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Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: a randomized controlled trial
Ferreira JB, Plentz RDM, Stein C, Casali KR, Arena R, Lago PD
International Journal of Cardiology 2013 Jun 5;166(1):61-67
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Autonomic imbalance, characterized by sympathetic hyperactivity and diminished vagal tone, is a known mechanism for essential hypertension. Inspiratory muscle training (IMT) demonstrates beneficial outcomes in a number of cardiovascular populations, which may potentially extend to patients with hypertension. The aim of this study was to further elucidate the effects of IMT on blood pressure and autonomic cardiovascular control in patients with essential hypertension. METHODS: Thirteen patients with hypertension were randomly assigned to an eight-week IMT program (6 patients) or to a placebo-IMT (P-IMT, 7 patients) protocol. We recorded RR interval for posterior analysis of heart rate variability and blood pressure, by ambulatory blood pressure monitoring (ABPM), before and after the program. RESULTS: There was a significant increase in inspiratory muscle strength in the IMT group (82.7 +/- 28.8 versus 121.5 +/- 21.8 cmH2O, p < 0.001), which was not demonstrated by P-IMT (93.3 +/- 25.3 versus 106.1 +/- 25.3 cmH2O, p > 0.05). There was also a reduction in 24-hour measurement of systolic (133.2 +/- 9.9 versus 125.2 +/- 13.0 mmHg, p = 0.02) and diastolic (80.7 +/- 12.3 versus 75.2 +/- 1.0 mmHg, p = 0.02) blood pressure, as well as in daytime systolic (136.8 +/- 12.2 versus 127.6 +/- 14.2 mmHg, p = 0.008) and diastolic (83.3 +/- 13.1 versus 77.2 +/- 12.2 mmHg, p = 0.01) blood pressure in the IMT group. In relation to autonomic cardiovascular control, we found increased parasympathetic modulation (HF 75.5 +/- 14.6 versus 84.74 +/- 7.55 nu, p = 0.028) and reduced sympathetic modulation (LF 34.67 +/- 20.38 versus 12.81 +/- 6.68 nu; p = 0.005). Moreover, there was reduction of cardiac sympathetic discharge (fLF) in IMT group (p = 0.01). CONCLUSIONS: IMT demonstrates beneficial effects on systolic and diastolic blood pressure as well as autonomic cardiovascular control in hypertensive patients.

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