Management and Control of Hypertension with Exercise

Management and Control of Hypertension with Exercise

Background and Significance

Hypertension is a critical risk factor for developing cardiovascular disease (CVD). It affects one billion individuals globally and is a top risk factor for death (Molmen-Hansen et al., 2012). In addition to this, it is linked with dyslipidemia, obesity, and diabetes mellitus, which are associated with complications such as heart failure, renal failure, myocardial infarction, and stroke (Cao et al., 2019). Low aerobic activity is a strong indicator for CVD and death for health and CVD patients and those with hypertension (Molmen-Hansen et al., 2012). Increased exercise capacity is thus linked with reduced CVD risk. Physical activity can thus be used as an intervention for preventing, controlling, and treating hypertension (Molmen-Hansen et al., 2012).

PICOT Question

In adults aged 30-60 years, does exercise, when compared to no exercise, reduce hypertension?

Brief Review of Each Study

The study by Kelley & Kelley (2000) was a meta-analysis of randomized controlled trials. Across all study designs, there was a decrease of ≈2% resting systolic blood pressure (SBP)  and 4% resting diastolic blood pressure (DBP). The overall study results indicated that progressive resistance exercises lead to small reductions in resting SBP and DBO\P. Even though these small reductions in blood pressure may have little effect in decreasing CVD disability and deaths, they can reduce the risk of coronary heart disease and stroke (Kelley & Kelley, 2000).

Molmen-Hansen et al. (2012) conducted a randomized control trial to determine the effects of aerobic interval training on myocardial function and blood pressure in hypertensive patients. The study has 88 patients with essential hypertension. They were randomized into the study group or control group. Systolic blood pressure was reduced by 12mmgHg in aerobic interval training and 3.5mmHG in moderate-intensity continuous training (Molmen-Hansen et al., 2012). There was an improvement in systolic myocardial function in both groups and an improvement in diastolic function in the aerobic interval training (AIT) group only. This study revealed a reduction of blood pressure in essential hypertension depends on the intensity of the exercise. AIT is effective in lowering blood pressure and improving cardiovascular risks.

Cao et al. (2019) conducted a meta-analysis and systematic review to assess the efficacy of the different periods of aerobic exercises on patients with hypertension. They used four databases to such for English publications. There were fourteen articles with 860 participants. The results from this analysis revealed that in comparison to the control groups, there was a major reduction in SBP in hypertensive patients (Cao et al., 2019). The study thus concluded that aerobic exercise might be effective in treating hypertension.

Kokkinos et al. (2001) conducted a review to assess the current literature on the effectiveness of anaerobic and aerobic exercises in lowering exercise and resting blood pressure in essential hypertension patients. The findings from the current literature revealed that moderate to intense aerobic exercise train can reduce BP in the early stages of hypertension. The average reduction in blood pressure for systolic is 10.5mmHg  and 7.6 mmHg in diastolic BP (DBP) (Kokkinos et al., 2001). Aerobic exercise training can also significantly reduce blood pressure in stage three hypertension. Resistance training exercises have not shown consistency in reducing blood pressure and are not recommended as the only exercise form for hypertension. The exercises should be done about three to five weeks, thirty to sixty minutes per session, for optimal benefits (Kokkinos et al., 2001).  The exercises should be individualized for each patient. The intensity should be low and duration short in the early stages, with a progressive increase until the set objectives are met.

Wen & Wang (2017) conducted a meta-analysis to evaluate the effects of aerobic exercises on reducing BP in hypertension. There was a total of 13 research studies on 803 patients with essential hypertension. The data from the meta-analysis revealed no major differences in SBP and DBP between the control group and the aerobic group before aerobic exercise training. However, after aerobic exercise training, there were major reductions in SBP and DBP in the aerobic group compared to the control group (Wen & Wang, (2017). From this study, it can be concluded that aerobic exercise training might significantly reduce blood pressure in incident hypertension.

Liu et al. (2017) conducted a meta-review and systematic analysis of studies to evaluate the dose-response relationship between physical activity (PA) and incident hypertension. The review revealed that PA has an essential clinical role in the primary prevention of essential hypertension. The studies revealed that there is a linear dose-to-response relationship between physical activity and hypertension. Positive benefits of physical activity can be realized with low physical activity levels. Still, an additional reduction in the risk for hypertension is achieved when the levels exceed the minimum recommendations (Liu et al., 2017).

Summary of the Evidence

The evidence from the articles has revealed that any type of physical activity can reduce essential hypertension. However, aerobic training is more effective in reducing hypertension compared to other physical activities. The duration of the exercises also influences the extent of reduction of hypertension. The exercises should be moderate to intense with a thirty to sixty-minute daily exercise. They should be conducted between three to five days a week. It is essential to set a minimum time for the exercises. Finally, the evidence of better control and management of blood pressure is seen with lifestyle modification, including exercise and/or physical activity, compared to pharmacological management alone.

Recommendations for Practice

The evidence from these studies has revealed that aerobic exercise can be used to prevent, control, and manage hypertension clinically. Nurses and other healthcare professionals should ensure that patient education includes recommendations for moderate-intense physical activity to ensure they reduce systolic and diastolic hypertension. These activities should be used in conjunction with pharmacotherapy and other lifestyle modifications.

Recommendations for Future Research

Future research should investigate the effects of the duration of physical activity in reducing hypertension and heart rate among adults. It is also critical to conduct the safety of the different intensities of these exercises in individuals with heart failures. Furthermore, more studies should determine to determine response differences related to gender or age.

Recommendation to Utilize the Evidence

This evidence can be used to support the theory that exercise can reduce essential hypertension in adult patients. The studies have revealed that exercise can prevent hypertension in persons who have not developed it. Individuals with a family history of hypertension can thus use this evidence to avoid hypertension by implementing an exercise regimen early in life. Individuals should exercise for at least thirty minutes to reduce hypertension. The exercises should also be done between three to five days a week. Studies have shown that aerobic exercises have a higher prevalence in reducing hypertension. Further studies are proving that a combination of resistance exercise and aerobic exercise can help reduce blood pressure.

References

Cao, L., Li, X., Yan, P., Wang, X., Li, M., Li, R., Shi, X., Liu, X., & Yang, K. (2019). The effectiveness of aerobic exercise for hypertensive population: A systematic review and meta‐analysis. The Journal of Clinical Hypertension, 21(7), 868-876. https://doi.org/10.1111/jch.13583

Kelley, G. A., & Kelley, K. S. (2000). Progressive resistance exercise and resting blood pressure. Hypertension, 35(3), 838-843. https://doi.org/10.1161/01.hyp.35.3.838

Kokkinos, P. F., Narayan, P., & Papademetriou, V. (2001). Exercise as hypertension therapy. Cardiology clinics, 19(3), 507-516.

Liu, X., Zhang, D., Liu, Y., Sun, X., Han, C., Wang, B., Ren, Y., Zhou, J., Zhao, Y., Shi, Y., Hu, D., & Zhang, M. (2017). Dose-response association between physical activity and incident hypertension. Hypertension, 69(5), 813-820. https://doi.org/10.1161/hypertensionaha.116.08994

Molmen-Hansen, H. E., Stolen, T., Tjonna, A. E., Aamot, I. L., Ekeberg, I. S., Tyldum, G. A., Wisloff, U., Ingul, C. B., & Stoylen, A. (2012). Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. European Journal of Preventive Cardiology, 19(2), 151-160. https://doi.org/10.1177/1741826711400512

Wen, H., & Wang, L. (2017). Reducing the effect of aerobic exercise on blood pressure of essential hypertensive patients. Medicine, 96(11), e6150. https://doi.org/10.1097/

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In adults aged 30-60 years, does exercise, when compared to no exercise, reduce
hypertension?
Paper Statement:
Management and control of hypertension with exercise
Summary of the evidence (at this point, it can be as bullet points):
• Exercise (any type of physical activity) can reduce hypertension.

Management and Control of Hypertension with Exercise

• Evidence shows aerobic exercise reduces hypertension the most.
• Duration of exercise influences the reduction of hypertension to various
degrees.
• A set minimum time for exercise is necessary.
• Evidence of better control and management of blood pressure seen with
lifestyle modification, including exercise and/or physical activity, compared
to pharmacological management alone.
Recommendation to utilize the evidence (at this point, it can be as bullet points):
• To support our theory that exercise does reduce hypertension.
• There is a component to the prevention of hypertension with exercise. So, those with a family history of hypertension can avoid this disease by
implementing exercise early in life.
• Include a minimum of 30 minutes of exercise to reduce hypertension
• Some studies suggest at least 150 minutes of exercise per week.
• Aerobic exercise is more prevalent in reducing hypertension, though further studies suggest combining aerobic and resistance for
increased reduction.