PED488

Hypertension and Exercise

Hypertension (Silent Killer)•Major risk factor…impacts

• heart disease• stroke• congestive heart failure• kidney• brain

• Risk increases several-fold with higher levels BP •cardiovascular disease, stroke, renal disease

• 90–95 percent of the cases of high blood pressure unknown

• high blood pressure is easily detected and usually controllable

• Is idiopathic…or has no know cause

• A condition in which the pressure of the blood pumping through the arteries is abnormally high• Force of blood against the walls of arteries• Recorded as two numbers

• as the heart beats systolic pressure • as the heart relaxes between beats diastolic pressure • millimeters of mercury = mmHg• written as SBP above or before DBP

• example: • blood pressure measurement of 120/80 mmHg• is expressed verbally as "120 over 80."

Blood Pressure Defined

Hypertension Video

• Overview• http://www.youtube.com/watch?v=fUcLrdPJurU• http://www.youtube.com/watch?v=xnyfElxkBlI&feature=related

•Exercise• http://www.youtube.com/watch?v=kYPQm0NHExQ

Interactive impact of HTN

Diagnosing and Evaluating HTNGet an accurate and consistent readings

pressure readings can vary widelyreadings done on different days (over month) to confirm

Patients should be seated and with no stimulants 30 min preceding measurement

Best to wait 5 min of complete rest and relaxation…quiet setting

Use appropriate cuff sizeShort sleeve shirt…rest arm on surfaceDeflate cuffWait 2 minutes between readings…2-3 to confirm

Category Follow-Up

Normal Blood Pressure

120/80 Recheck in two years

Prehypertension 120-139 / 80-89 Recheck in one year

Hypertension:Stage 1

140 -159 /90 - 99

Confirm in two months

Hypertension:Stage 2

> 160 / > 100 Evaluate or refer in one month

>180/>110 mm Hg Evaluate or refer immediately to one week, depending on clinical situation and/or complications

HTN: ACSM

Table 3-1

Recommended TreatmentNormal

•Encourage Life-Style ChangesPrehypertension

• Prescribe Life-Style Changes •For compelling indications* utilize initial drug therapy

Stage 1 Hypertension• Begin with Life-Style Changes • Consider monotherapy of blood pressure meds Stage 2 Hypertension• Life-Style Changes • Thiazide-type diuretic combined with blood pressure meds 

ACSM:Cornerstone of Antihypertensive Therapy

Lifestyle modificationPhysical ActivityWeight Reduction (if needed)DASH eating plan (i.e., a diet rich in fruits,

vegetables, and low-fat dairy products with a reduced content of saturated and total fat), dietary sodium reduction (no more than 100 mmol or 2.4 g sodium·d), and moderation of alcohol consumption

• Dangerous if untreated• Often systolic is especially meaningful

• better diagnosis of high blood pressure• most common form HTN• increases with age in older Americans

• Once developed cannot be cured once• due increased peripheral resistance

• DBP does not also need to be high to have HTN• Treatment high systolic pressure

HTN Treatment

Treatment of HTNSecondary BP • underlying disease or condition causes HTN• treatment of high blood pressure will include that condition

Primary BP LEVEL 1: Lifestyle Modifications

• Avoiding alcoholic drinks• Cut down on salt• Exercise regularly• Lose weight• Get enough calcium, magnesium and potassium• Quit smoking • Reduce intake of dietary saturated fats

Treatment of HTNLEVEL 2• drugs to lower blood pressure• common drugs for the treatment include:

• Diuretics to rid the body of excess salt and water•Angiotensin-converting enzyme (ACE) inhibitors to dilate the arteries and relieve pressure•Beta blockers to help the body avoid high blood pressure caused by stress•Calcium-channel blockers, which cause blood vessels to widen using a different mechanism

• SBP is focus of the therapy because it is more related to organ diseases than DBP• In the past, mono-drug therapy was the initial step in medications

•Combination therapy contemporary approach

ACSM: Medsmost patients with hypertension who require

drug therapy in addition to lifestyle modification two or more antihypertensive medications to

achieve the goal BP (i.e., <140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease)

• Regular physical activity lowers blood pressure for those who have hypertension. • With regular exercise

• systolic blood pressure is lowered about 11 mm Hg • diastolic blood pressure is lowered an average of 8 mm Hg

•Activity effects can occur after just a few weeks of training

Exercise and HTN

Exercise Prescription RecommendationsMost important lifestyle medicationSedentary have a 20-50% increased risk of developing HTNActual mechanisms for reduced BP thru exercise somewhat

unknownEvidence that it decreases nor epinephrine levelsMay decrease BP due to improved renal functionBelieved to cause improved changes in arterial structure to

reduce Pulse Volume Recording Has an insulin-like effect and increases muscle glucose

transport and uptake

Precautions

Marked elevation >180/110 mmHg should seek medical attention before adding training

If BP is >200/115 mmHg, no exercise on that dayResistance Training is not recommended as component of

fitness and only for those with controlled BP

Theory of AuscultationA BP cuff applied to the upper arm is inflated

with air pressure which occludes brachial artery blood flow = no sound.

When air pressure is slowly let out of the cuff, blood flow occurs and the first sound heard in the stethoscope is SBP (Phase 1 Korotkoff)

Sounds of Korotkoff come from the turbulence of blood in the artery, which is caused by blood moving from an area of higher pressure to lower pressure

When pressure inside cuff = the DBP, the artery is fully opened , no turbulence and sound disappears (Phase 5 Korotkoff)

Korotkoff SoundsPhase 1: SBP-onset of sound; faint, then clear,

progressively increasesPhase 2: soft tapping murmur (10-15 mmHg

after Phase 1); swishing soundPhase 3: loud tapping, high in pitchPhase 4: known as TRUE DBP, muffling sound,

less distinct, audiblePhase 5: known as Clinical DBP, complete

disappearance of sound (8-10 mmHg after muffling