RESUMO
Background: Left ventricular hypertrophy (LVH) is an endpoint of hypertensive cardiac alterations. Renin-angiotensin-aldosterone system (RAAS) blockers are among the most effective on LVH regression. Physical exercise combined to antihypertensive drug contributes to arterial pressure (AP) control and LVH prevention. We evaluated the effects of physical exercise combined to captopril or losartan during eight weeks for spontaneously hypertensive rats (SHR) on some cardiac parameters.Methods: SHR (n=5-6 per group) were sedentary or trained 5 days a week in treadmill during 8 weeks; and they were treated with daily oral captopril (12.5, 25, or 50mg/kg), losartan (2.5, 5, or 10mg/kg), or vehicle. At the end, it was obtained systolic AP (SAP), electrocardiogram (ECG), and hearts metalloproteinase 2 (MMP-2) activity and histology.Results: Captopril 25 and 50 mg/kg, and losartan 10 mg/kg lowered SAP of sedentary and trained SHR. Losartan 5 mg/kg combined with physical exercise also lowered SAP. Combined with exercise, captopril 50 mg/kg lowered 13.6% of QT interval, 14.2% of QTc interval, and 22.8% of Tpeak-Tend compared to sedentary SHR. Losartan 5 and 10mg/kg lowered QT interval of sedentary and trained SHR. Losartan 2.5, 5 and 10mg/kg combined with physical exercise lowered respectively 25.4%, 24.8%, and 31.8% of MMP-2 activity. Losartan (10mg/kg) combined with exercise reduced cardiomyocyte diameter.Conclusion: These data support the hypothesis of physical exercise combined with RAAS blockers could improve the benefits on hypertensive LVH treatment.
Assuntos
Hipertensão , Hipertrofia Ventricular Esquerda , Losartan , Animais , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Captopril/farmacologia , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/prevenção & controle , Losartan/farmacologia , Metaloproteinase 2 da Matriz/farmacologia , Ratos , Ratos Endogâmicos SHRRESUMO
INTRODUCTION: Physical exercise and antihypertensive drugs contribute to reduce or prevent hypertensive heart disease (HHD). The effect on blood pressure (BP) of both combined therapy is well documented, but not for the left ventricular (LV) function. AIM: A systematic review and meta-analysis was conducted for LV biomarkers analysis regarding to HHD on subjects treated with antihypertensive drugs combined with physical exercise practice. METHODS: The search was conducted on the Pubmed, Bireme, Lilacs, Central (Cochrane) and Science direct databases, comprising undetermined period of time, including randomized studies comparing trained and sedentary subjects, both treated with antihypertensive drugs. We analyzed the influence of combined therapy on echocardiogram parameters and BP. A significance level of 5% and 95% CI was considered for all outcomes. RESULTS: Five studies (N = 1738) were included in meta-analysis. Combined therapy decreased significantly LV mass (CI - 21.63 to - 1.81, N = 783) and heart rate (HR; CI - 4.23 to - 1.59, N = 1738), compared to antihypertensive drugs alone. There was a trend to decrease LV mass index (LVMI; CI - 5.57 to 0.71, N = 1674), systolic BP (CI - 2.47 to 1.23, N = 1674) and diastolic BP (CI - 2.16 to 0.28, N = 1674), a trend to increase of ejection fraction (EF; 95% CI - 0.50 to 2.12, N = 783) and LV end-diastolic diameter (CI - 0.85 to 0.92, N = 847) was similar. CONCLUSION: The antihypertensive therapy combined with physical exercise practice can reduce LV mass and HR. Therefore, combined therapy prescription should be considered for prevention and treatment of LV hypertrophy of hypertensive subjects.