Efeito do controle do ritmo respiratório sobre a pressão arterial em pacientes hipertensos: uma revisão integrativa de literatura
Effect of respiratory rhythm control on blood pressure in patients with hypertension: an integrative literature review
Luiz Fernando Martins de SOUZA FILHO, Jordana Campos Martins de OLIVEIRA, Wátila de Moura SOUSA, Ana Cristina Silva REBELO
Resumo
Introdução: A literatura aponta que o controle do ritmo respiratório apresenta benefícios na redução da pressão arterial em pacientes hipertensos. Objetivo: Investigar a eficácia do controle do ritmo respiratório (CRR) na pressão arterial sistólica (PAS) e diastólica (PAD) de pacientes com hipertensão arterial sistêmica (HAS). Metodologia: Trata-se de uma revisão integrativa, utilizando a base de dados Publisher Medline (Pubmed), em que foram considerados estudos clínicos que abordem o uso de CRR em pacientes com HAS, a fim de verificar a relação do CRR na PAS e PAD. Foram utilizados, na pesquisa, os descritores em inglês: blood pressure, hypertension, breathing e breathing exercises. Utilizados em combinação, pelo operador booleano AND, os critérios de inclusão foram: (1) ensaios clínicos randomizados, (2) disponível na íntegra, (3) disponível em inglês e/ou, português (4), publicados nos últimos dez anos. Os critérios de exclusão foram: (1) utilização de outros programas de exercícios, (2) outros quadros clínicos associados, (3) outros métodos de exercícios respiratórios. Resultados: Foram encontrados, 23 artigos com os descritores na Pubmed, dos quais, quatro artigos compuseram os resultados deste estudo. Conclusão: O CRR apresenta redução significativa dos valores da PAS e PAD, em especial, o CRR de forma lenta, expressando a relação de sincronia coração-pulmão e melhora da função autonômica, se apresentando como recurso complementar para programas de reabilitação cardíaca.
Palavras-chave
Abstract
Introduction: literature indicates that respiratory rhythm control has benefits in reducing blood pressure in hypertensive patients. Aim: To investigate the efficacy of respiratory rate control (RRC) on systolic (SBP) and diastolic (DBP) blood pressure in patients with systemic arterial hypertension (SAH). Methodology: This is an integrative review using Medline (Pubmed) database. Clinical studies addressing the use of RRC in patients with hypertension were considered to verify the relationship between RRC in SBP and DBP. The research descriptors in English were: blood pressure, hypertension, breathing and breathing exercises. They were combined using the boolean operator “AND”. Inclusion criteria were: (1) randomized controlled trials, (2) available in full, (3) available in English or Portuguese (4) published in the last 10 years. Exclusion criteria were: (1) use of other exercise programs, (2) other associated clinical conditions, (3) other breathing exercise methods. Results: We found 23 articles with the descriptors in Pubmed, of which 4 articles made up the results of this study. Conclusion: RRC confers a significant reduction in SBP and DBP values. Specifically, the slow RRC had effects on expressing the relationship of heart-lung synchrony and improving autonomic function, presenting itself as a complementary resource for cardiac rehabilitation programs.
Keywords
Referências
1. Oliveira GMM, Mendes M, Malachias MVB, Morais J, Moreira Filho O, Coelho AS, et al. 2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries. Arq Bras Cardiol. 2017 Nov;109(5):389-96. doi: https://doi.org/10.5935/abc.20170165.
2. Malachias MVB, Plavnik FL, Machado CA, Malta D, Scala LCN, Fuchs S. 7th Brazilian Guideline of Arterial Hypertension: Chapter 1 - Concept, Epidemiology and Primary Prevention. Arq Bras Cardiol. 2016 Sept; 107(3 Suppl 3):1-83. doi: https://doi.org/10.5935/abc.20160151.
3. Carvalho T, Cortez AA, Ferraz A, Nóbrega ACL, Brunetto AF, Herdy AH, et al. Diretriz de reabilitação cardiopulmonar e metabólica: aspectos práticos e responsabilidades. Arq Bras Cardiol. 2006 Jan;86(1):74-82. doi: https://doi.org/10.1590/S0066-782X2006000100011.
4. Herdy AH, López-Jiménez F, Terzic CP, Milani M, Stein R, Carvalho T, et al. South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation. Arq Bras Cardiol. 2014 Aug;103(2 Suppl.1):1-31. doi: https://doi.org/10.5935/abc.2014S003.
5. Mahtani KR, Beinortas T, Bauza K, Nunan D. Device-Guided Breathing for Hypertension: a Summary Evidence Review. Curr Hypertens Rep. 2016 Apr;18(4):33. doi: 10.1007/s11906-016- 0631-z.
6. de Carvalho T, Curi AL, Andrade DF, Singer Jda M, Benetti M, Mansur AJ. Cardiovascular rehabilitation of patients with ischemic heart disease undergoing medical treatment, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. Arq Bras Cardiol. 2007 Jan;88(1):72-8. doi: 10.1590/s0066-782x2007000100012.
7. Pinheiro CHJ, Medeiros RAR, Pinheiro DGM, Marinho MJF. Spontaneous respiratory modulation improves cardiovascular control in essential hypertension. Arq Bras Cardiol 2007 Jun;88(6):651-9. doi: http://dx.doi.org/10.1590/S0066-782X2007000600005. 8. Langer D, Probst VS, Pitta F, Burtin C, Hendriks E, Schans CPVD, et al. Clinical Practice Guideline for physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD) - Portuguese version. Rev Bras Fisioter. 2009 May-Jun;13(3):183-204. doi: https://doi.org/10.1590/S1413- 35552009005000034.
9. Telles S, Yadav A, Kumar N, Sharma S, Visweshwaraiah NK, Balkrishna A. Blood pressure and purdue pegboard scores in individuals with hypertension after alternate nostril breathing, breath awareness, and no intervention. Med Sci Monit. 2013 Jan 21;19:61-6. doi: 10.12659/msm.883743.
10. Altena MR, Kleefstra N, Logtenberg SJ, Groenier KH, Houweling ST, Bilo HJ. Effect of device- guided breathing exercises on blood pressure in patients with hypertension: a randomized controlled trial. Blood Press. 2009;18(5):273-9. doi: 10.3109/08037050903272925.
11. Hering D, Kucharska W, Kara T, Somers VK, Parati G, Narkiewicz K. Effects of acute and long- term slow breathing exercise on muscle sympathetic nerve activity in untreated male patients with hypertension. J Hypertens. 2013 Apr;31(4):739-46. doi: 10.1097/HJH.0b013e32835eb2cf.
12. Anderson DE, McNeely JD, Windham BG. Regular slow-breathing exercise effects on blood pressure and breathing patterns at rest. J Hum Hypertens. 2010 Dec;24(12):807-13. doi: 10.1038/ jhh.2010.18. Epub 2010 Mar 4.
13. Mourya M, Mahajan AS, Singh NP, Jain AK. Effect of slow- and fast-breathing exercises on autonomic functions in patients with essential hypertension. J Altern Complement Med. 2009 Jul;15(7):711-7. doi: 10.1089/acm.2008.0609.
14. Wojcicki JM, Geissler JD, Stokes CW, Heyman MB, Tran CT. The use of the RESPeRATE device to lower blood pressure in inner city obese adolescents and children: a pilot feasibility study. High Blood Press Cardiovasc Prev. 2013 Jun;20(2):89-92. doi: 10.1007/s40292-013-0014-3. Epub 2013 May 8.
15. Raupach T, Bahr F, Hermann P, Luethje L, Heusser K, Hasenfuss G, et al. Slow breathing reduces sympathoexcitation in COPD. Eur Respir J. 2008 Aug;32(2):387-92. doi: 10.1183/09031936.00109607. Epub 2008 Apr 2.
Submetido em:
09/10/2019
Aceito em:
16/09/2020
