Medical & Clinical Considerations



Signs & Symptoms

Hypertension is often referred to as the "silent killer" because many patients do not have any specific symptoms related to elevated blood pressure. However, symptoms do include [[#cite_note-1|[1]] ] :
· Headaches in the occipital region and occurs when waking up in the morning
· Dizziness
· Palpitations
· Fatigue
· Blurred vision

Obese_person_with_headache.jpg

Evaluation
Clinical evaluation of a person with hypertension should be aimed at assessing secondary forms of hypertension and the factors that may influence therapy. For example, determining whether target organ damage is present and identifying other risk factors for cardiovascular disease [[#cite_note-2|[2]] ] .

Other risk factors for cardiovascular disease include:
· Diabetes
· High cholesterol
· Obesity
· Coronary artery disease
· Smoking
· Physical inactivity
· Unhealthy diet
· Age (Males >45 years & Females >55 years)


The risk of exercise-induced adverse events is heightened in older people with coronary artery disease, a condition often associated with hypertension [[#cite_note-3|[3]] ] . Therefore, prior to initiating an exercise program, older patients with hypertension should be medically evaluated to identify if exercise training may be hazardous [[#cite_note-4|[4]] ] . Further, if any other cardiovascular disease risk factors are identified, then their specific considerations should be incorporated into the intervention therapy plan.

Exercise Testing
· Decrease in systolic BP (>10 mmHg)
· An excessive increase in systolic BP greater than 250 mmHg
· An excessive increase in diastolic BP greater than 115 mmHg

Common symptoms associated with low blood pressure include dizziness, light headedness, blurred vision or nausea. If detected, exercise should be terminated.

**Special Exercise Considerations [[#cite_note-5|[5]] ]
· Those with an elevated BP (>160/100) should add endurance training to their treatment only after initial drug therapy.
· Individuals should not be allowed to exercise on a given day if their resting systolic BP is more than 200 mmHg or diastolic BP is more than 110 mmHg.
· Diuretics and β-blockers may impair thermoregulation during exercise in hot or humid conditions. Therefore, it is important to be able to identify signs and symptoms of heat intolerance and be able to adjust the exercise routine accordingly.
· Ensure breathing patterns are maintained to avoid excessive straining when performing resistance exercise training.









HOME

  1. [[#cite_ref-1|^]] Contractor, A. & Gordon, N. Cited from: Ehrman, J. K., Gordon, P. M., Visich, P. S., & Keteyian, S. J. (2009). Clinical Exercise Physiology. Human Kinetics.
  2. [[#cite_ref-2|^]] Contractor, A. & Gordon, N. Cited from: Ehrman, J. K., Gordon, P. M., Visich, P. S., & Keteyian, S. J. (2009). Clinical Exercise Physiology. Human Kinetics.
  3. [[#cite_ref-3|^]] Thompson, P.D., Franklin, B.A., Balady, G.J., Blair, S.N., & Corrado, D. (2007). Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation, 115(17): 2358—68.
  4. [[#cite_ref-4|^]] Fletcher, G.F., Balady, G.J., Amsterdam, E.A., Chaitman, B., Eckel, R., & Fleg, J. (2001). Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation; 104(14): 1694—74.
  5. [[#cite_ref-5|^]] Contractor, A. & Gordon, N. Cited from: Ehrman, J. K., Gordon, P. M., Visich, P. S., & Keteyian, S. J. (2009). Clinical Exercise Physiology. Human Kinetics.