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goncalves_mi_dr_botfm.pdf: 902862 bytes, checksum: 001613f0a5340b1581c25e832b4433c8 (MD5) === Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) === O objetivo deste estudo prospectivo, controlado e aleatorio e investigar os efeitos de um programa de treinamento aerobio supervisionado sobre a pressao arterial, funcao vascular, e perfil metabolico-hormonal de hipertensos naomedicados, durante tres meses. Hipertensos sedentarios, com idade de 50(9) anos, foram divididos aleatoriamente em dois grupos na proporcao 2/1, intervencao e controle, respectivamente. O tamanho da amostra foi estimado para 10% erro À e 5% erro ¿, para detectar uma diferenca de 3 mL/kg/min no consume pico de oxigenio, com desvio padrao de 3 mL/kg/min, ao teste ergoespirometrico. Apos 3 meses de exercicios, o treinamento aerobio (n = 55, esteira eletrica, 50-75% VO2max, 3-5 sessoes/sem, 45 min/sessao) promoveu um aumento de 12% no VO2max (p = 0,0001), enquanto no grupo controle (n = 24, protocolo isometrico/postural, 3 sessoes/sem, 45 min/sessao) nao se observou mudanca no condicionamento aerobio. O consumo de sal dietetico durante o estudo provavelmente nao se alterou, como indicado pelo sodio urinario de 24 horas. A massa corporal diminuiu nos dois grupos ao final do estudo (p = 0,001 para aerobio e p = 0,03 para controle), assim como o colesterol plasmatico (p = 0,002 para aerobio e p = 0,0498 para controle). Isso pode sugerir uma mudanca voluntaria na dieta, visto nao ter havido orientacao nutricional previa. Ao final do estudo, nos dois grupos, a pressao arterial de 24 horas nao variou significativamente, assim como a elasticidade arterial (tonometria de aplanamento, HDI/PulseWave CR-2000), renina e aldosterona plasmaticos, e metanefrinas urinarias. Somente no grupo aerobio foi observado: diminuicao da resistencia insulinica (HOMA-IR, p = 0,036), diminuicao do cortisol plasmatico (p = 0,006), aumento na hiperemia reativa pos-isquemica (como indice de funcao endotelial, pletismografia de oclusao venosa, p = 0,009), e aumento no fluxo arterial basal de antebraco (pletismografia de oclusao venosa, p = 0,001) === The aim of this prospective controlled randomized study was to investigate the effects of 3 months of a supervisioned aerobic training program on blood pressure profile, vascular function, plasma and urine hormones, and metabolic parameters, including HOMA-RI estimation. Sedentary non-medicated hypertensive subjects, aged 50 (9) years, were randomized to intervention/control groups on a 2/1 proportion. The sample size was estimated to provide 90% power at alpha = 0,05 (one-tailed) to detect a 3-mL/kg/min difference in peak oxygen consumption, with a standard deviation of 3 mL/kg/min, at the treadmill ergospyrometric test. After 3 months, the aerobic training (n =55, eletronic treadmill, 50-75% VO2max, 3-5 sessions/wk, 45 min/session) was effective to promote a 12% increase in VO2max (p = 0,0001), while no significant variation was observed in the control (n = 24, postural/isometric protocol) group. As indicated by urinary sodium, dietary sodium probably did not vary during the study. BMI (aerobic p = 0,001 and control p = 0,03) and total cholesterol (aerobic p = 0,002 and control p = 0,0498) decrease both in intervention and control groups, suggesting a voluntary modification in dietary habits during the study, even nutritional orientation was not given. In intervention and control groups, 24-hours blood pressure profile did not significantly modify, as well as arterial compliance (HDI/PulseWave CR-2000 radial tonometry), plasma renin, aldosterone, C-peptide, and urine metanephrines. At the end of this study, in the intervention but not in the control group, was observed: a decrease in insulin resistance (p = 0,036), a decrease in plasma cortisol (p = 0,006), an increase in postischaemic hyperaemia (as an index of endothelial function, p = 0,009), and an increase in basal muscle forearm blood flow (p = 0,001). A significant correlation was found between changes in insulin resistance and endothelial function (R = -0,51, p < 0,04)
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