Ped488 htn s 11


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Ped488 htn s 11

  1. 1. PED488 Hypertension and Exercise
  2. 2. Hypertension ( Silent Killer) <ul><li>Major risk factor …impacts </li></ul><ul><ul><li>heart disease </li></ul></ul><ul><ul><li>stroke </li></ul></ul><ul><ul><li>congestive heart failure </li></ul></ul><ul><ul><li>kidney </li></ul></ul><ul><ul><li>brain </li></ul></ul><ul><li>Risk increases several-fold with higher levels BP </li></ul><ul><ul><li>cardiovascular disease, stroke, renal disease </li></ul></ul><ul><li>90–95 percent of the cases of high blood pressure unknown </li></ul><ul><li> high blood pressure is easily detected and usually controllable </li></ul><ul><li>Is idiopathic…or has no know cause </li></ul>
  3. 3. Blood Pressure Defined <ul><li>A condition in which the pressure of the blood pumping through the arteries is abnormally high </li></ul><ul><li>Force of blood against the walls of arteries </li></ul><ul><li>Recorded as two numbers </li></ul><ul><ul><li>as the heart beats  systolic pressure </li></ul></ul><ul><ul><li>as the heart relaxes between beats  diastolic pressure </li></ul></ul><ul><ul><li>millimeters of mercury = mmHg </li></ul></ul><ul><ul><li>written as SBP above or before DBP </li></ul></ul><ul><li>example: </li></ul><ul><ul><li>blood pressure measurement of 120/80 mmHg </li></ul></ul><ul><ul><li>is expressed verbally as &quot;120 over 80.&quot; </li></ul></ul>
  4. 4. Hypertension Video <ul><ul><li>Overview </li></ul></ul><ul><ul><ul><li> </li></ul></ul></ul><ul><ul><ul><li> </li></ul></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><ul><li> </li></ul></ul></ul>
  5. 5. Interactive impact of HTN
  6. 6. Diagnosing and Evaluating HTN <ul><li>Get an accurate and consistent readings </li></ul><ul><ul><li>pressure readings can vary widely </li></ul></ul><ul><ul><li>readings done on different days (over month) to confirm </li></ul></ul><ul><li>Patients should be seated and with no stimulants 30 min preceding measurement </li></ul><ul><li>Best to wait 5 min of complete rest and relaxation…quiet setting </li></ul><ul><li>Use appropriate cuff size </li></ul><ul><li>Short sleeve shirt…rest arm on surface </li></ul><ul><li>Deflate cuff </li></ul><ul><li>Wait 2 minutes between readings…2-3 to confirm </li></ul>
  7. 7. Category Follow-Up Normal Blood Pressure 120/80 Recheck in two years Prehypertension 120-139 / 80-89 Recheck in one year Hypertension: Stage 1 140 -159 /90 - 99 Confirm in two months Hypertension: Stage 2 > 160 / > 100 Evaluate or refer in one month >180/>110 mm Hg Evaluate or refer immediately to one week, depending on clinical situation and/or complications
  8. 8. HTN: ACSM <ul><li>Table 3-1 </li></ul>
  9. 9. Recommended Treatment <ul><li>Normal </li></ul><ul><ul><li>Encourage Life-Style Changes </li></ul></ul><ul><li>Prehypertension </li></ul><ul><ul><li>Prescribe Life-Style Changes </li></ul></ul><ul><ul><li>For compelling indications* utilize initial drug therapy </li></ul></ul><ul><li>Stage 1 Hypertension </li></ul><ul><li>Begin with Life-Style Changes </li></ul><ul><li>Consider monotherapy of blood pressure meds  </li></ul><ul><li>  </li></ul><ul><li>Stage 2 Hypertension </li></ul><ul><li>Life-Style Changes   </li></ul><ul><li>Thiazide-type diuretic combined with blood pressure me ds </li></ul><ul><li>  </li></ul>
  10. 10. ACSM: Cornerstone of Antihypertensive Therapy <ul><li>Lifestyle modification </li></ul><ul><ul><li>Physical Activity </li></ul></ul><ul><ul><li>Weight Reduction (if needed) </li></ul></ul><ul><ul><li>DASH eating plan (i.e., a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat), dietary sodium reduction (no more than 100 mmol or 2.4 g sodium·d), and moderation of alcohol consumption </li></ul></ul>
  11. 11. HTN Treatment <ul><li>Dangerous if untreated </li></ul><ul><li>Often systolic is especially meaningful </li></ul><ul><ul><li>better diagnosis of high blood pressure </li></ul></ul><ul><ul><li>most common form HTN </li></ul></ul><ul><ul><li>increases with age in older Americans </li></ul></ul><ul><li>Once developed cannot be cured once </li></ul><ul><ul><li>due increased peripheral resistance </li></ul></ul><ul><li>DBP does not also need to be high to have HTN </li></ul><ul><li>Treatment high systolic pressure </li></ul>
  12. 12. Treatment of HTN <ul><li>Secondary BP </li></ul><ul><li>underlying disease or condition causes HTN </li></ul><ul><li>treatment of high blood pressure will include that condition </li></ul><ul><li>Primary BP </li></ul><ul><li>LEVEL 1: Lif estyle Modifications </li></ul><ul><ul><li>Avoiding alcoholic drinks </li></ul></ul><ul><ul><li>Cut down on salt </li></ul></ul><ul><ul><li>Exercise regularly </li></ul></ul><ul><ul><li>Lose weight </li></ul></ul><ul><ul><li>Get enough calcium, magnesium and potassium </li></ul></ul><ul><ul><li>Quit smoking </li></ul></ul><ul><ul><li>Reduce intake of dietary saturated fats </li></ul></ul>
  13. 13. Treatment of HTN <ul><li>LEVEL 2 </li></ul><ul><li>drugs to lower blood pressure </li></ul><ul><li>common drugs for the treatment include: </li></ul><ul><ul><li>  Diuretics to rid the body of excess salt and water </li></ul></ul><ul><ul><li>Angiotensin-converting enzyme (ACE) inhibitors to dilate the arteries and relieve pressure </li></ul></ul><ul><ul><li>Beta blockers to help the body avoid high blood pressure caused by stress </li></ul></ul><ul><ul><li>Calcium-channel blockers , which cause blood vessels to widen using a different mechanism </li></ul></ul><ul><li>SBP is focus of the therapy because it is more related to organ diseases than DBP </li></ul><ul><li>In the past, mono-drug therapy was the initial step in medications </li></ul><ul><ul><li>Combination therapy contemporary approach </li></ul></ul>
  14. 14. ACSM: Meds <ul><li>most patients with hypertension who require drug therapy in addition to lifestyle modification </li></ul><ul><li>two or more antihypertensive medications to achieve the goal BP (i.e., <140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease) </li></ul>
  15. 16. Exercise and HTN <ul><li>Regular physical activity lowers blood pressure for those who have hypertension . </li></ul><ul><li>With regular exercise </li></ul><ul><ul><li>systolic blood pressure is lowered about 11 mm Hg </li></ul></ul><ul><ul><li>diastolic blood pressure is lowered an average of 8 mm Hg </li></ul></ul><ul><li>Activity effects can occur after just a few weeks of training </li></ul>
  16. 17. Exercise Prescription Recommendations <ul><li>Most important lifestyle medication </li></ul><ul><li>Sedentary have a 20-50% increased risk of developing HTN </li></ul><ul><li>Actual mechanisms for reduced BP thru exercise somewhat unknown </li></ul><ul><li>Evidence that it decreases nor epinephrine levels </li></ul><ul><li>May decrease BP due to improved renal function </li></ul><ul><li>Believed to cause improved changes in arterial structure to reduce Pulse Volume Recording </li></ul><ul><li>Has an insulin-like effect and increases muscle glucose transport and uptake </li></ul>
  17. 18. Precautions <ul><li>Marked elevation >180/110 mmHg should seek medical attention before adding training </li></ul><ul><li>If BP is >200/115 mmHg, no exercise on that day </li></ul><ul><li>Resistance Training is not recommended as component of fitness and only for those with controlled BP </li></ul>
  18. 19. Theory of Auscultation <ul><li>A BP cuff applied to the upper arm is inflated with air pressure which occludes brachial artery blood flow = no sound. </li></ul><ul><li>When air pressure is slowly let out of the cuff, blood flow occurs and the first sound heard in the stethoscope is SBP (Phase 1 Korotkoff) </li></ul><ul><li>Sounds of Korotkoff come from the turbulence of blood in the artery, which is caused by blood moving from an area of higher pressure to lower pressure </li></ul><ul><li>When pressure inside cuff = the DBP, the artery is fully opened , no turbulence and sound disappears (Phase 5 Korotkoff) </li></ul>
  19. 20. Korotkoff Sounds <ul><li>Phase 1 : SBP-onset of sound; faint, then clear, progressively increases </li></ul><ul><li>Phase 2 : soft tapping murmur (10-15 mmHg after Phase 1) ; swishing sound </li></ul><ul><li>Phase 3 : loud tapping, high in pitch </li></ul><ul><li>Phase 4 : known as TRUE DBP, muffling sound, less distinct, audible </li></ul><ul><li>Phase 5 : known as Clinical DBP, complete disappearance of sound (8-10 mmHg after muffling </li></ul>