: DOI:10.1093/eurheartj/eht151
Guimarães GV, Ciolac EG, Carvalho VO, D'Avila VM, Bortolotto LA, Bocchi EA. Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertension Research. 2010;33(6):627-32. Available from: DOI:10.1038/hr.2010.42
Montero D, Roche E, Martinez-Rodriguez A. The impact of aerobic exercise training on arterial stiffness in pre- and hypertensive subjects: a systematic review and meta-analysis. International Journal of Cardiology.2014;173:361–368. DOI: 10.1016/j.ijcard.2014.03.072
Beck DT, Martin JS, Casey DP, Braith RW. Exercise training reduces peripheral arterial stiffness and myocardial oxygen demand in young pre-hypertensive subjects. American Journal of Hypertension. 2013; 26:1093-102. Available from: DOI:10.1093/ajh/hpt080
Márquez-Celedonio FG, Téxon-Fernandéz O, Chavez-Negrete A, Hérnadez-Lópes, Marín-Rendón, Berlín-Lascurian S. Clinical effect of lifestyle modification on cardiovascular risk in prehipertensives: PREHIPER I study. Revista Española de Cardiologia. 2009;62(1):86-90. Available from: DOI: 10.1016/S0300-8932(09)70025-9
Hwang IC, Kim KH, Choi WS, Kim HJ, Im MS, Kim YJ, et al. Impact of acute exercise on brachial artery flow-mediated dilatation in young healthy people. Cardiovascular Ultrasound. 2012; 10:39. Available from: DOI:10.1186/1476-7120-10-39
Miyashita H, Aizawa A, Hashimoto J, Hirooka Y, Imai Y, Kawano Y, et al. Cross-sectional characterization of all classes of antihypertensives in terms of central blood pressure in Japanese hypertensive patients. American Journal of Hypertension. 2010; 23:260-268. Available from: DOI:10.1038/ajh.2009.255
Sabovic M, Safar ME, Blacher J. Is there any additional prognostic value of central blood pressure wave forms beyond peripheral blood pressure? Current Pharmaceutical Design. 2009;15(3):254-66. Available from: DOI: 10.2174/138161209787354249
Laurent S, Briet M, Boutouyrie P. Large and small artery cross-talk and recent morbidity-mortality trials in hypertension. Hypertension. 2009; 54:388-392. Available from: DOI: 10.1161/HYPERTENSIONAHA.109.133116
Vlachopoulos C, Aznaouridis K, O'Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central hemodynamics: a systematic review and meta-analysis. European Heart Journal. 2010;31(15):1865-71. Available from: DOI:10.1093/eurheartj/ehq024
Christ-Roberts CY, Pratipanawatr T, Pratipanawatr W, Berria R, Belfort R, Kashyap S, Mandarino LJ. Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight nondiabetic and type 2 diabetic subjects. Metabolism. 2004;53(9):1233-42. Available from: DOI: 10.1016/j.metabol.2004.03
Iborra RT, Ribeiro IC, Neves MQ, Charf AM, Lottenberg SA, Negrão CE, et al. Aerobic exercise training improves the role of high-density lipoprotein antioxidant and reduces plasma lipid peroxidation in type 2 diabetes mellitus. Scandinavian Journal of Medicine & Science in Sports. 2008;18(6):742-50. Available from: DOI:10.1111/j.1600-0838.2007.00748.x
Harthmann AD, De Angelis K, Costa LP, Senador D, Schaan BD, Krieger EM, Irigoyen MC. Exercise training improves arterial baro- and chemoreflex in control and diabetic rats. Autonomic Neuroscience. [Online]2007;133(2):115-20. Available from: DOI: 10.1016/j.autneu.2006.10.004
Qiu S, Cai X, Schumann U, Velders M, Sun Z, Steinacker JM. Impact of walking on glycemic control and other cardiovascular risk factors in type 2 diabetes: a meta-analysis. PloS One. 2014;9(10): e109767. Available from: DOI:10.1371/journal.pone.0109767
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