Efectos agudos del ejercicio en la presión arterial. Implicaciones terapéuticas en pacientes hipertensos


  • Pablo Álvarez Aguilar Universidad de Costa Rica



Palabras clave:

Ejercicio, hipertensión, hipotensión post-ejercicio


El abordaje de la hipertensión arterial se realiza desde distintos frentes; sin embargo, el tratamiento no farmacológico puede ser subvalorado por el personal médico.

El tratamiento con ejercicio es una herramienta terapéutica que puede contribuir al control de las cifras tensionales de los pacientes hipertensos, reducir su necesidad de medicamentos, mejorar su calidad de vida, disminuir la mortalidad cardiovascular y otras comorbilidades.

El dominio de los fundamentos de prescripción de ejercicio en pacientes hipertensos es una herramienta con un alto potencial terapéutico que debería ser manejada por cualquier médico general.

En este trabajo se abordan los mecanismos fisiológicos implicados en la hipotensión post-ejercicio y las bases de la prescripción de un plan de ejercicio en pacientes hipertensos.


Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 2004; 36:533-53.

Chobanian AV. Shattuck Lecture. The hypertension paradox--more uncontrolled disease despite improved therapy. N Engl J Med 2009; 361:878-87.

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevante of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903-13.

Oparil S, Zaman M, Calhoun D. Pathogenesis of Hypertension. Ann InternMed 2003; 139: 761-776.

World Health Organization (WHO)/International Society of Hypertension (ISH) statement on the management of hypertension. J Hypertens 2003; 21:1983-92.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560-72.

European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21:1011-53.

Hackam DG, Quinn RR, Ravani P, Rabi DM, Dasgupta K, Daskalopoulou SS, et al; Canadian Hypertension Education Program. Canadian Hypertension Education Program. The 2013 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2013; 29(5):528-42

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507-20.

Fitzgerald W. Labile hypertension and jogging: new diagnostic tool or spurious discovery? Br Med J (Clin Res Ed) 1981; 282: 542-544

Kurl S, Laukkanen JA, Rauramaa R, Lakka TA, Sivenius J, Salonen JT. Systolic blood pressure response to exercise stress test and risk of stroke. Stroke 2001; 32:2036-41.

Crisafulli A, Carta C, Melis F, Tocco F, Frongia F, Santoboni UM, et al. Haemodynamic responses following intermittent supramaximal exercise in athletes. Exp Physiol 2004; 89:665-74.

Pigozzi F, Spataro A, Alabiso A, Parisi A, Rizzo M, Fagnani F, et al. Role of exercise stress test in master athletes. Br J Sports Med 2005; 39: 527-31.

Wilcox RG, Bennett T, Macdonald IA, Broughton Pipkin F, Baylis PH. Postexercise hypotension: the effects of epanolol or atenolol on some hormonal and cardiovascular variables in hypertensive men. Br J Clin Pharmacol 1987; 24:151-62.

Kaufman FL, Hughson RL, Schaman JP. Effect of exercise on recovery blood pressure in normotensive and hypertensive subjects. Med Sci Sports Exerc 1987; 19:17-20

Wallace JP, Bogle PG, King BA, Krasnoff JB, Jastremski CA. A comparison of 24-h average blood pressures and blood pressure load following exercise. Am J Hypertens 1997; 10:728-34.

Rueckert PA, Slane PR, Lillis DL, Hanson P. Hemodynamic patterns and duration of post-dynamic exercise hypotension in hypertensive humans. Med Sci Sports Exerc 1996; 28:24-32.

Mota MR, Pardono E, Lima LC, Arsa G, Bottaro M, et al. Effects of treadmill running and resistance exercises on lowering blood pressure during the daily work of hypertensive subjects. J Strength Cond Res 2009; 23:2331-8.

MacDonald JR, MacDougall JD, Hogben CD. The effects of exercising muscle mass on post exercise hypotension. J Hum Hypertens 2000; 14:317-320

Westhoff TH, Schmidt S, Gross V, Joppke M, Zidek W, van der Giet M, Dimeo F. The cardiovascular effects of upper-limb aerobic exercise in hypertensive patients. J Hypertens 2008; 26:1336-42.

Brown SP, Clemons JM, He Q, Liu S. Effects of resistance exercise and cycling on recovery blood pressure. J Sports Sci 1994; 12:463-468

MacDonald JR, MacDougall JD, Interisano SA, Smith KM, McCartney N, Moroz JS, et al. Hypotension following mild bouts of resistance exercise and submaximal dynamic exercise. Eur J Appl Physiol Occup Physiol 1999; 79: 148-154

Farrel P, Joyner M, Caiozzo V; American College of Sports Medicine. ACSM’s Advanced Exercise Physiology. Seg. Ed. Baltimore: Lippincott Williams & Wilkins, 2012.

MacDonald JR. Potential causes, mechanisms, and implications of post exercise hypotension. J Hum Hypertens 2002; 16:225-36.

Smelker C, Foster C, Maher M, Martinez R, Porcari J. Effect of Exercise Intensity on Postexercise Hypotension. J Cardiopulm Rehabil 2004; 24:26973.

Rodriguez D, Polito M, Bacurau R, Prestes J, Pontes F. Effect of Different Resistance Exercise Methods on Post-Exercise Blood Pressure. Int J Exerc Sci 2008; 1:153-162.

Forjaz CL, Santaella DF, Rezende LO, Barretto AC, Negrão CE. Effect of exercise duration on the magnitude and duration of post-exercise hypotension. Arq Bras Cardiol 1998; 70 :99-104.

Ciolac EG, Guimarães GV, D Avila VM, Bortolotto LA, Doria EL, Bocchi E. Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients. Int J Cardiol. 2009; 133:381-7.

Boone JB Jr, Probst MM, Rogers MW, Berger R. Postexercise hypotension reduces cardiovascular responses to stress. J Hypertens 1993; 11:449-53.

Piepoli M et al. Persistent peripheral vasodilation and sympathetic activity in hypotension after maximal exercise. J Appl Physiol 1993; 75:1807-1814.

Somers VK, Conway J, Coats A, Isea J, Sleight P. Postexercise hypotension is not sustained in normal and hypertensive humans. Hypertension 1991; 18:211-5.

Franklin PJ, Green DJ, Cable NT. The influence of thermoregulatory mechanisms on post-exercise hypotension in humans. J Physiol 1993; 470: 231-41.

Pescatello LS, Fargo AE, Leach CN Jr, Scherzer HH. Short-term effect of dynamic exercise on arterial blood pressure. Circulation 1991; 83:1557-61.

Hara K, Floras JS. Influence of naloxone on muscle sympathetic nerve activity, systemic and calf haemodynamics and ambulatory blood pressure after exercise in mild essential hypertension. J Hypertens 1995; 13:447-61.

Brownley KA, West SG, Hinderliter AL, Light KC. Acute aerobic exercise reduces ambulatory blood pressure in borderline hypertensive men and women. Am J Hypertens 1996; 9:200-6.

BrandãoRondon MU, Alves MJ, Braga AM, Teixeira OT, Barretto AC, Krieger EM, Negrão CE. Postexercise blood pressure reduction in elderly hypertensive patients. J Am Coll Cardiol 2002; 39:676-82.

Owen A, Wiles J, Swaine I. Effect of isometric exer ciseon resting blood pressure: a meta análisis J Hum Hypertens 2010; 24:796-800.

Kelley GA, Kelley KS. Isometric handgrip exercise and resting blood pressure:

a meta-analysis of randomized controlled trials. J Hypertens. 2010; 28:411-8.

Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and metaanalysis. Mayo Clin Proc. 2014; 89:327-34.

Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehabil. 2007; 14:12-7.

Tsai JC, Yang HY, Wang WH, Hsieh MH, Chen PT, Kao CC, et al. The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension. Clin Exp Hypertens 2004; 26:255-65.

Coats AJ. Systemic and forearm vascular resistance changes after upright bicycle exercise in man. J Physiol 1989; 413: 289–298.

Cléroux J, Kouamé N, Nadeau A, Coulombe D, Lacourciere Y. Baroreflex regulation of forearm vascular resistance after exercise in hypertensive and normotensive humans. Am J Physiol 1992; 263:H1523-31.

Hagberg JM, Montain SJ, Martin WH. Blood pressure and hemodynamic responses after exercise in older hypertensives. J Appl Physiol 1987; 63:270-6.

Floras JS, Wesche J. Haemodynamic contributions to post-exercise hypotension in young adults with hypertension and rapid resting heart rates. J Hum Hypertens 1992; 6: 265-9

Potts JT. Inhibitory neurotransmission in the nucleus tractussolitarii: implications for baroreflex resetting during exercise. Exp Physiol 2006; 91:5972.

Joyner MJ. Baroreceptor function during exercise: resetting the record. Exp Physiol 2006; 91:27-36.

Legramante JM, Galante A, Massaro M, Attanasio A, Raimondi G, Pigozzi F, et al. Hemodynamic and autonomic correlates of postexercise hypotension in patients with mild hypertension. Am J Physiol Regul Integr Comp Physiol. 2002; 282:R1037-43.

Halliwill JR, Taylor JA, Eckberg DL. Impaired sympathetic vascular regulation in humans after acute dynamic exercise. J Physiol 1996; 495: 279-88.

Floras JS, Sinkey CA, Aylward PE, Seals DR, Thoren PN, Mark AL. Postexercise hypotension and sympathoinhibition in borderline hypertensive men. Hypertension 1989; 14: 28-35.

MacDonald JR, Hogben CD, Tarnopolsky MA, MacDougall JD. Post exercise hypotension is sustained during mild exercise and simulated activites of daily living. J Hum Hypertens 2001; 15: 567-72.

Grassi G. Role of the sympathetic nervous system in human hypertension. J Hypertens. 1998;16:1979-87.

Landry JF. A study of some potential correlates of the hypotensive effects of prolonged submaximal exercise in normotensive men. Can J PhysiolPharmacol 1992; 70: 53-59.

Schweda F, Friis U, Wagner C, Skott O, Kurtz A. Renin release. Physiology (Bethesda). 2007; 22:310-9.

Wilcox RG, Bennett T, Brown AM, Macdonald IA. Is exercise good for high blood pressure? Br Med J (Clin Res Ed) 1982; 285:767-9

Bohem M, Nabel E. Angiotensin Converting Enzyme 2 – A new cardiac regulator. N Eng J Med 2002; 347:1795-7.

Holmes CL, Landry DW, Granton JT. Science review: Vasopressin and the cardiovascular system part 1--receptor physiology. Crit Care. 2003; 7:427-34.

Michelini LC. Endogenous vasopressin and the central control of heart rate during dynamic exercise. Braz J MedBiol Res 1998; 31:1185-95.

Michelini LC. Differential effects of vasopressinergic and oxytocinergic preautonomic neurons on circulatory control: reflex mechanisms and changes during exercise. Clin Exp Pharmacol Physiol 2007; 34:369-76.

Vogelsang TW, Yoshiga CC, Højgaard M, Kjaer A, Warberg J, Secher NH, Volianitis S. The plasma atrial natriuretic peptide response to arm and leg exercise in humans: effect of posture. Exp Physiol 2006; 91:765-71.

Hara K, Floras JS. Effects of naloxone on hemodynamics and sympathetic activity after exercise. J Appl Physiol 1992; 73:2028-35.

Dunn KM, Nelson MT. Potassium channels and neurovascular coupling. Circ

J. 2010; 74:608-16.

Saltin B. Exercise hyperaemia: magnitude and aspects on regulation in humans. J Physiol. 2007; 583:819-23.

Dora KA. Coordination of vasomotor responses by the endothelium. Circ J 2010;74:226-32.

Martin EA, Nicholson WT, Curry TB, Eisenach JH, Charkoudian N, Joyner MJ. Adenosine transporter antagonism in humans augments vasodilator responsiveness to adenosine, but not exercise, in both adenosine responders and non-responders. J Physiol. 2007; 579:237-45.

de Souza Nery S, Gomides RS, da Silva GV, de MoraesForjaz CL, Mion D Jr, Tinucci T. Intra-arterial blood pressure response in hypertensive subjects during low- and high-intensity resistance exercise. Clinics (Sao Paulo) 2010; 65:271-7.

Francois H, Coffman TM. Prostanoids and blood pressure: which way is up? J Clin Invest 2004; 114:757-9.

Sadowski J, Badzynska B. Intrarenal vasodilator systems: NO, prostaglandins and bradykinin. Anintegrativeapproach. J Physiol Pharmacol 2008; 59Suppl 9:105-19.

Wilson JR, Kapoor SC. Contribution of prostaglandins to exercise-induced vasodilation in humans. Am J Physiol 1993; 265:H171-5.

Howard MG, DiCarlo SE. Reduced vascular responsiveness after a single bout of dynamic exercise in the conscious rabbit. J Appl Physiol 1992; 73:2662-7.

Patil RD, DiCarlo SE, Collins HL. Acute exercise enhances nitric oxide modulation of vascular response to phenylephrine. Am J Physiol 1993; 265: H1184-8.

Koltyn KF, Umeda M. Exercise, hypoalgesia and blood pressure. Sports Med. 2006; 36:207-14.

Cunha GS, Ribeiro JL, Oliveira AR. Levels of beta-endorphin in response to exercise and overtraining Arq Bras Endocrinol Metabol 2008; 52:589-98.

Pepe S, van den Brink OW, Lakatta EG, Xiao RP. Cross-talk of opioid peptide receptor and beta-adrenergic receptor signalling in the heart. Cardiovasc Res 2004; 63:414-22.

Lechin F, van der Dijs B, Orozco B, Lechin ME, Báez S, Lechin AE, Rada I, Acosta E, Arocha L, Jiménez V, et al. Plasma neurotransmitters, blood pressure, and heart rate during supine-resting, orthostasis, and moderate exercise conditions in major depressed patients. Biol Psychiatry 1995; 38:166-73.

Ryushi T, Kita I, Sakurai T, Yasumatsu M, Isokawa M, Aihara Y, et al. The effect of exposure to negative air ions on the recovery of physiological responses after moderate endurance exercise. Int J Biometeorol 1998; 41:132-6.

MacDonald JR, Rosenfeld JM, Tarnopolsky MA, Hogben CD, Ballantyne CS, MacDougall JD. Post exercise hypotension is not mediated by the serotonergic system in borderline hypertensive individuals. J Hum Hypertens 2002; 16:33-9

de Moraes AC, Fernández-Alvira JM, Carvalho HB, Meirhaeghe A,

Dallongeville J, Kafatos A, et al. Physical activity modifies the associations between genetic variants and blood pressure in European adolescents. J Pediatr 2014; 165:1046-9.

Petriz BA, Franco OL. Effects of hypertension and exercise on cardiac proteome remodelling. Biomed Res Int. 2014; 2014:634132.

Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013; 15(6):659-68.

Álvarez C, OlivoJ, Robinson O, Quintero J, Carrasco V, Ramírez-Campillo R, et al. Efectos de una sesión de ejercicio aeróbico en la presión arterial de niños, adolescentes y adultos sanos. Rev Med Chile 2013; 141:1363-1370

Taylor D Physical activity is medicine for older adults. Postgrad Med J. 2014; 90:26-32

Park J, Quyyumi AA, Middlekauff HR. Exercise pressor response and arterial baroreflex unloading during exercise in chronic kidney disease. J Appl Physiol (1985). 2013; 114:538-49.

Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012; 98:349-60.

Ekelund U1, Ward HA1, Norat T1, Luan J1, May AM1, Weiderpass E, et al. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr 2015; 101:613-21.

Laursen AS, Hansen AL, Wiinberg N, Brage S, Sandbæk A, Lauritzen T, et al. Higher physical activity is associated with lower aortic stiffness but not with central blood pressure: the ADDITION-Pro Study. Medicine (Baltimore) 2015; 94:e485.

Endes S, Schaffner E, Caviezel S, Dratva J, Autenrieth CS, Wanner M, et al. Physical activity is associated with lower arterial stiffness in older adults: results of the SAPALDIA 3 Cohort Study. Eur J Epidemiol. 2015 Jul 29. [Epub ahead of print].

Lo AX, Donnelly JP, McGwin G Jr, Bittner V, Ahmed A, Brown CJ. Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults ≥65 years with heart failure. Am J Cardiol 2015; 115:797-801.

Faselis C, Doumas M, Pittaras A, Narayan P, Myers J, Tsimploulis A, et al. Exercise capacity and all-cause mortality in male veterans with hypertension aged ≥70 years. Hypertension 2014; 64:30-5.

Schnohr P, O’Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol 2015; 65:411-9.

Schnohr P, Marott JL, Lange P, Jensen GB. Longevity in male and female joggers: the Copenhagen City Heart Study. Am J Epidemiol 2013; 177:683-9.

Neil FG Hypertension. En: Durstine J, Moore G, Painter PL, Scott O. ACSM´s: Exercise Management for persons with chronic diseases a disabilities. Terc. Ed. EEUU: Human Kinetics, 2009.

Weir MR. In the clinic: hypertension. Ann Intern Med. 2014; 161:ITC1-15.



2015-10-19 — Actualizado el 2015-10-19


Cómo citar

Aguilar, P. Álvarez. (2015). Efectos agudos del ejercicio en la presión arterial. Implicaciones terapéuticas en pacientes hipertensos. Acta Médica Costarricense, 57(4), 163–171. https://doi.org/10.51481/amc.v57i4.897