HYPERTENSION

Genetic predisposition ● Family history

Lifestyle ● Physical inactivity

● Sex (men are at increased risk) ● Overweight or obesity ● Age (risk increases with age) ● Race (African-Americans at higher risk)

● Diabetes (risk also affected by lifestyle)

● Smoking Table 3: Risk factors associated with hypertension

exercise programmes and the existence of an inverse relationship between physical activity levels and hypertension (2,6,7). Reviews have also shown endurance exercise programmes to be as, if not more effective, than other nonpharmacalogical strategies (eg. reduction in sodium intake, behavioural therapies). Furthermore an acute 30 to 45 minute bout of dynamic aerobic exercise may reduce systolic blood pressure by as much as 10-20 mm Hg. It is thought that this effect is caused by reduced cardiac output and may last for up to nine hours (2,3).

The exact mechanisms explaining the favourable effects associat- ed with physical activity remain unclear. However, possible expla- nations include either one or a combination of the following:

● Reduced cardiac output at rest ● Decreased sympathetic nervous system activity ● Reduced total peripheral vascular resistance at rest ● Improved kidney function ● Enhanced insulin sensitivity (2,6,7,8)

Possible side effects

Dehydration, muscle weakness, aching limbs

Considerations

Ensure access to fluids during/after exercise, exercise capability may be lowered

Physical activity recommendations Physical activity may be incorporated into an overall treatment or preventative strategy for mild to moderate hypertension (2,3,7). It should be recommended alongside other relevant lifestyle issues given below:

● Undertaking recommended physical activity levels ● Weight management ● Dietary restriction of sodium in line with recommended levels ● Reduction of alcohol consumption to recommended levels ● Smoking cessation ● Reduce dietary fat and saturated fat ● Stress management

Exercise recommendations for the prevention or management of mild to moderate hypertension are to gradually progress towards participating in moderate intensity activities that use the large muscle groups (eg. brisk walking, cycling, swimming) for a dura- tion of 20-60 minutes, three to five times per week (1,2,7). The recent physical activity recommendations of building up to 30 minutes of moderate physical activity on at least five days per

Popular drug choices in this category

These are commonly used drugs and prescribing habits vary widely however the main generic components of this variety of drugs include frusamide, bumetanide, amiloride, triamterine

Tiredness, postural hypotension, fatigue, dizziness, cold extremities

Restricted reliability of heart rate monitor, rating of perceived exertion is more appropriate, care when getting up from floor/chair exercises

Dizziness, light-headedness, headaches, dry cough

Care when getting up from floor/chair exercises, prolonged cool down advisable

Generic pharmaceutical names include atenolol, propranolol, sotalol and bisoprolol

● High total cholesterol ● Excessive sodium intake ● High alcohol intake ● Stress

When considering recommending physical activity to reduce blood pressure it is important to take into account the numerous bene- fits associated with an active lifestyle. These include favourable effects upon body weight, blood lipid profile, insulin resistance, mental health, self-esteem while providing opportunities for social contact, all or some of which may be relevant for hyper- tensive individuals.

Generic names (proprietary names in brackets) include enalapril (Innovace), captopril, imidapril (Tanatril) and lisinopril (Zestril)

Headaches, dizziness, faintness, stomach disturbances

Restricted reliability of heart rate monitor, rating of perceived exertion more appropri- ate

Generic names (proprietary names in brackets) include lercanidipine (Zanidip), amlodipine, felodipine (Plendil), nifedipine

Dizziness, postural hypotension, fatigue, weakness

Care when getting up from floor/chair exercises, prolonged cool down advisable

Doxazosin (Cardura), indoramin, prazosin

Dizziness, lightheadedness

Care when getting up from floor/chair exercises, prolonged cool down advisable

Losartin (Cozaar), valsartan, irbesartan (Aprovel), candesartan

SportEX 13