Assessment and Management of Hypertension PDF

Assessment and Management of Hypertension By Prof. Dr. Mona Abdel Khalek Dr. Mina Atef Dr. Ahmed Abd-Elhalim Definition • 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....

Assessment and Management of Hypertension By Prof. Dr. Mona Abdel Khalek Dr. Mina Atef Dr. Ahmed Abd-Elhalim Definition • 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 Risk Factor Smoking LDL Cholesterol >140 mg/dl HDL Cholesterol < 40 mg/dl Obesity Diabetes Hyperinsulinemia Sedentary lifestyle Percent 35 40 25 40 15 50 >50 Types of hypertension • Essential hypertension – 95% – No underlying cause • Secondary hypertension – Underlying cause Classification of Blood Pressure Blood Pressure Category Systolic mmHg Diastolic mmHg Normal <120 <80 Prehypertension 120–139 80–89 Stage 1 (Mild) 140-159 90-99 Stage 2 (Moderate) 160-179 100-109 Stage 3 (Severe) > 180 > 110 Hypertension 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 also associated with obesity, salt intake, low potassium intake, physical inactivity, heavy alcohol use and psychological stress • Intra-abdominal fat and hyperinsulinemia may play a role in the pathogenesis 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 can increase blood glucose levels • Beta blockers: decrease the body’s response to impulses from the nervous system, which can lead to insomnia, depression, and cold extremities and also may decrease blood glucose levels. • Calcium channel blockers: can cause heart palpitations, swollen ankles, and headaches. Exercise Prescription • VO2 max (also maximal oxygen consumption, maximal oxygen uptake, peak oxygen uptake or maximal aerobic capacity) is the maximum rate of oxygen consumption measured during exercise. The name is derived from V - volume, O2 - oxygen, max - maximum. Maximal oxygen consumption reflects the cardiorespiratory fitness of an individual and is an important determinant of their endurance capacity during prolonged exercise. Exercise Prescription Exercise Prescription • The current exercise prescription for the treatment of hypertension is: cardiovascular mode, for 20–60 minutes, 3–5 days per week, at 40– 70% of maximum oxygen uptake (VO˙ 2max). 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 least at moderate intensity (e.g. brisk walking), Start at 50-60% maximum heart rate & slowly increase to 70%. • Resistance exercise should be at moderate intensity, which could be expressed as 50 to 70% of 1-repetition maximum (1-RM – maximum amount of weight one can lift in a single repetition for a given exercise) Exercise Prescription • Duration: • Aerobic exercise: Start with 20-30 min/day of continuous activity for first 3 week, then 30-45 min/day for next 4-6 week, and 60 min/day as maintenance. • Resistance exercise: session should minimally include 8–10 exercises and should consist of at least 1 set of 8–12 repetitions per exercise Exercise Prescription • Type: • Aerobic exercises such as walking, jogging, cycling and swimming . Rope skipping is also a very good option that can be performed every day, requires little equipment and learning, and involves a lot of muscle group. However, any activity that uses large muscle groups, can be maintained continuously, and is rhythmical and aerobic in nature is recommended as the primary modality for those with hypertension. Exercise Prescription • Type: • Resistance exercise should involve the major muscle groups (legs, hips, chest, back, abdomen, shoulders, and arms). • Resistance exercise performed should be alternating between upperbody and lower-body works to allow for adequate rest between exercises. • Some examples of resistance exercise include chest press, shoulder press, triceps extension, biceps curl, pull-down (upper back), lowerback extension, abdominal crunch/curl-up, quadriceps extension or leg press, leg curls (hamstrings), and calf raise Examples of resistance exercise quadriceps extension leg curls hamstring biceps curl Possible effect of Exercise on Blood pressure • Reduced visceral fat independent of changes in body weight or BMI. • Altered renal function to increase elimination of sodium leading to reduce fluid volume Possible effect of Exercise on Blood pressure • Lower cardiac output and peripheral vascular resistance at rest and submaximal exercise • Decreased HR • Decreased sympathetic and increased parasympathetic tone • Lower blood catecholamines (High catecholamine levels in blood are associated with stress) and plasma renin activity Safety considerations • The risk of cardiovascular disease in patients with hypertension is determined not only by the level of blood pressure, but also by the presence or absence of target organ damage and other risk factors such as smoking, dyslipidemia and diabetes. • Avoid holding your breath during weight training as this can cause large changes in the BP which may cause the patient to faint. Safety considerations • Avoid exercises in which the head is lower than the heart as this can raise your blood pressure. • If the blood pressure is high, you should avoid lots of overhead arm work. Safety considerations • Intensive isometric exercise such as heavy weight lifting can have a marked pressor effect and should be avoided. • If hypertension is poorly controlled, heavy physical exercise postponed until appropriate drug treatment has been instituted and blood pressure lowered. Safety considerations • β-blockers may adversely affect thermoregulatory function and cause hypoglycemia in some individuals. In these situations, educate patients about the sign and symptoms of heat intolerance and hypoglycemia, and the precautions that should be taken to avoid these situations. • Antihypertensive medications such as calcium channel blockers, βblockers and vasodilators may lead to sudden reductions in postexercise blood pressure. Extend and monitor the cool-down period carefully in these situations. Safety considerations • Patients should be informed about the nature of cardiac prodromal symptoms e.g. shortness of breath, dizziness, chest discomfort or palpitation and seek prompt medical care if such symptoms develop. Effects of endurance, circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients Age (Dordr). 2015 Oct; 37(5): 101. Published online 2015 Sep 17. (Venturelli M et.al) • Experimental design: After baseline evaluations (PRE), participants were assigned to four different groups. ET group, endurance exercise training on treadmill, elliptical, and stepper ergometers; CT group, short bouts of dynamic exercises on knee extension (KE), knee flexion (KF), calf rise (CR), and leg press (LP) ergometers; RT group, relaxing training program; CTRL group, no intervention Thank you