Exercise Therapy in Hypertensive Cardiovascular Disease

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Abstract

Hypertension is rare in the young, but its prevalence increases with age. Exercise contributes to the prevention of hypertension in normotensive subjects and to the control of blood pressure in hypertensive patients. The overall cardiovascular risk of the hypertensive patient does depend not only on blood pressure but also on the presence of other risk factors, target organ damage, and associated clinical conditions. The recommendations for preparticipation screening, sports participation, and follow-up depend on the overall risk profile of the individual patient. When antihypertensive treatment is required in addition to nonpharmacologic measures, calcium-channel blockers and blockers of the renin-angiotensin system are currently the drugs of choice for the patient who exercises.

Section snippets

Definition of hypertension and epidemiology

The diagnosis of hypertension (HTN) is based on multiple conventional blood pressure (BP) measurements, taken on separate occasions, in the sitting position, by use of a mercury sphygmomanometer or another calibrated device and is universally defined as a systolic BP of 140 mm Hg or higher, a diastolic BP of 90 mm Hg or higher, or both1, 2, 3 (Table 1). However, approximately 25% of patients with HTN by conventional measurements have a normal BP out of the office on 24-hour ambulatory

HTN as a CV risk factor

Hypertension is associated with an increased incidence of all-cause and CV mortality, sudden death, stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, and renal insufficiency. In the population at large, the relationship between CV complications and usual BP is linear on a logarithmic scale.10 In those older than 50 years, systolic BP is a more important risk factor than diastolic BP. The prognosis of white-coat HTN is better than that of sustained

Etiology of HTN

Approximately 95% of hypertensive patients have essential or primary HTN, which is a multifactorial disease, resulting from an interaction between genetic and lifestyle/environmental factors including being overweight, high salt intake, excessive alcohol consumption, and physical inactivity. There is indeed evidence from cross-sectional epidemiological studies that physical inactivity is involved in the pathogenesis of HTN, and longitudinal observational studies found that physical activity

Assessment of the severity of HTN and risk stratification

The severity of HTN does depend not only on the BP level (Table 1) but also on the presence of other CV risk factors, organ damage, and CV and renal complications. Table 2 summarizes the classification based on the overall CV risk, as proposed by the European societies of HTN and cardiology.2 The terms low, moderate, high, and very high added risk, in comparison with healthy normotensives without risk factors, are calibrated to indicate an approximate absolute 10-year risk of CVD of less than

Assessment of the risk associated with exercise

Exercise-related sudden death at a younger age is mainly attributed to hypertrophic cardiomyopathy, anomalies of the coronary arteries, or arrhythmogenic right ventricular dysplasia23,27, 28, 29 and is unlikely to be related to HTN. On the other hand, coronary heart disease has been identified in approximately 75% of victims of exercise-related sudden death above the age of 35 years.30 Whether elevated BP is a cause of exercise-related sudden death on its own is not known, but HTN is certainly

Diagnostic evaluation

Diagnostic procedures are aimed at (1) establishing BP levels; (2) identifying secondary causes of HTN; (3) evaluating the overall CV risk by searching for other risk factors, target organ damage, and concomitant diseases or accompanying clinical conditions.1, 2 Diagnostic procedures comprise a thorough individual and family history; physical examination, including repeated BP measurements according to established recommendations; and laboratory and instrumental investigations, of which some

Dynamic exercise

Systolic BP increases during acute dynamic exercise in proportion to the intensity of the effort.36 During longer term stable exercise, the BP tends to decrease after an initial increase of short duration. The increase is greater for systolic than for diastolic BP, which only slightly increases or even remains unchanged. For the same oxygen consumption, the rise is more pronounced in older subjects and when exercise is performed with smaller than with larger muscle groups. Acute exercise is

General recommendations

Physically active patients and athletes with HTN should be treated according to the general guidelines for the management of HTN.1, 2, 3 Appropriate nonpharmacologic measures should be considered in all patients; these include moderate salt restriction, increase in fruit and vegetable intake, decrease in saturated and total fat intake, limitation of alcohol consumption to no more than 20- to 30-g ethanol per day for men and no more than 10- to 20-g ethanol per day for women, smoking cessation,

Statement of Conflict of Interest

The author declares that there is no conflict of interest.

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