ABC | Volume 115, Nº1, July 2020

Original Article Perrier-Melo et al. Post-Exercise Hypotension: Interval Vs. Continuous Arq Bras Cardiol. 2020; 115(1):5-14 diastolic BP at rest was 118/65.46 mmHg in IE and 117.27 / 64.73 mmHg in CE. Six studies involved 89 pre-hypertensive patients (n = 1 woman), 27,31-33,36,37 with a mean age of 29.15 years, and mean BMI of 24.68 km/ m 2 . Mean systolic and diastolic BP at rest was 127.22 / 73.12 mmHg in IE and 126.72 / 73.22 mmHg in CE. Four studies involved 61 hypertensive patients (n = 34 women), 30,34,35,38 mean age of 60,67 years, and mean BMI of 29,97 km/m 2 and all used antihypertensive medication. Regarding the BP measurement, of the 12 included studies, four used the auscultatory method (~ 33%), while the others used the oscillometric method in an automatic equipment. All studies used inferential statistics, adopting a value of p ≤ 0.05. Table 1 and 2 shows additional information on the characteristics of the studies and interventions. Characteristics of interventions Of the 12 studies included, seven (~ 58%) used a cycle ergometer, 26,27,31-35 and five used a treadmill 29,30,36-38 in the exercise sessions. When the IE session was performed on the treadmill, reductions in systolic and diastolic BP of ~ 9.8 and 4.4 mmHg were observed, respectively. When the IE session was performed on a cycle ergometer, the reduction in systolic and diastolic BP was ~ 7.6 and 3.7 mmHg, respectively. The reduction in systolic and diastolic BP after the CE session on the treadmill was ~ 6.2 and 2.5 mmHg, respectively, and the reduction in systolic and diastolic BP in the cycle ergometer was ~ 4.5 and 2.6 mmHg, respectively. The most frequently used IE protocol consisted of 4 minutes at high intensity, followed by 3 minutes, 27,34 2 minutes 35 or 1 minute 31 of active recovery. The other protocols used shorter periods (30 seconds to 3 minutes) at high intensity. The CE protocols, on the other hand, had a constant stimulus, lasting between 30 and 70 minutes. Table 3 shows the qualitative assessment of the included studies. According to the TESTEX scale (0-15 points), all studies had scores > 10 points. The weakest points in the studies were: lack of allocation concealment (92%), 26-29,31-37 blinding of the evaluator to evaluate the outcome (100%) 26,27,29–36 and absence of the reporting of adverse events (75%). 26,29-31,33-37 Effect of IE versus CE on clinical BP Figure 2 (panel A) shows the direct comparison between the effects of IE and CE on systolic BP. The meta-analysis showed a significant difference in favor of IE (WMD: -2.93 mmHg [95% CI: -4.96, -0.90], p = 0.005). Moderate heterogeneity was found for this analysis (I 2 = 50%; p = 0.01). A sensitivity analysis showed that the effect in favor of IE on PEH persisted after the removal of each of the included studies. The direct comparison between the effects of IE and CE on diastolic BP showed a significant difference in favor of IE (WMD: -1.73 mmHg [95% CI: -2.94, -0.51], p = 0.005). Low heterogeneity was found for this analysis (I 2  = 0%; p = 0.49), as shown in Figure 2 (panel B). In the sensitivity analysis, all studies (one by one) were removed and it was found that only the removal of the study by Maya et al. 36 from the analysis made the positive Table 1 - Characteristics of participants included in the studies Authors Participants Men (%) / Women (%) Age (years) BMI (kg/m 2 ) Sample characteristic Pimenta et al. 38 n=20 (15 women) 25%/75% 51±8 years 30±6 kg/m 2 Hypertensive men and women Costa et al. 30 n= 19 hypertensive women 0/100% 67.6±4.7 years 27.2 kg/m 2 Physically active and inactive women Boeno et al. 37 n= 13 pre-hypertensive men 100%/0 22.7±2.6 years 25.3 kg/m 2 Pre-hypertensive and physically inactive men Maya et al. 36 n= 30 pre-hypertensive men 100%/0 23±6.5 years 23.9 kg/m 2 Pre-hypertensive and physically active men Santos et al. 35 n=15 hypertensive NI 65.1±4.7 years 29.1 kg/m 2 Physically active men and women Morales-Palomo et al. 34 n=7 men and women with metabolic syndrome 57%/43% 55±9 years 29.1 kg/m 2 Normotensive men and women with metabolic syndrome Morales-Palomo et al. 34 n= 7 men 100%/0 59±6 years 33 kg/m 2 Hypertensive men with metabolic syndrome Costa et al. 29 n= 14 men 100%/0 24.9±4.1 years 24.2 kg/m 2 Normotensive and physically active men Graham et al. 33 n=12 men 100%/0 23±3 anos 24 kg/m 2 Pre-hypertensive and physically inactive men Angadi et al. 27 n=11 pre-hypertensive individuals 91%/9% 24.6±3.7 years 24.4 kg/m 2 Pre-hypertensive men and women Lacombe et al. 32 n=13 men 100%/0 57±4 years 28.6 kg/m 2 Pre-hypertensive and physically inactive men Rossow et al. 26 n= 15 men 100%/0 25.8±6.5 years 22.6 kg/m 2 Trained normotensive men Rossow et al. 26 n=10 women 0/100% 25±3.4 years 22.2 kg/m 2 Trained normotensive women Mourot et al. 31 n=10 men 100%/0 24.6±0.6 years 21.86 kg/m 2 Trained pre-hypertensive men SOURCE: The author. Recife, 2019. 8