Study of cardiovascular parameters in hypertensive women before and after menopause - association effects of aerobic physical training and Enalapril Maleate and Losartan

Author(s)

Stella Vieira Philbois Duarte

• Document type: Doctoral Thesis
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina de Ribeirão Preto (PCARP/BC)
• Defense date: 2022-06-28

Examining board members

Hugo Celso Dutra de Souza; Deoclecio Alves Chianca Junior; Marli Cardoso Martins Pinge; Valdo José Dias da Silva

• Advisor: Hugo Celso Dutra de Souza

Abstract

Menopause results from the significant reduction in the ovarian hormones production that occurs during the climacteric. These hormones, especially estrogens, are known to positively influence cardiovascular autonomic regulation, including through their actions on the renin-angiotensin-aldosterone system (RAAS). However, in women who even before the climacteric have cardiovascular disease, in the case of systemic arterial hypertension (SAH), the consequences on cardiovascular autonomic regulation can be even more serious. In this case, the pharmacological prescription, including drugs with action on the RAAS, associated with changes in lifestyle, such as the regular practice of aerobic physical exercises, is often indicated and presents very encouraging hemodynamic results. However, we are not aware of the effects of the association of pharmacological treatment and aerobic physical training on the cardiovascular autonomic control of these hypertensive women, before and after menopause. Aim: to investigate in women with SAH, both at reproductive age and after physiological menopause, the effects of pharmacological treatment with Enalapril Maleate and Losartan associated with aerobic physical training on hemodynamics and cardiovascular autonomic control. Methods: 60 hypertensive women and 60 normotensive sedentary women were divided into four groups; pre-climacteric group (30 - 45 years; N=30) and post-menopausal group (55 - 65 years; N=30). All groups underwent the following experimental procedures: co lipid profile dosage; anthropometric analysis; assessment of cardiopulmonary capacity through the ergospirometric test; assessment of cardiovascular autonomic control by analyzing baroreflex sensitivity and heart rate (HRV) and blood pressure (BPV) variability. Additionally, the groups of women with SAH (pre-climacteric and post-menopausal) underwent a protocol of aerobic physical training, supervised, and monitored for 16 weeks, 3 times a week, lasting 70 minutes per session. Results: Blood pressure (BP) control through pharmacological treatment did not normalize cardiovascular autonomic parameters, when compared with normotensive women, both before and after menopause. However, the pre-climacteric hypertensive group showed a predominance of the vagal autonomic component in the balance of cardiac autonomic modulation. Aerobic physical training promoted positive effects on hemodynamics by reducing BP, heart rate and increasing VO2peak, and on cardiovascular autonomic modulation by increasing parameters that represent vagal modulation under different methods of HRV analysis and reducing LF of the BPV. Conclusion: Pharmacological therapy is effective in controlling BP, but it did not normalize cardiovascular autonomic modulation in women with SAH, both before and after menopause. Aerobic physical training was important to reduce the sympathetic influence on the vessels and promoted positive effects on HRV. (AU)

• FAPESP's process: 18/17892-5 - Study of cardiovascular parameters in hypertensive women, before and after the menopause - effects of the association of aerobic physical training with enalapril maleate and losartan
• Grantee: Stella Vieira Philbois Duarte
• Support Opportunities: Scholarships in Brazil - Doctorate