Hypertension

Hypertension is defined as systolic pressure at rest (SP or RRs) ≥ 140 mmhg and/or diastolic pressure (DP or RRD) ≥ 90 mmhg. Systolic blood pressure is the blood pressure exerted on the artery wall during the contraction of the myocard, and diastolic blood pressure is the pressure that is made on the wall of the arteries when the heart is in the relaxation phase between contractions.

Blood pressure is marked with the RR in honor of Italian doctor Riva-Roccija who invented a simple sphygmomanometer to measure blood pressure. Hypertension increases the risk of occurrence of cardiovascular disease, chronic kidney disease, peripheral artery disease, stroke and heart infarction.

A very troubling fact is that roughly 65 million Americans have high blood pressure, while in Croatia there are 1.6 million people with the same problem. In 2013 more than 360 000 Americans died due to elevated blood pressure as a primary or secondary factor. This is 1000 deaths daily associated with hypertension. Seven out of 10 people who have a heart attack have elevated blood pressure. Most elderly people have hypertension, but luckily there is a “cure” that has no connection to the pharmacy, and it is called physical activity which reduces blood pressure regardless of age.

In patients with elevated blood pressure, who regularly do aerobic physical activity, blood pressure is reduced by 5-8 mmhg, and certain authors say it decreases even 10 mmhg. Immediately after aerobic training a person will appear to have lowering of blood pressure that can be prolonged even up to 22 hours. However, for those who have a resting blood pressure value of 200/110 mmhg, the exercise is contraindicated.

Each increase in systolic blood pressure of 20 mmhg and diastolic for 10 mmhg doubles the risk of cardiovascular diseases. Due to the significant overlap of excessive weight and hypertension, as well as obesity and hypertension, the training program should be also based on the reduction of body weight. Obesity is disease increasingly affecting children and adolescents. With proper nutrition and regular physical activity, the energy deficit of 500-1000 kcal/day will be optimal. Most people with hypertension can certainly start with moderately-intensive aerobic activities after a medical examination. People with hypertension who wish to exercise at high intensity or persons from the highest risk group who want to participate in moderately-intensive activity must do one of the gradual exercise tests (GXT). If blood pressure levels increase to 250/115 mmhg during exercise training should be discontinued.

The training program should consist primarily of aerobic moderate intensity exercises (40-70% HRR) that should be carried out most days of the week, preferably every day. So, swimming, biking, walking etc. We may use simple methods such as measuring the frequency of the heart or subjective load measures such as Borg scale exertion (RPE) or conversation test to assess the training intensity.

For people who consume medicines, specific beta-blockers, the burden will be assessed solely by subjective load measures. The given medicine lowers the frequency of the heart, so the exercise load estimation by measuring heart rate can result in underestimating the intensity of training. The training should take 30-60 minutes, and can be interval or continuous. Persons who are not able to regularly do their trainings can practice 3 times a day for at least 10 minutes to meet the recommendations of the World Health Organization and to achieve significant health benefits. We can implement the resistance training in training program 2-3 days a week, moderate intensity with at least 1 sets in which we will activate large groups of muscles through 8-12 repetitions. The sets should be stopped if the RPE is between 13-15. It is very important to avoid the Valsalva maneuver (forced exhale along the closed airways) which can increase arterial blood pressure. Therefore, low intensity resistance training is recommended with a large number of repetitions.

In today’s world of sedentary lifestyle there is increasing risk of many chronic diseases and not only hypertension. Physical activity has major role in prevention of 40 diseases. General recommendations include at least 150 minutes of aerobic moderately intensive activity per week or at least 75 minutes of highly intensive activity with a minimum of 2-3 resistance trainings. Do you satisfy the World Health Organization’s recommendations regarding regular physical activity?

References  

1. American College of Sports Medicine (2010). ACSM’s Guidelines for Exercise Testing and Prescription, 8th ed. Philadelphia: Lippincott Williams & Wilkins.
   2. American College of Sports Medicine (2008). ACSM’s Health-Related Physical Fitness Assesment Manual, 2nd ed. Philadelphia: Lippincott Williams & Wilkins.
   3. Jonas S., Phillips E.M.; Američko društvo sportske medicine. Vježbanje je lijek, liječnički vodič za propisivanje vježbanja
   4. Downloaded from: https://www.cdc.gov/bloodpressure/facts.htm