Hypertension

Overview to the Condition:

Hypertension is characterised by elevated blood pressure within the arterial wall. The result is made up of two components; systolic and diastolic blood pressure. Systolic (SBP) is the contractile phase of the heart and gives the higher of the two readings and diastolic (DBP) is the relaxation phase. There are various classifications for hypertension. (ACSM 2009)

Table 1: Classification and Management of Blood Pressure for Adults (ACSM 2009)

BP ClassificationSBPmmHgDBPmmHgLifestyle ModificationWithout Compelling IndicationWith Compelling Indication
Normal<120<80Encourage  
Pre-hypertensive120-13980-89YesNo antihypertensive drug indicatedDrugs for Compelling Indications*
Stage 1 Hypertension140-15990-99YesAntihypertensive drugs indicatedDrugs for compelling indications.*  Other Antihypertensive drugs as needed
Stage 2 Hypertension≥160≥100YesAntihypertensive drugs indicated. Two-drug combination for most 

*Include heart failure, post myocardial infarction, high coronary artery disease risk, diabetes, chronic kidney disease and recurrent stroke prevention.

A significant amount of evidence (Shoemaker et al 2009, de Man et al 2009, Mereles et al 2006) has shown that cardiovascular endurance training, both continuous and interval are beneficial for blood pressure control. However, one study comparing the two (Guimaraes et al 2010) concluded that only interval training reduced arterial stiffness. This is an important factor when treating patients with arterial hypertension. Therefore, interval training would be a more beneficial treatment method for a patient with this condition. The mechanisms involved in this physiological change in blood pressure are not fully understood but there are a few possibilities;

  • Decrease in plasma norepinephrine levels
  • Increase in circulating vasodilator substances
  • Amelioration of hyperinsulinemia
  • Alteration in renal function

Physically active individuals with hypertension have vastly lower mortality rates than individuals that are sedentary or have lower levels of cardiovascular fitness. (ACSM 2009)

Management and Medication:

The treatment of the condition is through two main areas, lifestyle changes and medication. Lifestyle changes may be necessary if the client has high levels in the following areas;

  • Inactivity –> Increase cardiovascular activity to 30 minutes a day 3-5 days a week
  • Stress –> Diaphragmatic breathing techniques
  • Obesity –> Lose weight
  • Alcohol –> Reduce alcohol to 1 or 2 drinks for females and males respectively
  • Tobacco –> Quit smoking
  • Salt –> Reduce intake to 65 mmol/day

There are a variety of medications which can be prescribed dependant on the severity of the hypertension, these include; thiazide-type diurectics, beta-blockers, angiotensin-converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARBs), calcium channel blockers and aldosterone antagonists. (ACSM 2009)

Exercise Prescription:

As cardiovascular activity has been proven to reduce resting blood pressure (Shoemaker et al 2009, de Man et al 2009, Mereles et al 2006) this forms the basis to any exercise prescription. The American College of Sports Medicine (ACSM 2009) suggest the following.

Table 2: Exercise Prescription for Hypertension (ACSM 2009)

ModeGoalIntensity/Frequency/DurationTime to Goal
AerobicControl BP at and during exerciseImprove coronary artery disease riskIncrease VO2maxIncrease peak work and enduranceIncrease caloric expenditure40-80% HRMRPE 11-13/204-7 days/week30-60 min/sessionBurn 700-2000 kcal/week4-6 months
StrengthIncrease strength1 set of 8-12 reps60-80% 1RM4-6 months

Precautionary measures to be taken when prescribing physical activity;

  • Beta-Blockers: Attenuate HR by 30 contractions per minute
  • Alpha1 blockers, alpha2 blockers, calcium channel blockers and vasodilators: May cause hypotension post exertion
  • Do not exercise if resting blood pressure is >200mmHg for systolic or >115mmHg for diastolic
  • Do not exercise if stage 2 hypertension is not controlled with medication
  • Avoid exercises which involve raising arms above shoulder height or supine