Abstract

Research Article

Treating Blood Hypertension in a Brazilian Community: Moving from Reactive Homeostatic Model to Proactive Allostatic Healthcare

Roberto Carlos Burini*, Mariana Santoro Nakagaki, Edilaine Michelin and Franz Homero Paganini Burini

Published: 26 January, 2018 | Volume 2 - Issue 1 | Pages: 001-016

The responsiveness of hypertensive subjects to different types of physical exercises and length of intervention, has been investigated in samples of our dynamic cohort study (“Move for Health” program) based on spontaneous demand for healthy lifestyle with supervised exercises and dietary counseling. After clinical selection and baseline assessments they were spontaneously assigned to exercise protocols of strength (PAc) isolated or combined with endurance (walking) exercises (PMi) daily or in alternated days(PMiA), hydrogymnastics(PHy) and tread mill high- intensity exercises(PHit), applied during 10(experiment 1) and 20(experiment 2) weeks of intervention. Baseline demographic, socioeconomic, anthropometric and physical activity and fitness characteristics were similar among protocols. Ten-week training improved VO2max. Similarly in all protocols while hand grip increased only in PAc. In average, there was a 16% reduction rate of hypertension rate from baseline with both, SBP and DBP, reduced by PHy and only SBP by the PMi. After adjustments hypertension was more reduced by PAc, PMi and PHy. In the 20-week experiment, higher SBP was similarly reduced by PAc or PMiA and DBP by PMiA, after adjustments. Hence, so far, our generated data suggest physical exercises as an effective tool for hypertension reduction, from 10 weeks to 3 year-long supervised protocols composed by surface or aquatic activities with strength or endurance exercises. PAc takes longer and short-period responsiveness can be achieved by either combined (strength-endurance) or hydrogymnastic exercises. Thus, exercise training is a time-and type-dependent tool, feasible, costless and scientific-based rheostatic-allostatic alternative for the current “sick-care” drug-dependent homeostatic approach to hypertension med care.

Read Full Article HTML DOI: 10.29328/journal.ach.1001006 Cite this Article Read Full Article PDF

Keywords:

Blood hypertension; Primary care; Epigenetics; Physical exercises

References

  1. Burini RC, Kano HT, Burini FHP, McLellan KCP. Metabolic Syndrome-From the Mismatched Evolutionary Genome with the Current Obesogenic Environment to the Lifestyle Modification as a Primary Care of Free-Living Adults in a Brazilian Community. In: Jody Morton. editor. Metabolic Syndrome: Clinical Aspects, Management Options a53610-723-4nd Health Effects. Nova Science Publ. 2017; 978-981.
  2. Zhu Y, Bian Z, Lu P, Karas RH, Bao L, et al. Abnormal vascular function and hypertension in mice deficient in estrogen receptor beta. Science. 2002; 295: 505-508. Ref.: https://goo.gl/4CTp8z
  3. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004; 22: 11-19. Ref.: https://goo.gl/ooYsZp
  4. Schmidt MI, Duncan BB, Mill JG, Lotufo PA, Chor D, et al. Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol. 2015; 68-75. Ref.: https://goo.gl/ooYsZp
  5. Burini RC, Simonetti LA, Maesta N, Waib PH. Efficiency and Cost less of a Long-term Physical Exercise Program to Non-medicated Hypertensive Males. Advanced Studies in Medical Sciences. 2013; 1: 111-123. Ref.: https://goo.gl/80WAEp
  6. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011; 377: 1778-1797. Ref.: https://goo.gl/5SZcBe
  7. Bertoldi AD1, Kanavos P, França GV, Carraro A, Tejada CA, et al. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Global Health. 2013; 9: 62. Ref.: https://goo.gl/wCbbwU
  8. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022 / Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Brasília: Ministério da Saúde. 2011.
  9. Moreira GC, Cipullo JP, Martin JF, Ciorlia LA, Godoy MR, et al. Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city: populational study. J Hypertens. 2009; 27: 1900-1907. Ref.: https://goo.gl/1gRtyO
  10. Dib MW, Riera R, Ferraz MB. Estimated annual cost of arterial hypertension treatment in Brazil. Rev Panam Salud Publica. 2010; 27: 125-131. Ref.: https://goo.gl/y3jH5n
  11. Schmidt MI, Duncan BB, Silva GA, Menezes AN, Monteiro CA, et al. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011; 377: 1949-1961. Ref.: https://goo.gl/MsPCDg
  12. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365: 217-223. Ref.: https://goo.gl/yn9A9N
  13. Lawrence J, Appel Michael W, Brands Stephen R. Sacks -Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart Association. Hypertension. 2006; 47: 296-308. Ref.: https://goo.gl/4c9dbx
  14. Burini RC, Kano HT, Nakagaki MS, das Neves Mendes Nunes C, Burini FHP. The lifestyle modification effectiveness in reducing Hypertension in a Brazilian Community: From the epigenetic basis of Ancestral Survival to the Contemporary Lifestyle and Public Health Initiatives. Heighpubs J Clin Hypertens. 2017; 1: 10-31. Ref.: https://goo.gl/Xz6QfL
  15. Burini RC, de Oliveira EP, Michelin E, McLellan KCP. Epidemic obesity: An Evolutionary Perspective on the Modern Obesity Crisis to a Rationale for a Treatment. In Obesity Epidemic. 2014. Ref.: https://goo.gl/dx86lQ
  16. McLellan KCP, Manda RM, Sloan LA, Burini RC. Epigenetics of Glucose Metabolism and the Basis for T2DM Interventions. 2013; 51-70. Ref.: https://goo.gl/sShhhJ
  17. Young JH. Evolution of blood pressure regulation in humans. Curr Hypertens Rep. 2007; 9: 13-18. Ref.: https://goo.gl/R8g7Db
  18. Zhou, MS Aimei Wang, Hong Yu. Link between insulin resistance and hypertension: What is the evidence from evolutionary biology? Diabetol Metab Syndr. 2014; 6: 12. Ref.: https://goo.gl/DJE5Hk
  19. Straub RH. Evolutionary medicine and chronic inflammatory state-known and new concepts in pathophysiology. J Mol Med (Berl). 2012; 90: 523-534. Ref.: https://goo.gl/1SzE9M
  20. Johnson AR, Milner JJ, Makowski L. The inflammation highway: metabolism accelerates inflammatory traffic in obesity. Immunol Rev. 2012; 249: 218-238. Ref.: https://goo.gl/vPMfUy
  21. Machnik A, Neuhofer W, Jantsch J, Dahlmann A, Tammela T, et al. Macrophages regulate salt- dependent volume and blood pressure by a vascular endothelial growth factor-C-dependent buffering mechanism. Nat Med. 2009; 15: 545-552. Ref.: https://goo.gl/4B0Nv1
  22. Horita S, Seki G, Yamada H, Suzuki M, Koike K, et al. Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens. 2011; 2011: 391762. Ref.: https://goo.gl/911IgF
  23. Soeters MR, Soeters PB. The evolutionary benefit of insulin resistance. Clin Nutr. 2012; 31: 1002- 1007. Ref.: https://goo.gl/cOjYSp
  24. Weder AB. Evolution and hypertension. Hypertension. 2007; 49: 260-265. Ref.: https://goo.gl/sKLg5a
  25. Di Rienzo A, Hudson RR. An evolutionary framework for common diseases: the ancestral- susceptibility model. Trends Genet. 2005; 21: 596-601. Ref.: https://goo.gl/cfnELl
  26. Tsatsoulis A, Mantzaris MD, Bellou S, Andrikoula M. Insulin resistance: an adaptive mechanism becomes maladaptive in the current environment - an evolutionary perspective. Metabolism. 2013; 62: 622-633. Ref.: https://goo.gl/nnhceD
  27. Rahal A, Kumar A, Singh V, Yadav B, Tiwari R, et al. Oxidative Stress, Prooxidants, and Antioxidants: The Interplay. BioMed Research International. 2014; 2014: 761264. Ref.: https://goo.gl/R9AQBe
  28. Dimitrios NT, Geogrios KC, Dmitrios IXH. Neurohormonal hypothesis in heart failure. Hellenic Journal of Cardiology. 2003; 44: 195-205. Ref.: https://goo.gl/SKcxF6
  29. McEwen, Bruce S. Protective and Damaging Effects of Stress Mediators. N Engl J Med. 1998; 338: 171-179. Ref.: https://goo.gl/ut9vL
  30. McEwen BS, Wingfield JC. The concept of allostasis in biology and biomedicine. Horm Behav. 2003; 43: 2-15. Ref.: https://goo.gl/EgpEoj
  31. Sterling P. Principles of allostasis: optimal design, predictive regulation, pathophysiology and rational therapeutics. IN: Allostasis, Homeostasis, and the Costs of Adaptation, J. Schulkin (ed). Cambridge University Press. 2004.
  32. Lücher C, Frerking M. Restless AMPA receptors: implications for synaptic transmission and plasticity. Trends Neurosci. 2003; 24: 665-670. Ref.: https://goo.gl/38F6CC
  33. Ikeda H, Heinke B, Ruscheweyh R, Sandkühler J. Synaptic plasticity in spinal lamina I projection neurons that mediate hyperalgesia. Science. 2003; 299: 1237-1240. Ref.: https://goo.gl/oRVSr1
  34. Eyer J, Sterling P. Stress-related mortality and social organization. Review of Radical Political Economics. 1977; 9: 1-44. Ref.: https://goo.gl/v3bDkW
  35. Henry JP, Meehan JP, Stevens PM. The use of psychosocial stimuli to induce prolonged systolic hypertension in mice. Psychosomatic Medicine. 1967; 29: 408. Ref.: https://goo.gl/zSf3Mx
  36. Carretero OA, Oparil S. Essential Hypertension part II: treatment. Circulation. 2000; 101: 446- 453. Ref.: https://goo.gl/tFZ4hL
  37. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, et al. Effects of blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. New Eng J Med. 2001; 344: 3-9. Ref.: https://goo.gl/tWEkhM
  38. Moreto F, Kano HT, Torezan GA, Oliveira EP, Manda RM, et al. Changes in malondialdehyde and C-reactive protein concentrations after lifestyle modification are related to different metabolic syndrome-associated pathophysiological processes, Diabetes and Metabolic Syndrome. 2015; 9: 218-222. Ref.: https://goo.gl/ZWMwUS
  39. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35: 1381-1395. Ref.: https://goo.gl/Za6wJL
  40. Heyward VH. Avaliação da composição corporal aplicada (1st Edn.) São Paulo. 2000.
  41. World Health Organization. OBESITY Preventing and managing the global epidemic: report of a WHO Consultation on Obesity. Geneva: World Health Organization. 1998.
  42. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol. 2000; 89: 465-471. Ref.: https://goo.gl/6nTxxh
  43. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998; 147: 755-763. Ref.: https://goo.gl/eHzhfy
  44. Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004; 159: 413-421. Ref.: https://goo.gl/BCvDn6
  45. Bray G. An approach to the classification and evaluation of obesity. In: Bjorntorp P, Brodoff BN. Obesity. 1992; 294-308.
  46. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. 9th ed. 2013.
  47. Balke B, Ware RW. An experimental study of Air Force personel. US Armed Forces Med J 1959; 10: 675-88. Ref.: https://goo.gl/64mUir
  48. Nakagaki MS, Michelin E, Teixeira O, Burini RC. Cardiorespiratory Fitness and Insulin Sensitivity Response to high-Intensity Interval Training in Overweight Post- menopausal Women. Diabetes Obes Int J. 2017; 2: 000152.
  49. Picon RV, Fuchs FD, Moreira LB, Riegel G, Fuchs SC. Trends in Prevalence of Hypertension in Brazil: A Systematic Review with Meta-Analysis. PLoS ONE. 2012; 7: e48255. Ref.: https://goo.gl/fl0ZKM
  50. Booth, FW, Gordon SE, Carlson CJ, Hamilton MT. Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol (1985). 2000; 88: 774-787. Ref.: https://goo.gl/FYdzga
  51. Posch K, Schmidt K, Graier WF. Selective stimulation of L-arginine uptake contributes to shear stress-induced formation of nitric oxide. Life Sci. 1999; 64: 663-670. Ref.: https://goo.gl/0ZWmlL
  52. Corson MA, James NL, Latta SE, Nerem RM, Berk BC, et al. Phosphorylation of endothelial nitric oxide synthase in response to fluid shear stress. Circ Res. 1996; 79: 984-991. Ref.: https://goo.gl/HCfkMe
  53. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000; 32: 498-504. Ref.: https://goo.gl/Jzi8XZ
  54. Burini RC, Torezan GA, Sloan LA, Corrente JE, McLellan KCP. Dietary Intake Association with IFG and Responses of a Lifestyle Changing Protocol in a Community-B based Adult Cohort. Endocrinol Metab Synd. 2014; 3: 125. Ref.: https://goo.gl/QZHZVY
  55. de Lemos AS WM, Long CJ, Sivapackianathan R, Rader DJ. Identification of genetic variants in endothelial lipase in persons with elevated high-density lipoprotein cholesterol. Circulation. 2002; 106: 1321-1326. Ref.: https://goo.gl/Tc6ofm
  56. I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Arq Bras Cardiol. 2005; 84: 1-28. Ref.: https://goo.gl/rd2wbu
  57. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360: 1903-1913. Ref.: https://goo.gl/Nm32SP
  58. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007; 25: 1105-1187. Ref.: https://goo.gl/KOcH1K
  59. McLellan et al. In: Zimering MB, Topics in the prevention, treatment and complications of Type 2 Diabetes (1st Edn), Intech Open Access Publisher. 2011.
  60. Sociedade Brasileira de Cardiologia. VI Diretrizes Brasileiras de Hipertensão. Arq Bras Cardiol. 2010; 95: 1-51. Ref.: https://goo.gl/TFyceC
  61. Third Report of the National Cholesterol Education Program (N. C. E. P.) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106: 3143-3421.
  62. Wilson FH, Disse-Nicodème S, Choate KA, Ishikawa K, Nelson-Williams C, et al. Human hypertension caused by mutations in WNK kinases. Science. 2001; 293: 1107-1112. Ref.: https://goo.gl/dHVZSe

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