ABC | Volume 114, Nº4, April 2020

Original Article Hydrotherapy Reduces Arterial Stiffness in Pregnant Women With Chronic Hypertension Giovana Macêdo Linhares, 1 Antonio Vieira Machado, 1 Marcus Vinícius Bolívar Malachias 1 Faculdade de Ciências Médicas de Minas Gerais, Instituto de Pesquisas e Pós-Graduação, 1 Belo Horizonte, MG – Brazil Mailing Address: Marcus Vinícius Bolívar Malachias • Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro. Postal Code 30130-110, Belo Horizonte, MG – Brazil E-mail: mbolivar@cardiol.br Manuscript received January 25, 2018, revised manuscript May 05, 2019, accepted December 03, 2019 DOI: https://doi.org/10.36660/abc.20190055 Abstract Background: Chronic hypertension (CH) and high arterial stiffness (AS) increase the risk of complications during pregnancy, such as superimposed preeclampsia and low fetal growth. Objective: To evaluate the impact of hydrotherapy, a non-pharmacological treatment strategy, on AS in pregnant women with CH. Methods: Cross-sectional study evaluating the effect of a standardized hydrotherapy session on AS in pregnant women with CH and controls. We used the device Mobil-O-Graph® NG to measure blood pressure (BP), heart rate (HR), and AS before and after a hydrotherapy session involving stretching, warming up, strengthening, and relaxation. The level of significance adopted in the statistical analyses was 5%. Results: We evaluated 36 pregnant women, including 12 with hypertension (HG) and 24 controls (CG), aged 30.4 ± 4.8 years and at 29.2 ± 3.3 gestational weeks. Hydrotherapy promoted in both groups a significant reduction in AS assessed by the augmentation index at a HR of 75 bpm (AIx@75) (HG: 28.8 ± 7.3%, before; 22.4 ± 6.9%, after; p = 0.024; and CG: 29.1 ± 7.4%, before; 22.9 ± 6.6%, after; p = 0.001), as well as a reduction in HR (HG: 93.4 ± 11.8 bpm, before; 82.4 ± 10.0 bpm, after; p < 0.001; and CG: 91.4 ± 13.4 bpm, before; 81.5 ± 12.6 bpm, after; p < 0.001), but a nonsignificant reduction in BP. Conclusion: We demonstrated that a hydrotherapy session acutely reduces AS assessed by AIx@75, and may represent a potential non‑pharmacological strategy to prevent maternal and fetal complications in pregnant women with CH. (Arq Bras Cardiol. 2020; 114(4):647-654) Keywords: Hypertension; Hydrotherapy; Pregnancy, High-Risk Ris/complications; Vascular Stiffness; Pre-Eclampsia. Introduction Hypertensive syndromes in pregnancy are associated with a higher risk of maternal and fetal complications. The various forms of hypertension during pregnancy cause about 14% of maternal deaths and are associated with dysfunctions affecting the newborn, such as low birth weight. 1,2 Several hypertensive syndromes occur during pregnancy, including preeclampsia, eclampsia, chronic hypertension, chronic hypertension with superimposed preeclampsia, and gestational hypertension. 3 Chronic hypertension (CH) causes 1 to 5% of all complications in pregnancy. 2 In women with normotension or hypertension and in individuals in the general population, increased arterial stiffness (AS) has been recognized as a marker of higher risk for cardiovascular outcomes with even more significance than elevated peripheral blood pressure (BP) measured at the brachial artery (bBP). 4-6 A portion of the pulse wave directed to the periphery is reflected back from peripheral impedance points. In healthy individuals, the reflected wave returns to the aorta during diastole. Due to aging or conditions that compromise arterial compliance, stiffer arteries reduce the transit time of incident and reflected waves. Consequently, reflected waves reach the aorta earlier, increasing central arterial pressures. The increased central pressure can be quantified by the augmentation index (Alx), defined as the percentage of central pulse pressure attributed to the reflected wave. 7 Evidence points out to Alx as a hallmark of the pathophysiology of hypertensive syndromes of pregnancy. 7 Increased Alx is recognized as a cardiovascular risk marker 5,7 and has been correlated with pregnancy complications, such as superimposed preeclampsia and fetal growth restriction, and a potentially additional future cardiovascular risk in women. 8-11 Evidence shows a beneficial effect of regular physical activity in pregnant women with hypertension. 10,11 Aquatic physical therapy, better known as hydrotherapy, is a non‑pharmacological intervention used in various clinical contexts that utilizes the properties of immersion in warm water associated with the practice of combined aerobic and resistance exercises. 12-17 However, no studies have evaluated the impact of this physical activity on AS in pregnant women with hypertension. 647