2.20.08 High Blood Pressure

High Blood Pressure

See Pkt.

HTN: Hypertension
HBP: High Blood Pressure

Resting: SBP > or = 140 and/or DBP > or = 90
Or normal but on hypertensive medication

New Category" Pre-hypertensive
Research shows that ppl with these BPs have a significantly increased risk of CVD. Must change lifestyle.
SBP 120-139
DBP 80-89

ACSM Position stand- Quiz on this, very difficult to read
AHA Science advisory- just an FYI for us, no quiz over it

Prevalence
Increased BP affects 58.4 million Americans
90-95% of hypertensives- Dr.s don't know what it is due to. Called essential hypertension.
Increased prevalence in males, older adults, African Americans.

Stage 2-Stage 3 HBP
SBP > or = 160
DBP > OR = 100
Increased risk for CVD
Inc. CHF
Inc. peripheral artery disease- claudication (harding of leg arteries)
Inc. renal failure

Quiz question on stages
Risk Factors
Lifestyle modifications= non-medication ways
1. Endurance program
2. Body weight loss
(SEE LIST)
3. Eating a DASH diet (semi-vegetarian)- high fruits, high veg, protein in the form of low-fat dairy

Response to Exercise
With increasing level of exercise, SBP goes up, DBP stays fairly level.
Automatic termination of GXT if SBP > or = 250 (Anyone), DBP > or = 115

Medications
BP: Anti hypertensives
heart rhythm (which affects BP)
Force of L ventricular contraction (also affects BP)
May affect response to exercise
Must know what medications do to exercise:
type
dosage
time as it relates to time of exercise
DR.'S OKAY

Vein dilation
Brain- sympathetic and parasympathetic nervous systems
Kidneys play a major role

ACE INHIBITORS
affect kidneys to lower BP
Blocks kidney enzyme-prevents constriction hormone
does not cause changes in heart rate
unresponsive to other medications-very potent drugs
if the person is exercising, this should be the drug of choice

ALFA BLOCKERS
decrease peripheral nervous system to dilate veins
Do not cause changes in heart rate
suffer more from sudden hypotension because of poor blood flow back to the heart- cool down is important

ALFA SIMULATORS
increase parasympathetic to dilate blood vessels

BETA BLOCKERS
also used for angina (chest pain), migraines, and CAD
Compete for same receptor site at catacolomens so they can't increase BP (ventricular contraction)
affect heart and lungs (difficulty breathing)
go back to Dr. if this happens
affects person's ability to exercise (use RPE)
decreased resting and exercise HR
decreased blood pressure
decreases body's ability to dissipate heat. (climate controlled environment).
can cause hypoglycemia
only do testing on correct dosage of medication (the dosage on which they will be during your exercise program)
Chest pain- BBs allow them the work out at higher intensities without chest pain

CALCIUM CHANNEL BLOCKERS
chest pain, arrhythmia, HBP
Block Ca Dependant contraction of muscles
increase, decrease or do not affect HR (depends on which type)
decreased BP- cool down is important (blood pooling)
does not affect THR (Can use Karvonen formula)
ACSMs treatment of choice for very active ppl.

DIGITALIS
anti-arrhythmic
flutter of atria- increased vigor of contractions
decreases HR
does not affect BP

DIURETICS
anti-hypertensive/Congestive HF (CHF)
decreases water in the body
lowers BP
Does not affect HR
Can cause dehydration
hypocalimia- lose a lot of K. this can cause arrhythmia, potatoes have 3 x more K than bananas
hypoglycemia
historical the 1st type of drugs given
aren't as potent
not necessarily 1st given anymore

NITRATES
address chest pain
lower BP
Nitro-glycerin
relaxes smooth muscle
Increase RHR
Increase or do not affect Exercising HR
Decreased RBP
Decrease or do not affect Exercising BP
Increase work capacity at point of chest pain

PERIPHERAL VASODILATORS
RHR/EHR is not affected, or increases
hypotension
tachycardia > 100 RHR

Regular Endurance Training
FITT
Frequency: Most, if not all days per week
Intensity: 40- < 60 % VO2 reserve
Time (Duration): > or = 30 min. of continuous activity
Type (Mode): Aerobic w/supplemental resistance. Can decrease BP by 5-7 points with endurance training in normal AND HBP people.

VO2R= % I (VO2max- VO2rest) + VO2rest
must understand METs well to use this

When you aerobically exercise, it lowers BP for about 22 hours.

If overweight or obese, exercise to burn 300 additional kcals.

Decreases RBP in non-HBP and HBP ppl.
Decreased D and I can still help
Chronic aerobic exercise does NOT lower HBP in children and teens
Fat loss is a better way to lower BP.

Resistance training should not be the primary mode- usually never performed to RM (only to volitional fatigue)

Recommendations for Resistance Training
8-12 Reps
10-15 for Older Adults
8-10 exercises
1 Set
2-3 days per week

CWT-Circuit Weight Training
8-12 diff. exercises
50% RM (20 reps)
has been shown to benefit

Fat loss is the best way
in an obese person, 22 lbs. of fat loss has been shown to decrease SBP by 15 points, and DBP by 10 pts. Additional weight lost is added onto those point values.

If someone has a normal BP but has an elevated response to exercise, they have a high risk in the future and should be recommended to make lifestyle changes.