Post-Exercise Hypotension Is Mediated by a Decrease in Sympathetic Nerve Activity in Stages 2-3 CKD

Abstract

Background: This study aimed at evaluating the after effects of a single bout of aerobic exercise on muscle sympathetic nerve activity (MSNA), peripheral vascular resistance and blood pressure (BP) in stages 2-3 chronic kidney disease (CKD) patients. We hypothesized that CKD patients present a greater decline in these variables after the exercise than healthy individuals. Methods: Nine patients with stages 2-3 CKD (50 ± 8 years) and 12 healthy volunteers (50 ± 5 years) underwent 2 sessions, conducted in a random order: exercise (45 min, cycle ergometer, 50% of peak oxygen uptake) and rest (seated, 45 min). Sixty minutes after either intervention, MSNA (by microneurography), BP (by oscillometry), and forearm vascular resistance (FVR) were measured. A 2-way analysis of variance with group (between) and session (within) as main factors was employed, accepting p < 0.05 as significant. Results: Diastolic BP and MSNA were higher in the CKD than the control group in both sessions. Responses after exercise were similar in both groups. Systolic BP, diastolic BP, MSNA and FVR were significantly lower after the exercise than after the rest session in both the CKD and the control groups (162 ± 15 vs. 152 ± 23 and 155 ± 11 vs. 145 ± 16 mm Hg, 91 ± 11 vs. 85 ± 14 and 77 ± 5 vs. 71 ± 10 mm Hg, 38 ± 4 vs. 31 ± 4 and 34 ± 2 vs. 27 ± 4 burst/min, 59 ± 29 vs. 41 ± 29 and 45 ± 20 vs. 31 ± 8 U, respectively, all p < 0.05). Conclusion: These results showed that aerobic exercise may produce hemodynamic and neural responses that can be beneficial to these patients in spite of CKD.

Neural mechanismsand post-exercise hypotension: The importance of experimental studies

“…The use of physical exercise to reduce blood pressure in hypertensive subjects is already well emphasized in clinical trials and systematic reviews 8,43,44,45 . In addition, several clinical trials identified the effectiveness of physical training to reduce blood pressure levels 46,47,48 , as well as in meta-analysis 7,49,50,51 . Meta-analysis of Halbert et al 51 published for two decades, showed reductions of -4.7mmHg and -3.1mmHg in systolic and diastolic blood pressure, respectively.…”

“…In addition, several clinical trials identified the effectiveness of physical training to reduce blood pressure levels 46,47,48 , as well as in meta-analysis 7,49,50,51 . Meta-analysis of Halbert et al 51 published for two decades, showed reductions of -4.7mmHg and -3.1mmHg in systolic and diastolic blood pressure, respectively. Fagard 49 identified reductions of -3.3 mmHg in systolic blood pressure and -3.5 mmHg in diastolic blood pressure.…”

Post-Exercise Neurovascular Control in Chronic Heart Failure Patients

“…In fact, they depend on long-term effects over time. Previous studies have shown that an acute bout of moderate aerobic exercise reduces MSNA in men with borderline hypertension and patients with chronic kidney disease [5,13]. Floras and colleagues [13] reported that a single session on treadmill reduced about 10 bursts/100 heartbeats in borderline hypertensive patients recorded 60 min after exercise.…”

“…Floras and colleagues [13] reported that a single session on treadmill reduced about 10 bursts/100 heartbeats in borderline hypertensive patients recorded 60 min after exercise. Additionally, Aprile and colleagues [5] found that an acute bout of cycle ergometer moderate exercise reduced MSNA in patients with chronic kidney disease when recorded 60 min after exercise. We found no such responses in patients with CHF.…”

Reprodutibilidade da hipotensão pós-exercício e de seus mecanismos hemodinâmicos e autonômicos

“…Assim, na maior parte dos estudos, (BONSU;TERBLANCHE, 2016;CAVALCANTE et al, 2016;COSTA et al, 2016;CUCATO et al, 2015;DE BRITO et al, 2015;DUJIĆ et al, 2006;FLORAS et al, 1989;FORJAZ et al, 1998aFORJAZ et al, , 1998bHAGBERG;MONTAIN;MARTIN, 1987;HARVEY et al, 2005;HAYES;LUCAS;SHI, 2000;HEFFERNAN et al, 2007;JONES et al, 2008;LACOMBE et al, 2011;LEGRAMANTE et al, 2002;LIU et al, 2012;LYNN;MINSON;HALLIWILL, 2009;HOGBEN, 1999HOGBEN, , 2000RONDON et al, 2002;RUECKERT et al, 1996;SENITKO;CHARKOUDIAN;HALLIWILL, 2002;SOMERS et al, 1991;SOUZA et al, 2016;WILCOX et al, 1982), os valores pré-exercício são considerados como o controle e a HPE é calculada comparando-se os valores medidos após o exercício com os avaliados pré-exercício (cálculo I = PA pós-exercício -PA pré-exercício). No entanto, em outros estudos (ANGADI; BHAMMAR; GAESSER, 2015;APRILE et al, 2016;CARVALHO et al, 2015;CAVALCANTE et al, 2016;CLÉROUX et al, 1992;…”