Application of the fourth ventricle (CV4) technique in subjects with systemic arterial hypertension (SAH) stage I: quasi-experimental study

Abstract

Introduction: Arterial Hypertension Systemic (AHS) is a chronic disease that has few symptoms in its early stage. AHS promotes a major impact on public health, because it accounts for 45% of deaths related to heart problems and 51% of strokes worldwide. Thus, there is a real need to find new therapies that help to minimize and / or control the deleterious effects of hypertension. In this light alternative approaches such as manual treatments seem to have an influence on the regulation of blood pressure (BP). Cranial Osteopathic Manipulative Medicine (MMO) possesses a technique known as compression of the 4th ventricle (CV4). This technique denotes an autonomic effect, suggesting therefore an effect on the BP. Despite this cranial technique is broadly used in the field of osteopathy, there is still a lack of research to discuss the effects on autonomic function, especially in BP. Objective: To compare the behavior of blood pressure (BP) and heart rate variability (HRV) among hypertensive stage I and normotensive, who were submitted to cranial technique of the 4th ventricle compression. Methods: In this experimental controlled study 30 men between 40 and 60 years were analyzed and divided into two groups: normotensive (NT) and hypertensives (HT). Individuals of the HT group were recruited in the Osteopathy clinic of the Municipal Rehabilitation Hospital Pedro II. Every individual of this group had a SBP between 140-160mmHg what characterized AHS stage I. The CV4 maneuver was applied in both groups and the PA was collected at 5 time points: pre; post-intervention; 5; 10; 15min after the intervention. Concomitantly, we analyzed the heart rate variability (HRV) in time-frequency domain. The time-frequency parameters were obtained from measurements of RR intervals collected during the times of interest. Data were analyzed using a two-way ANOVA for analysis of the condition factor (hypertensive and normotensive) and time (pre and post-intervention, 5, 10 and 15min). The significance level was 95% (p ≤ 0.05). Results: Our findings showed a reduction in BP in the HT group. It was noticed a significant intergroup difference (p = 0.01), with respect to SDNN values mainly between pre and 15min moments. Concerning RNSSD values, highlights were differences between the pre- and 10 minutes (p = 0.01) only in the NT group. There was an increase in HF values and a LF attenuation in both groups at all time points (pre, post, 5, 10, 15min. Conclusion: The data reveal BP reduction in the HT group in the pre-15min, and a increase in parasympathic activity and decreased sympathic in both groups. This suggests a change in the sympathetic-vagal balance. However, there is need for futher studies to bring to light more dta on BP reduction mechanisms with CV4.