RAFAEL ANDRADE REZENDE
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- Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men(2020) BRITO, Leandro C.; AZEVEDO, Luan; PECANHA, Tiago; FECCHIO, Rafael Yokoyama; REZENDE, Rafael Andrade; SILVA, Giovanio Vieira da; PIO-ABREU, Andrea; MION, Decio; HALLIWILL, John R.; FORJAZ, Claudia L. M.Background Post-exercise hypotension (PEH) is greater after evening than morning exercise, but antihypertensive drugs may affect the evening potentiation of PEH. Objective: To compare morning and evening PEH in hypertensives receiving angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB). Methods Hypertensive men receiving ACEi (n = 14) or ARB (n = 15) underwent, in a random order, two maximal exercise tests (cycle ergometer, 15 watts/min until exhaustion) with one conducted in the morning (7 and 9 a.m.) and the other in the evening (8 and 10 p.m.). Auscultatory blood pressure (BP) was assessed in triplicate before and 30 min after the exercises. Changes in BP (post-exercise - pre-exercise) were compared between the groups and the sessions using a two-way mixed ANOVA and consideringPResults In the ARB group, systolic BP decrease was greater after the evening than the morning exercise, while in the ACEi group, it was not different after the exercises conducted at the different times of the day. Additionally, after the evening exercise, systolic BP decrease was lower in the ACEi than the ARB group (ARB = -11 +/- 8 vs -6 +/- 6 and ACEi = -6 +/- 7 vs. -8 +/- 5 mmHg, evening vs. morning, respectively, P for interaction = 0.014). Conclusions ACEi, but not ARB use, blunts the greater PEH that occurs after exercise conducted in the evening than in the morning.
- Post-Exercise Hypotension and Its Mechanisms Differ after Morning and Evening Exercise: A Randomized Crossover Study(2015) BRITO, Leandro C. de; REZENDE, Rafael A.; SILVA JUNIOR, Natan D. da; TINUCCI, Tais; CASARINI, Dulce E.; CIPOLLA-NETO, Jose; FORJAZ, Claudia L. M.Post-exercise hypotension (PEH), calculated by the difference between post and pre-exercise values, it is greater after exercise performed in the evening than the morning. However, the hypotensive effect of morning exercise may be masked by the morning circadian increase in blood pressure. This study investigated PEH and its hemodynamic and autonomic mechanisms after sessions of aerobic exercise performed in the morning and evening, controlling for responses observed after control sessions performed at the same times of day. Sixteen pre-hypertensive men underwent four sessions (random order): two conducted in the morning (7:30am) and two in the evening (5pm). At each time of day, subjects underwent an exercise (cycling, 45 min, 50%VO(2)peak) and a control (sitting rest) session. Measurements were taken pre- and post-interventions in all the sessions. The net effects of exercise were calculated for each time of day by [(post-pre exercise)-(post-pre control)] and were compared by paired t-test (P<0.05). Exercise hypotensive net effects (e.g., decreasing systolic, diastolic and mean blood pressure) occurred at both times of day, but systolic blood pressure reductions were greater after morning exercise (-7 +/- 3 vs. -3 +/- 4 mmHg, P<0.05). Exercise decreased cardiac output only in the morning (-460 +/- 771 ml/min, P<0.05), while it decreased stroke volume similarly at both times of day and increased heart rate less in the morning than in the evening (+7 +/- 5 vs. +10 +/- 5 bpm, P<0.05). Only evening exercise increased sympathovagal balance (+1.5 +/- 1.6, P<0.05) and calf blood flow responses to reactive hyperemia (+120 +/- 179 vs. -70 +/- 188 U, P<0.05). In conclusion, PEH occurs after exercise conducted at both times of day, but the systolic hypotensive effect is greater after morning exercise when circadian variations are considered. This greater effect is accompanied by a reduction of cardiac output due to a smaller increase in heart rate and cardiac sympathovagal balance.