Date post: | 24-May-2015 |
Category: |
Health & Medicine |
Upload: | mjpol |
View: | 327 times |
Download: | 5 times |
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