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Hypertension

Hypertension. United States 50 million people with HBP or taking medication! Table 10.1 1993 Joint National Committee on Blood Pressure ACSM recruited these guidelines! Normal <130 <85 High normal 130-139 85-89 Hypertension Stage 1 (mild) 140-159 90-99

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Hypertension

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  1. Hypertension • United States • 50 million people with HBP or taking medication! • Table 10.1 • 1993 Joint National Committee on Blood Pressure • ACSM recruited these guidelines! • Normal <130 <85 • High normal 130-139 85-89 • Hypertension • Stage 1 (mild) 140-159 90-99 • Stage 2 (mod.) 160-179 100-109 • Stage 3 (severe) 180-209 110-119 • Stage 4 (very sev.) 210 120

  2. Hypertension • Proper function of the circulatory system rely on 3 factors • Healthy heart • Blood vessels that permit a free flow of blood • Sufficient level of pressure throughout the system to maintain • proper blood flow

  3. CV Control during Exercise • Start of exercise • Central command stimulates CVC •  HR,  strength of heart contraction •  vasoconstriction or alternate organs • Coordinates with CNS • Motor unit recruitment • Breathing process • Vagus tone decreases • Removes parasympathetic control of heart •  BP

  4. CV Control during Exercise • Muscle pump  venous return • Muscle actions cause pressure changes • Intrathoracic pressure changes with breathing • Baroreceptor set-point  •  stimulation of the CVC • Hypothalamus stimulated by  temperature •  CVC to  cardiovascular activity • Release of catecholamines from adrenal glands •  HR,  vasodilation, effects on metabolism

  5. CV Control during Exercise • Sympathetic stimulation causes vasconstriction •  blood flow to organs • Maintain pressure in veins with vasoconstriction • Local changes in metabolism •  muscle blood flow to working skeletal muscle •  Exercise intensity •  Type III & IV afferent receptors activity • Causes vasoconstriction in large muscles • Helps to maintain blood pressure

  6. CV Control during Exercise • With exercise progression • Signals from central command • CVC • Hypothalamus • Baroreceptors • Chemoreceptors • Muscle afferent receptors balanced • Q and circulatory conductance are balanced to maintain BP!!

  7. Exercise Response • Elevated resting baseline will lead to a higher absolute level during • exercise in the hypertensive patient! • Recent research • Drop in SBP during 1 to 3 hours post exercise • 10 to 20 mmHg drop • Moderate intensity dynamic exercise • 30 to 45 minutes • Acute decrease in SV instead of vasodilation! • Untreated hypertension may cause a decrease in exercise capacity! • Certain anti-hypertensive medications may limit exercise capacity! • Beta-blocker treatment!

  8. Exercise Training Effects • Chronic aerobic training can lead to 10 mmHg drop in SBP & DBP • in Stage 1 & 2 hypertensive individuals! • Possible mechanisms • Decrease in plasma norepineprhine levels • Adrenergic hormone that causes venoconstriction! • Increase in circulating vasodilator substances • Improvement of hyperinsulinemia • Alteration in renal function • Resistance training does elicit a greater pressor response! • Circuit is better than heavy resistances!

  9. Management • Goal of treating hypertension according to JNC! • Prevent morbidity & mortality associated with high BP! • Following steps to lifestyle modification: • Decrease body fat% • Limit alcohol intake (2 glasses of beer or wine, 1 drink) • Regular aerobic exercise • Reduce sodium intake to less than 2.3 grams per day • Maintain adequate dietary levels of K, Ca, and Mg! • Stop smoking • Reduce dietary fat, saturated fat, & cholesterol!

  10. Medication • Beta-blockers can decrease exercise HR response! • Ca antagonists decrease exercise HR response! • Diltiazem & verapamil • Antihypertensives that cause vasodilation • Careful with post-exercise hypotension • Use longer cool-down periods • Decrease intensity gradually! • 75%, 60%, 55%, 50%, 40%

  11. Exercise Testing • Test performed with medication! • Relative contraindication to testing • Resting SBP > 200 mmHg & DBP > 115 mmHg • Absolute contraindication for exercise test termination • SBP > 260 mmHg & DBP > 115 mmHg

  12. Exercise Programming • Stage 3 hypertensive individuals • Add aerobic exercise after initiating drug therapy! • Mode • Large muscle group dynamic aerobic exercise • Frequency • 3 to 7 days per week • Intensity • 40-70% of VO2max • Resistance training should not be the only form of exercise! • Use it as one component of a well-rounded program!

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