Assessment and Management of Hypertension

Assessment and Management of Hypertension

• Hypertension is defined as systolic blood pressure (SBP) of 140 mmHg or greater, diastolic blood pressure (DBP) of 90 mmHg or greater, or taking antihypertensive medication.

Prevalence of Other Risk Factors With Hypertension

• Smoking: 35%
• LDL Cholesterol >140 mg/dL: 40%
• HDL Cholesterol < 40 mg/dL: 25%
• Obesity: 40%
• Diabetes: 15%
• Hyperinsulinemia: 50%
• Sedentary lifestyle: >50%

Types of Hypertension

• Essential hypertension: 95% - No underlying cause
• Secondary hypertension: Underlying cause

Classification of Blood Pressure

Target Organ Damage

• Heart: Left ventricular hypertrophy, Angina or myocardial infarction, Heart failure
• Brain: Stroke or transient ischemic attack
• Chronic kidney disease
• Peripheral arterial disease
• Retinopathy

Pathophysiology of Hypertension

• High blood pressure is associated with obesity, high salt intake, low potassium intake, physical inactivity, heavy alcohol use, and psychological stress.
• Intra-abdominal fat and hyperinsulinemia play a role in the development of hypertension.

Management of Hypertension

• Lifestyle Changes for Hypertension
• Anti-hypertensive Medications
• Physical activity & Exercise Prescription

Lifestyle Changes for Hypertension

• Reduce excess body weight
• Reduce dietary sodium to ≤ 2.4 g/day
• Maintain adequate dietary intake of potassium, calcium, and magnesium
• Exercise moderately each day
• Engage in meditation or relaxation daily
• Cessation of smoking

Anti-hypertensive Medications and their side effects

• Diuretics: Deprive the body of potassium and increase blood glucose levels
• Beta blockers: Decrease the body's response to impulses, can lead to insomnia, depression, and cold extremities, and decrease blood glucose levels.
• Calcium channel blockers: Can cause heart palpitations, swollen ankles, and headaches.

Exercise Prescription

• VO2 max is the maximum rate of oxygen consumption.
• The current exercise prescription for hypertension is cardiovascular mode for 20–60 minutes, 3–5 days per week, at 40–70% of maximum oxygen uptake (VO2 max).
• VO2 max ≈ HRmax / HRrest × 15.3 mL/(kg·minute)

Exercise Prescription: Frequency

• Aerobic exercise preferably: 5 days/week as a minimum.
• Resistance exercise twice to thrice weekly on nonconsecutive days.

Exercise Prescription: Intensity

• Aerobic exercise should be at moderate intensity (e.g., brisk walking), starting at 50–60% maximum heart rate and slowly increasing to 70%.
• Resistance exercise should be at moderate intensity (50–70% of 1-repetition maximum (1-RM)).

Exercise Prescription: Duration

• Aerobic exercise: Start with 20–30 min/day for the first 3 weeks, then 30–45 min/day for the next 4–6 weeks, and 60 min/day for maintenance.
• Resistance exercise: Sessions should include 8–10 exercises with at least 1 set of 8–12 repetitions per exercise.

Exercise Prescription: Type

• Aerobic exercises (walking, jogging, cycling, swimming, rope skipping) are recommended.
• Resistance exercise should involve major muscle groups (legs, hips, chest, back, abdomen, shoulders, and arms). Resistance exercise should alternate between upper and lower body to allow adequate rest between exercises. Examples include: chest press, shoulder press, triceps extension, biceps curl, pull-downs, lower back extensions, abdominal crunches, leg press, leg curls, and calf raises.

Possible effect of Exercise on Blood pressure

• Reduced visceral fat independent of changes in body weight or BMI
• Altered renal function to increase sodium elimination, which leads to reduced fluid volume
• Lower cardiac output and peripheral vascular resistance at rest and submaximal exercise
• Decreased HR
• Decreased sympathetic and increased parasympathetic tone
• Lower blood catecholamines (high catecholamines associated with stress) and plasma renin activity

Safety Considerations

• Cardiovascular disease risk is determined by blood pressure, presence of target organ damage, and risk factors like smoking, dyslipidemia, and diabetes.
• Avoid holding breath during weight training.
• Avoid exercises where head is lower than heart. Avoid overhead arm work when blood pressure is high.
• Avoid intensive isometric exercises (heavy weightlifting) if hypertension is poorly controlled, wait until blood pressure is lowered.
• Beta-blockers may affect thermoregulation and cause hypoglycemia. Educate patients on symptoms and precautions.
• Antihypertensive medications (calcium channel blockers, beta-blockers, vasodilators) can cause sudden drops in post-exercise blood pressure. Extend and monitor the cool-down period.
• Inform patients about cardiac prodromal symptoms (shortness of breath, dizziness, chest discomfort, or palpitation) and encourage prompt medical care if these symptoms occur.