HTN

Question 1

Respond on acute exercise (4)

Answer 1

1. Hypertensive response: SBP more 250 mmHg or DBP more 115 mmHg
2. Exaggerated response to exercise: SBP more 210mmHg (men) and SBP more 190mmHg (Women)
3. Individuals on B-blockers will have attenuated HR response and reduced maximal capacity
4. Individuals on diuretics may experience hypokalemia and other electrolytes imbalance, dysrhythmias, or potentially false-positive test

Question 2

BENEFITS (4)

Acute benefits (1)
Chronic effect (5)

Answer 2

1. Acute benefits of a single exercise training bout for HTN:
   - Post-exercise reduction in BP of about 4/2mmHg that can last up to 22-24 hr
2. Chronic effects of aerobic exercise training on BP
   - Reduction in resting BP of 5-7 mmHg in ind with HTN
   - Reduction in ambulatory BP and BP at fixed submax work load
   - Regression of cardiac wall thickness and LV mass in ind with HTN with regular activity
   - Lower LV mass in ind with pre-HTN and a moderate-to-high physical fitness status.
   - This benefits may be supplemented with mod intensity resistance training but evidence is less consistent for this mode of exercise used alone

Question 3

Precautions (8)

Answer 3

1. Considerations should be given to level of BP control, recent changes in anti-HTN meds, med-related effects, presence of target organ disease, other comorbidities (obesity, CVD, etc.), and age
2. An exaggerated BP response to low intensities and at HR levels <85% APMHR can occur even after BP control; CET may help detect the HR at which this exaggerated response occurs (i.e. threshold)
3. Prudent to keep SBP ≤ 220 mmHg and/or DBP ≤ 105 mmHg
4. B-blockers and diuretics may impair thermoregulation. B-blockers may also predispose to hypoglycemia and mask some of its signs. Inform patients of these risks and of signs and symptoms of heat intolerance and hypoglycemia
5. Ca-channel blockers and vasodilators can provoke post-exercise hypotension. Extend and monitor cool-down carefully
6. B-blockers may attenuate HR response during submax and max exercise and may decrease exercise capacity in patients without myocardial ischemia. Consider using RPE to monitor intensity if actual peak exercise HR is not available (e.g., was not measured).
7. BP-lowering effects of exercise training are independent of age, so older individuals with HTN experience similar reductions in BP than younger ones
8. Avoid valsalva manoeuvre

Question 4

Exercise testing (4)

Answer 4

1. HTN individuals whose BP is not controlled (resting SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) should consult with their MD prior to initiating an ex program to determine if CET is needed
2. Individuals with stage 2 HTN (SBP ≥ 160 mmHg or DBP ≥ 100 mmHg) or with target organ disease must not engage in any exercise, including a CET, prior to a medical evaluation and adequate BP management
3. If test is non-diagnostic, meds should be taken at usual time; if test is diagnostic, BP meds may be withheld (physician approval)
4. Resting SBP>200 mmHg or DBP>110 mmHg is a relative contraindications to exercise testing