Fapesp: Exercise improves blood pressure in patients with rheumatoid arthritis

Walking for 30 minutes at moderate intensity can temporarily lower blood pressure in patients with rheumatoid arthritis. And more: in tests conducted by researchers at the University of São Paulo (University of the South PacificWomen with autoimmune diseases and high blood pressure showed improvement after physical exercise, not only when they were at rest, but also during stressful episodes — such as cognitive and physical tests — that tend to raise blood pressure in these patients.

Rheumatoid arthritis is an autoimmune inflammatory disease, characterized mainly by joint pain and functional disability, and may present as a secondary problem such as high blood pressure. So much so that cardiovascular disease is the largest cause of death for people with rheumatoid arthritis. Previous studies have shown that individuals with autoimmune diseases have a 50% higher risk of dying from cardiovascular disease than the general population.

“Rheumatoid arthritis is intrinsically linked to problems with high blood pressure, both due to severe inflammation and due to certain medications (used to treat autoimmune diseases) that can have a detrimental effect on the function and structure of blood vessels. In this way, the patient’s arthritis may be under control and increase His blood pressure gets worse, and varies more than usual throughout the day. “Therefore, in these cases, it is necessary to consider non-pharmacological strategies that complement blood pressure control,” explains Thiago Picanha, a collaborating researcher at the USP School of Medicine and a professor at the University of South Pacific. Pacific. Department of Sport and Exercise Sciences at Manchester Metropolitan University (United kingdom).

The study was previously supported Visp As part of a thematic project studying the effects of reducing sedentary lifestyle in different clinical populations.

It is already known that physical exercise is one of the best non-drug ways to control blood pressure in general. “But it is still not known exactly what happened to people with rheumatoid arthritis and high blood pressure as a result of autoimmune diseases. After all, stressful events, such as stress or situations that cause pain, can increase stress in These individuals. “However, the results of our study were very positive and reinforce the importance of physical exercise in cardiovascular management and as a complementary means of controlling blood pressure in these patients,” says Tatianne Almeida de Luna, first author of the article that was the result of her master’s thesis. Her own.

Peçanha says the results of the study in patients with rheumatoid arthritis can be extrapolated to other inflammatory autoimmune diseases, such as lupus, psoriatic arthritis, inflammatory myopathy, and juvenile lupus. “This is because rheumatoid arthritis is a model of an inflammatory disease similar to these other diseases. Therefore, inflammation and its consequences, such as high blood pressure, also occur in a similar way in these other diseases.”

Blood pressure in the arteries

Patients with rheumatoid arthritis tend to have high systolic blood pressure (when the heart contracts to push blood into the arteries). It is worth noting that high blood pressure is a chronic disease characterized by high levels of blood pressure in the arteries. It occurs when systolic and diastolic pressure values ​​equal or exceed 140/90 mm Hg (or 14 x 9).

Previous studies show that approximately 50% of patients do not reach the ideal value for systolic blood pressure control (less than 140 mm Hg), and this appears to occur even in those who adhere to antihypertensive treatments. Even during sleep, when blood pressure (systolic and diastolic) is expected to drop slightly, patients with rheumatoid arthritis tend to maintain higher values.

The researchers explain that these patients also typically show an increased blood pressure response when they encounter stressful situations, such as during mental stress, physical exertion, or in response to pain, which may contribute to the higher cardiovascular risk in this disease. A recent study by the same group of researchers noted that postmenopausal women with rheumatoid arthritis experience an increase in blood pressure in response to lower extremity exercise, and the greater the inflammation, the greater the increase in blood pressure.

Temporary reduction

In the work published in Journal of Human HypertensionThe researchers analyzed 20 women diagnosed with rheumatoid arthritis and high blood pressure, aged between 20 and 65 years. The study volunteers are part of the Rheumatoid Arthritis Outpatient Clinic at Hospital das Clínicas of the University of the South Pacific School of Medicine. It is worth noting that the fertile participants took the study’s tests when they were in the initial follicular phase of their menstrual cycle (between one and seven days after the start of menstruation).

The study was conducted with volunteers in three meetings. In the first session, after they made their choice, the researchers measured blood pressure and performed a physical test on the participants. In the second meeting, the volunteers’ blood pressure was measured before and after walking for 30 minutes on a comfortable treadmill. In the third session, they remained standing on the treadmill in a resting position for 30 minutes and measured their blood pressure before and after this period. Since this is a randomized study, the order of exercise or rest was randomized.

After performing physical exercises or resting, the volunteers underwent tests that simulated bouts of stressful stimuli that could increase blood pressure in these patients. In the cognitive stress test, participants had to answer a color questionnaire, while they were given cards drawn in one color and with the name of another color written on them. In the physical pain stress test, they placed their hands flat in a tub of water at 4 degrees Celsius. In both phases of the study, volunteers continued to monitor their blood pressure in real time for 24 hours using an ambulatory blood pressure monitor.

Thus, the researchers found that the systolic blood pressure of the 20 women remained stable in the period immediately before and after walking. However, it increased in the comparison made on the rest day. “This shows that exercise prevents high blood pressure,” says Pisanha.

Post-test monitoring revealed that exercise reduced 5 mmHg in average systolic blood pressure. “This is in line with what meta-analyses show with this type of exercise in the general population,” he adds. “This reduction value is important, because it is associated with a 14% lower risk of death from stroke, and a 9% lower risk of death from coronary artery disease,” he adds. “The overall risk of death is reduced by 7% for people with high blood pressure.”

“The temporary effect of a single session of exercise is very important, as acute decreases in blood pressure are expected to accumulate over successive days of exercise and lead to sustained decreases over time, which may contribute to better control of hypertension in rheumatoid arthritis.” ” “, says Peçanha.

But the researcher highlights the importance of the findings regarding the role of exercise in lowering blood pressure, even in tests that simulate stressful events.

“The cognitive stress test, for example, is widely used in studies that evaluate the cardiovascular response to mental stress. In general, for patients with rheumatoid arthritis, the psychological stress induced by a cognitive stress test causes an increase in the average In systolic blood pressure (to 16 mmHg), diastolic blood pressure (to 12 mmHg), and heart rate (increased by 8 beats per minute).. However, after exercise, we noticed that the patients’ systolic blood pressure decreased by 6. mmHg, which did not happen in the session in which they remained at rest.

For tests that simulate physical pain stress, an increase in mean systolic blood pressure (to 18 mmHg), diastolic blood pressure (to 11 mmHg), and heart rate (increase by 1 beat per minute) is expected. . However, in the study, six patients showed a greater increase in systolic blood pressure (to 25 mmHg). On the day the volunteers walked for 30 minutes, the drop in systolic blood pressure was 1 mmHg on average, while it increased by 4 mmHg on the day they rested.

“Since these stressful situations are known to increase the risk of cardiovascular diseases, such as stroke and myocardial infarction, the study shows that lowering systolic blood pressure induced by physical exercise has the potential to reduce cardiovascular problems in people with arthritis.” “Rheumatoid”. States.

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