Week 2 - Fitness Lifestyle

• Hypertension Overview

  • High BP is a known risk factor for stroke, Congestive Heart Failure (CHF), angina, renal failure, myocardial infarction (Question: what is high BP?)

  • Hypertension clusters with Hyperlipidemia, Diabetes and Obesity as an increase risk

  • Drugs have been effective in treating high BP but because of their side effects and cost, non-pharmacological alternatives are attractive.

• BP General Guidelines

• Risk Factors Associated with Hypertesnion:

  • Obesity: intra-abdominal fat (BMI equal to or greater than 30)

  • Physical inactivity

  • Heavy alcohol consumption

  • Diet: salt intake, low potassium intake

  • Dyslipidemia (fats in bloodstream)

  • Smoking (acute level)

  • Diabetes (type II)

  • Age >55 for men or >65 for women

  • Family history:

    • Women <65

    • Men <55

• Prevalence of Other Risk Factors

  • High blood pressure + one of the following will increase risk by…

    • Smoking 35%

    • LDL Cholesterol >140mg/dl 40%

    • HDL Cholesterol <40mg/dl 25%

    • Obesity 40%

    • Diabetes 15%

    • Sedentary lifestyle >50%

• Hypertension Prevention

1. Lifestyle Modifications

Versus

2. Pharmacological Intervention - Meds

• Lifestyle modification can reduce number of meds and dosage of meds

• May prevent hypertension

• Little cost–minimal risk with lifestyle intervention

• Treatment Basics

  • Prehypertension - No risk factors or Target Organ Disease = try lifestyle changes

  • Stage 1 - try lifestyle change but newer approach is aggressive – one drug needed.

  • Stages 2 - start with 2 drug therapy

What Lifestyle Changes Work?

• Lifestyle Changes

1. Body Composition?

• If BMI >25 or waist >34 inches (86 cm) in women, >39 inches for men (100cm)

• Change energy balance - caloric restriction & increase PA

• Only 10 lbs reduction in body weight = can results in decrease 5-29 mmHg

2. Alcohol?

• Moderation of alcohol intake, causes resistance to antihypertensive meds

• Per day: men 2 drinks, women 1 drink… of 1 ounce of liquor, 24 oz beer, 10 oz wine, 3 oz 90 proof

3. PA?

• PA to moderate level of fitness reduces risk for CV disease and mortality: 4-9 mmHg lower

• Low intensity = 40-60% max heart rate

• 30 minute brisk walk per day - most days

4. Diet?

• Sodium restriction - reduction to 2.4 g/day may lower 2-8 mmHg

• Maintain adequate dietary intake of potassium, calcium and magnesium

• More daily fresh fruits and vegetables. Lower fat

• 8-14 mmHg reduction - same as single drug therapy!

5. Smoking?

• Smoking a cigarette raises BP

• Smoking cessation may not significantly lower BP but… it prolongs life!

• Stop Smoking!!!

• What if Lifestyle Intervention doesn't work?

  • Pharmacologic treatment works

  • Reduces CV mortality, morbidity, stroke, CHF, renal disease, and all cause mortality

• Pharmacologic Approach - Drugs

  • Diuretics, ACE I, Beta Blocker, Calcium, etc.

  • Most patients need 2 or more antihypertensive drugs.

  • Note: treat with diuretics, ace inhibitors and/or beta blockers to reduce morbidity and mortality

• Treatment Summary for Hypertension:

  • Lifestyle Intervention:

1. Change BC

2. Reduce Alcohol

3. Increase PA

4. Changes in Diet

5. Smoking

• Pharmacologic Treatment

• Facts Related to Fitness Assessment and Pre-Screening BP

1. Refer to posted article: Evidence-based risk assessment and recommendations for exercise testing and PA clearance in apparently healthy individuals

• Sedentary Time and Risk of Death

  • Every hour of television watched after the age of 25 reduces the viewer’s life expectancy by 21.8 minutes

  • An adult who spends an average of six hours a day watching TV over the course of a lifetime can expect to live 4.8 years fewer than a person who does not watch TV.

• When to take a 3rd collection (if needed)
  • Always go through sites 2 times in the proper order
  • Look at data collected and determine if difference between collection 1 & 2 is > 0.4 mm
  • If greater than 0.4 mm then do a 3rd collection for those sites only

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