Title:Aerobic Physical Exercise is Essential for Cardiac Autonomic Regulation
in Hypertensive Patients Undergoing Chronic Treatment with Renin-
Angiotensin System Inhibitors
Volume: 21
Issue: 4
Author(s): Tábata de Paula Facioli, Stella Vieira Philbois, Jens Tank, Ada Clarice Gastaldi, Bruno Augusto Aguilar, Ana Catarine da Veiga Oliveira, Lucas Dalvit Ferreira and Hugo Celso Dutra de Souza*
Affiliation:
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Keywords:
Hypertension, cardiac autonomic control, pharmacological treatment, aerobic physical training, enalapril, losartan.
Abstract:
Background: Hypertension treatment with renin-angiotensin system inhibitors (RASi) presents
contradictions about the recovery of damage in cardiovascular autonomic modulation characterized
by reduced heart rate variability (HRV) and increased blood pressure variability (BPV). Conversely,
the association of RASi with physical training can influence achievements in cardiovascular autonomic
modulation.
Objective: To investigate the effects of aerobic physical training on hemodynamics and cardiovascular
autonomic modulation in hypertensive volunteers untreated and treated with RASi.
Methods: A non-randomized controlled trial in which 54 men (≅ 40-60 years old) with a history of hypertension
for >2 years were allocated in accordance with their characteristics into three groups: untreated
(Control; n=16), treated with type 1 angiotensin II (AT1) receptor blocker (losartan; n=21), and
treated with angiotensin-converting enzyme inhibitor (enalapril; n=17). All participants underwent hemodynamic,
metabolic, and cardiovascular autonomic evaluation using baroreflex sensitivity (BRS) and
spectral analysis of HRV and BPV, before and after 16 weeks of supervised aerobic physical training.
Results: The volunteers treated with RASi had lower BPV and HRV, both in the supine position and in
the tilt test, with the losartan group having the lowest values. Aerobic physical training increased HRV
and BRS in all groups. However, the association of enalapril with physical training appears to be more
prominent.
Conclusion: Long-term treatment with enalapril and losartan may harm the autonomic modulation of
HRV and BRS. Aerobic physical training is essential to promote positive adjustments in the autonomic
modulation of HRV and BRS in hypertensive patients treated with RASi, especially with enalapril.
