高血压英文ppt精品课件therapeuticrole of exercise in treating

Therapeutic role of exercise in treating hypertension Dalynn T. Badenhop, Ph.D., FACSM Professor of Medicine Director , Cardiac Rehabilitation Medical College of Ohio Educational Objectives zTo explain the acute blood pressure response to exercise zTo list the mechanisms by which exercise may improve hypertension zTo apply exercise guidelines in treating hypertension zTo prescribe appropriate drug therapy for active hypertensive patients Overview of Hypertension zHigh BP is a risk factor for stroke, CHF, angina, renal failure, LVH and MI zHypertension clusters with hyperlipidemia, diabetes and obesity zDrugs have been effective in treating high BP but because of their side effects and cost, non-pharmacologic alternatives are attractive 1997 JNC VI Classification of Blood Pressure Blood Pressure CategorySystolicDiastolic Optimal 180 110 Overview of Hypertension zJoint National Committee VI (JNC VI) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (1997) y50 million hypertensive patients in the U.S. zNational Health and Nutrition Examination Survey III (NHANES III) (1995) yonly 21% of treated hypertensive patients have BP controlled to 140 mg/dl40 HDL Cholesterol 50 Kaplan NM. Dis Mon 1992; 38:769-838 Cardiovascular Consequences of Hypertension zIndividuals with BP 160/95 have CAD, PVD SBP 70 mm Hg at 8 METs; DBP 10 mm Hg at any workload. zSubjects in CARDIA study with exaggerated exercise BP were 1.7 times more likely to develop HTN 5 years later J Clin Epidemiol 51 (1): 1998 NIH Consensus Conference on Physical Activity and CV Health (1995) zReview of 47 studies of exercise and HTN z70% of exercise groups decreased SBP by an avg. of 10.5 mm Hg from 154 z78% of subjects decreased DBP by an avg. of 8.6 mm Hg from 98 zOnly 1 study showed increased BP w/ EX zBeneficial responses are 80 times more frequent than negative responses Hagberg, J., et.al., NIH, 1995: 69-71 Increasing Lifestyle Activity for Patients with High- Normal Blood Pressure and Stage I Hypertension Medical College of Ohio Study Group Kevin A. Phelps, D.O. Larry Johnson, M.D. Sandra Puczynski, Ph.D. Dalynn Badenhop, Ph.D. Michael McCrea Wendy Boone, RN, M.P.H Lifestyle Activity vs. Structured Exercise z JAMA 1999; 281(4): 327-334 ymoderate-intensity lifestyle activity showed similar or better results versus structured exercise for ximproved cardiovascular fitness xreduced body fat xdecreased total cholesterol xreduced blood pressure xpatient compliance z In the past five years the Surgeon General, CDC, NIH, and ACSM have published position statements on the potential health benefits of lifestyle activity zTwenty-four week, physician-directed intervention program to lower BP by increasing physical activity zPatients randomized into two groups: yGroup 1 - educational intervention monitored via activity logs yGroup 2 - educational intervention monitored via activity logs and pedometer Study Design The Pedometer za small device worn at the waist that counts steps zused successfully in obesity studies Study Hypotheses zAdding a pedometer yto goal setting will increase the level and frequency of physical activity ywill improve BP control of adult patients with high-normal BP or Stage 1 HTN Main Outcome Measures zBlood Pressure and BMI zPhysical Activity assessed by: ytwo questionnaires xPhysical Activity Recall Scale (PASE): assessed activity in past seven days xPhysician-based Assessment and Counseling for Exercise (PACE) : assessed readiness for change in level of physical activity Patient Education Tool Methods: Patient Identification zPotential subjects identified by chart audit yaverage BP of past three visits in High Normal BP or Stage 1 HTN category zExclusion Criteria: yAntihypertensive med use yconfirmed BP 160/100 yDx DM, CHF, CAD, CVD, CA, MR ypregnant ychild ( 230 mm Hg; DBP 110 mm Hg). Restrictions on participation in vigorous exercise should be placed on patients with left ventricular hypertrophy. Weight Training zResistive exercise produces the most striking increases in BP zResistive exercise results in less of a HR increase compared with aerobic exercise and as a result the “rate pressure product” may be less than aerobic exercise zAssessment of BP response by handgrip should be considered in patients w/ HTN zGrowing evidence that resistive training may be of value for controlling BP Kelemen, et.al., JAMA 263:2766- 71,1990 Drug Therapy for Active Hypertensive Patients Hypertension only zThiazide diuretics in combination with a potassium supplement are effective and inexpensive zDiuretics limit plasma volume expansion and decrease peripheral resistance zOther antihypertensive drugs can be used as monotherapy for this type of patient Drug Therapy for Active Hypertensive Patients Hypertension with other diseases CAD - calcium-channel blocker or a beta- blocker Diabetes - ACE inhibitor LVH but coughs with ACE inhibitor - angiotensin-2-receptor blocker Elderly men with prostatism - peripheral alpha-blocker (terazosin, doxazosin) Drug Therapy for Active Hypertensive Patients zBeta1-selective blockers such as atenolol or metoprolol are preferable to non-selective agents such as propranolol, nadolol or pindolol for hypertensive patients engaged in regular exercise Kaplan, N.M., Am J Hypertens 2:75-77,1989 Beta-blocker therapy and exercise zNon-selective Beta-blockers may increase a patients disposition to exertional hyperthermia. So patients should adhere strictly to guidelines for fluid replacement zPatients should use fluid replacement drinks with low concentrations of K+ to avoid the risk of hypokalemia Gordon, N.F., Am J Cardiol 55: 74-78,1985 Beta-blocker therapy and exercise zExercise therapy is desirable during Beta-blocker therapy to offset the adverse alterations in lipoprotein metabolism contributed by some Beta -blocker medications Gordon, N.F., Compr Ther 14: 52-57, 1988 Beta-blocker therapy and exercise zExercise intensity for patients on Beta- blocker medications should be in accordance with traditional guidelines based on the results of individualized exercise testing performed on the medication. American College of Sports Medicine Guidelines for Exercise Testing and Prescription, 2000 Beta-blocker therapy and exercise zNon-selective Beta-blockers dramatically reduce peak aerobic capacity and at the same time increase a patients rating of perceived exertion for a given amount of work. Kaplan, N.M., Am J Hypertens 2:75-77,1989 Beta-blocker therapy and exercise zPatients treated with Beta-blockers are capable of deriving the expected enhancement of cardiorespiratory fitness during training, irrespective of the type of drug used Blood, S.M., J Cardiopulmonary Rehabil 8: 141-144, 1988 SUMMARY zPhysical activity has a therapeutic role in the treatment of hypertension zNo consistent relationship between reduced weight and lower BP zExercise at lower intensities is effective in treating mild to moderate hypertension zExercise testing may help identify exaggerated BP responses to exercise SUMMARY zExercise prescription for HTN should be based on medical hx and risk factor status zExercise prescription should be adapted to antihypertensive medications that