ASSESSMENT OF HYPERTENSION AND PHYSICAL ACTIVITY SOLUTIONS

ASSESSMENT OF HYPERTENSION AND PHYSICAL ACTIVITY SOLUTIONS

Introduction and overview.

Leisure centres provide several specialist exercises programs for various chronic conditions. This paper seeks to tackle a chronic condition, precisely hypertension. Hypertension in simpler terms is referred to as high blood pressure. It is a severe condition which leaves the patients vulnerable to diseases relating to the heart, kidney, brain and other essential body organs. According to research conducted by the World Health Organization (WHO), approximately 1.13 billion individuals globally are suffering from hypertension with around 60% of them from low to middle income earning countries (Who.int, 2019). In the year 2015, in a group of four men, one was expected to have hypertension, and among five women, one was expected to have the condition. This condition has claimed a lot of lives late and premature deaths globally. In the leisure centre, there is a need for an education component which explains to the individuals with hypertension more on the condition. This paper depicts an education programme containing the epidemiology of the condition, the pathology of the condition and the physical activity routines effective for prevention or treatment of hypertension.

Hypertension definition

Hypertension is a condition achieved when blood pressure is substantially higher than normal. As blood flows in the arteries, the pressure is exerted to the walls of the arteries, this pressure, when measured, is used to determine the blood pressure. Blood pressure is stated as two digits. The first digit commonly referred to as systolic is the pressure indicated in the arteries as the heartbeats. The second digit is referred to as diastolic, and it shows the pressure registered from the blood vessels when the heart rests.

When blood pressure is measured on two separate days, two indications show that an individual has hypertension. When the systolic pressure is greater than or equal to 140mmHg in both the testing sessions, this is an indication. Also, if the diastolic blood pressure indicates a figure greater or equal to 90mmHg, this shows the individual has hypertension.

Epidemiology of hypertension

Hypertension is one of the leading factors resulting to death hence regarded as an epidemic. In the world, over one billion are affected by this condition. In accordance with a report from world health statistics, hypertension is approximately diagnosed in 29% of the men and around 24% of the females. In those who do not exhibit hypertension readings during diagnosis at ages of around 55 to 65, approximately 90% of them will end up being hypersensitive once they hit the ages between 80 years to 85 years. Hypertension is a universal condition which affects individuals regardless of their background or source of income. Worldwide, in the 2004 research showed that in 58.8 million death witnessed, out of that total number hypertension resulted to 12.8% of the deaths, this sums up to about 7.5 million deaths (Kumar, 2013 p.56). Besides these statistics, hypertension is the reason behind 51% of cerebrovascular diseases and around 45% of ischemic heart diseases, which led to deaths around the world. Assessing the condition in a country’s basis, from research conducted in Japan annually, approximately 100,000 people die due to hypertension (Chapter 1. Epidemiology of hypertension, 2014, p.260). Hypertension has also greatly impacted China. With reference to a national survey of hypertension prevalence in China between the years 2012 and 2015, 23% of the adult population aged 18 years and above had hypertension (Liu et al., 2019, p.1). These statistics indicate the reason behind hypertension being referred to as an epidemic.  It has declared the lives of many individuals, and many individuals are still suffering from it currently hence raising the need for countries to invest more in creating awareness concerning the condition and availing treatment means.

Hypertension is a universal condition which affects different people. In order to comprehensively understand who is affected by the condition, it is essential to assess the determinants of hypertension which may also be referred to as the risk factors of hypertension. Hypertension bears several risk factors one of them being age. Vulnerability to developing hypertension increases as an individual grows older. Approximately at the age of 64, most individuals tend to contract hypertension with males being affected more than females. The race is another factor; people from African heritage tend to be more susceptible to developing high blood pressure in comparison to the whites. Family history is a factor that is unavoidable. People who have a history of high blood pressure in their lineage have high chances of developing the condition as it runs in the family. These risk factors represent determinants which individuals cannot manipulate to avoid developing the condition (Peltzer and Pengpid, 2018, p.7).

Some other risk factors are open to manipulation by individuals who aim to avoid that come with the condition. One of them is being obese, people who are overweight require more blood to supply their body organs hence a rise in blood volume in the body. This increase result in an increase in blood pressure hence the development of high blood pressure. Another factor is being physically inactive; individuals who are not active physically tend to develop high heart rates. With the increased rates, there is a subsequent increase in blood pressure hence the development of hypertension. Being physically inactive also boosts the risk of being obese. Usage of tobacco is another factor, intake of tobacco regardless of the form whether as smoke, through chewing or passive smoking is a risk factor. Tobacco destroys the linings of the arteries hence narrowing them, increasing an individual’s risk of developing heart disease.

Excess salt and minimal potassium in one’s diet is another risk factor, dieting is essential for the body, using excessive sodium leads to high blood pressure and using minimal potassium leads to the body having excess potassium which leads to high blood pressure. Drinking alcohol is another risk factor; over drinking damages, the heart hence can lead to hypertension over time. Over drinking also takes a toll on the brain and liver. These are some of the risk factors of hypertension; this condition is majorly evident in adults though some children may contract it as well. In children who develop the condition, it usually arises due to problems with their kidneys or heart. Other children may develop the condition due to poor lifestyle routines like unhealthy dieting, physical inactivity and obesity.

Pathophysiology of hypertension

Hypertension, as earlier discussed, is a dangerous increase in blood pressure which is detrimental to the body organs in the long-term. Results of hypertension present an increase in mortality and morbidity. Blood pressure is obtained from the cardiac output and systemic vascular resistance. Patients diagnosed with arterial hypertension tend to depict a rise in cardiac output, a rise in systemic vascular resistance or both. In the younger individuals, the cardiac output is usually higher, whereas, in the older patients, systemic vascular resistance increases and the vasculature stiffens. An increase in vascular tone may be experienced due to an increase in the alpha-adrenoceptor stimulation or due to a rise in the excretion of peptides. The final occurrence is the rise in cytosolic calcium inside the vascular smooth muscle resulting in vasoconstriction. Peptides cause the vascular smooth muscle to increase in mass, also known as vascular remodelling. The rise in systemic vascular resistance and vascular stiffness, increase the force exerted on the left ventricle; this results in left ventricular hypertrophy as well as left ventricular diastolic dysfunction (Foëx and Sear, 2004 p.72).

In the youth age group, the pulse pressure exerted from the left ventricle is lower and waves which are reflected by the peripheral vasculature appear after the end of the systole hence raising the pressure in the initial stages of diastole and enhance coronary perfusion. Upon ageing, the aorta stiffens and pulse pressure increases due to the elastic arteries. The reflected waves progress from early diastole to late systole. As a result, there is a rise in left ventricular afterload, thus contributing to left ventricular hypertrophy. The increase of pulse pressure due to ageing is a key contributor to coronary heart diseases.

In patients with hypertension, there is a rise in the release of norepinephrine as well as higher sensitivity of the peripheral to norepinephrine. There also exists a rise in reaction to stressing stimuli. Another characteristic of hypertension is a reset in the baroreflexes and a reduction in baroreceptor sensitivity. Renin-angiotensin plays a part in some types of hypertension, and it is reduced by primary hyperaldosteronism. Black or elderly patients mostly have low-renin hypertension. Some have high-renin hypertension, and they are more vulnerable to developing myocardial infarction as well as other cardiovascular issues(Beevers, 2001, p.915).

Essential hypertension and experimental hypertension, the regulation of volume and ratios between blood pressure and sodium release are abnormal. Evidence reveals the reset of pressure natriuresis causes hypertension. Patients diagnosed with essential hypertension, reset of natriuresis pressure is categorised by a simultaneous change to higher blood pressure and salt-insensitive hypertension, or to lower pressure natriuresis and salt-sensitive hypertension.

Treatment of hypertension by physical activity

Physical activity is essential for individuals who have hypertension. It is employed as a means to control blood pressure levels in hypertensive patients. In people who intend to attempt preventing themselves from developing high blood pressure, physical activity is highly advised. Physical activity regularly through different exercising routine, strengthens the heart. When the heart is strong, it bears the ability to pump blood as expect while utilising minimal effort. With reduced heart effort, the force exerted on the artery walls decreases hence lowering blood pressure. Regularly exercising reduces the systolic pressure by 4 to 9mmHg. In patients with hypertension, exercise aids in a reduction to their medications. Increased physical activity also helps in the maintenance of healthy weight, essentially preventing high blood pressure which arises from the effects of being obese. Different exercises have been studied with regards to their impact on blood pressure levels.

One of the exercises is aerobic exercise, according to a meta-analysis of random controlled attempts, it was concluded that aerobics exercises contribute to a reduction in the overall SBP and DBP. The amount varies between hypertensive patients and non-hypertensive patients. The exercise depicted more decrease in patients with hypertension. This research showed that aerobic exercise results in a significant reduction in ambulatory blood pressure. In adults with hypertension who were involved in the randomised trials, a drop of 3.8 mmHg and 3mmHg for day systolic and diastolic blood pressure, respectively (Diaz and Shimbo, 2013 p.11).

Resistance exercise training is another physical activity which is employed for the treatment of hypertension. This training basically involves moderate-intensity training sessions in a week for six weeks to 48 weeks. From meta-analysis studies with 2344 hypertensive participants, under resistance exercise training routine where the result indicated that the SBP and DBP dropped -0.4mmHg in both cases. The reduction in the pressures was more evident in the people who were in the late stages of hypertension and those who engaged in more resistance exercise training than the others.

The other routine in the concurrent exercise training, this training involves two pieces of training simultaneously, i.e., dynamic resistance and aerobic exercises. These exercises can be performed on the same day or on separate days but interchanges between the two exercises. The American College of Sports Medicines recommends that adults with hypertension should utilise these exercises and perform them at least 30 minutes in a day for effectiveness. From research conducted, there was a 5.3 and 2.9mmHg reduction in SBP and 5.6 and 3.6mmHg reduction in DBP in prehypertensive and hypertensive patients. This shows that this training is efficient (Lopes et al., 2018, p.67).

Finally, there is isometric exercise training; this training is suitable for individuals who cannot do aerobics or resistance exercise training. It takes place when the muscle gains tension with no change in joint movement. Recent research refers to isometric exercise training as a non-pharmacological hypertensive therapy. Analysis of the program indicated that the longer individuals participate in the program, the more reductions they had. Hyper tensive participants recorded a reduction in their SBP and DBP levels after participating in the isometric exercises (Lopes et al., 2018, p.68).

In conclusion, hypertension is a chronic condition which involves a severe increase in blood pressures. The older individuals are more vulnerable to being affected by the condition. It has several risk factors, i.e., age, race, stress levels, poor dieting, being obese, chronic conditions etc. Several treatment methods are employed, and the non-pharma logical, physical activity treatments are very effective in treatment and prevention. The three forms of exercises utilised for treatment are aerobic exercise, concurrent exercise training and isometric exercise training.

References

Beevers, G. (2001). ABC of hypertension: The pathophysiology of hypertension. BMJ, 322(7291), pp.912-916.

Chapter 1. Epidemiology of hypertension. (2014). Hypertension Research, 37(4), pp.260-265.

Diaz, K. and Shimbo, D. (2013). Physical Activity and the Prevention of Hypertension. Current Hypertension Reports, 15(6), pp.659-668.

Foëx, P. and Sear, J. (2004). Hypertension: pathophysiology and treatment. Continuing Education in Anaesthesia Critical Care & Pain, 4(3), pp.71-75.

Kumar, J. (2013). Epidemiology of hypertension. Clinical Queries: Nephrology, 2(2), pp.56-61.

Liu, B., Liu, H., Na, R., Li, X., Li, Q., Chen, L., Tu, W., Hu, J., Cheng, D., Cao, Y., Li, Z., Fang, W., Zhu, N. and Yu, Q. (2019). A Comparison on Prevalence of Hypertension and Related Risk Factors between Island and Rural Residents of Dalian City, China. International Journal of Hypertension, 2019, pp.1-8.

Liu, B., Liu, H., Na, R., Li, X., Li, Q., Chen, L., Tu, W., Hu, J., Cheng, D., Cao, Y., Li, Z., Fang, W., Zhu, N. and Yu, Q. (2019). A Comparison on Prevalence of Hypertension and Related Risk Factors between Island and Rural Residents of Dalian City, China. International Journal of Hypertension, 2019, pp.1-8.

Lopes, S., Mesquita-Bastos, J., Alves, A. and Ribeiro, F. (2018). Exercise as a tool for hypertension and resistant hypertension management: current insights. Integrated Blood Pressure Control, Volume 11, pp.65-71.

Peltzer, K. and Pengpid, S. (2018). The Prevalence and Social Determinants of Hypertension among Adults in Indonesia: A Cross-Sectional Population-Based National Survey. International Journal of Hypertension, 2018, pp.1-9.

Who.int. (2019). Hypertension. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/hypertension [Accessed 28 Nov. 2019].