Introduction:
1.) Bolivar, J.J. (2013). Essential hypertension: an approach to its etiology and neurogenic pathophysiology. International Journal of Hypertension. DOI: 10.1155/2013/547809
The purpose of this study was to determine and understand the etiology of hypertension. Bolivar provided the basic definition of hypertension, i.e. the systolic blood or diastolic pressure and the applied an evolutionary point of view. Most importantly, Bolivar notes that the etiology of hypertension cannot be determined. For this reason, the term ‘essential’ is added, bringing about the reference of ‘essential hypertension’, which is understood to result from the combined action of various factors, genetic, environmental and behavioral. Now, because of this multifactorial nature of the disease, Bolivar arrives at the premise that hypertension is not merely the rise in blood pressure, but the inability of other parts of the body to counteract the rise in – and normalize – blood pressure in one or more other parts of the body.
2.) He, W. J., Li, C., Rao, D. C., Hixson, J. E., Huang, J., Cao, J., & ... Kelly, T. N. (2015). Associations of Renin-Angiotensin-Aldosterone System Genes With Blood Pressure Changes and Hypertension Incidence. American Journal Of Hypertension, 28(11), 1310-1315. doi:10.1093/ajh/hpv033
The purpose of this study was to determine the association between the genes involved in the Renin Angiotensin Aldosterone system (RAAS) with changes in blood pressure and successive hypertension. The study was conducted on numerous subjects, where ten genes associated with RAAS were analyzed and identified in each individual. Blood pressure recordings were then taken immediately after and then measured 7 years later for comparison purposes. The results concluded that the specific gene NR3C2 involved in RAAS is associated with increased blood pressure over time and contributes to hypertension.
3.) Lopez, A. (2016). Making Positive Health Changes In Obese/Overweight Children With Hypertension. Pediatric Nursing, 42(5), 243-246.
The purpose of this article was to identify the best intervention strategies proven to successfully help reduce hypertension in overweight and obese children. The authors researched a number of different studies that focused on overweight children with hypertension and chose four articles for further analysis. Results concluded that physical activity and diet are the two main manageable factors contributing to hypertension in obese children. Physical activity and less sodium intakes in the diet have proven to work in reducing hypertension in overweight and obese children, which is similar to recommendations for hypertensive adults. The authors concluded that health providers need to situate further emphasis on education of these two aspects to reduce the high prevalence of hypertension in children.
4.) Oti, S. O., de Vijver, S. v., Gomez, G. B., Agyemang, C., Egondi, T., Kyobutungi, C., & Stronks, K. (2016). Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya. Bulletin Of The World Health Organization,94(7), 501-509. doi:10.2471/BLT.15.156513
The purpose of this study was to evaluate the effects of an intervention program in Nairobi, Kenya. The intervention was focused on increasing the communities’ awareness on hypertension and increasing the treatment levels. The participants were 6780 Africans who suffered from elevated blood pressure, with systolic blood pressure measuring at least 140 mmHg and diastolic measuring at least 90 mmHg. Anthropometric and clinical assessments including skinfold measurements, blood lipid testing, BMI measurements were all measured pre and post intervention. The results proved that the intervention- screening, diagnosis, and chronic treatment, were successful amongst the population in raising awareness of hypertension. In summary, the intervention reached 60% of the target population, provided access to treatment for 68% of eligible patients with hypertension, retained 27% in care and achieved blood pressure control among 33% of patients retained in care.
5.) Xinji, Z., Yuan, Z., Xiang, X., Xiuqiang, M., & Jia, H. (2016). The relation between health insurance and management of hypertension in Shanghai, China: a cross-sectional study. BMC Public Health, 161-8. doi:10.1186/s12889-016-3627-3
The purpose of this study was to determine the relationship between blood pressure and types of health insurance or lack there of. The study consisted of 31,531 men and women that were randomly selected in Shanghai. The participants were asked to provide their blood pressure status, how they managed their high blood pressure, what kind of health insurance that they have and any other demographic information that they could provide. For the study, a weighted propensity score model was used to adjust cofounders and to help determine the differences between hypertension management depending on where the participants were enrolled for health insurance. The results found that there were slight differences in the control of health insurance between all of the participants between the different health insurance plans. In conclusion, it was found that individuals who had health insurance had a positive correlation benefitting patients with high blood pressure.
Exercise Guidelines:
1.) Börjesson, M., Onerup, A., Lundqvist, S., & Dahlöf, B. (2016). Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs. British Journal Of Sports Medicine, 50(6), 356-363. doi:10.1136/bjsports-2015-095786
The purpose of this study was to determine the effects of physical activity on blood pressure in hypertensive individuals. The study consisted of the analysis of 27 previously controlled random studies. The study was a combination of three different methods of physical activity including isometric activity, dynamic resistance and cardiovascular exercise. The results proved that medium to high intensity exercise or physical activity reduces blood pressure by at least a mean of 11/5 millimeters of mercury. The study proved that as both the prevalence of hypertension and physical inactivity are high and increasing in today's society, PA has a great role to play as a single or additive treatment for hypertension.
2.) Brito, A. d. F., de Oliveira, C. V. C., Santos, M. d. S. B. and Santos, A. d. C. (2014), High-intensity exercise promotes post exercise hypotension greater than moderate intensity in elderly hypertensive individuals. Clin Physiol Funct Imaging, 34: 126–132. doi:10.1111/cpf.12074
The purpose of this study was to explain the relationship between high-intensity resistance exercise and forearm vascular resistance within a population of elderly, hypertensive individuals. Ten hypertensive elderly individuals were studied and subjected to three experimental sessions; control session, exercise intensities of 50% and 80% of 1RM. For each session, subjects were evaluated pre-and post-intervention. In result of the intervention, the PEH was greater in 80% intensity group compared to those at 50%, with the lower value of BP being found at 90 min of recovery for the two sessions. In conclusion, high intensity resistance exercise can lower the blood pressure of hypertensive, elderly individuals.
3.) Heyward, V. H., & Gibson, A. (2014). Advanced fitness assessment & exercise prescription (7th ed.). Champaign, IL: Human Kinetics Books.
Chapter 1 (page 10) describes hypertension and ways to decrease blood pressure with simple lifestyle changes such as exercise. They recommend regular physical activity to prevent the development of hypertension and to help lower blood pressure. The author says that regular activity is beneficial to young, old, overweight or obese individuals. This text gives overall guidelines and recommendations for exercise to decrease blood pressure and also includes the amount of exercise that is necessary and the specific types. In conclusion the author promotes exercise as a key aspect in lowering blood pressure.
4.) Millar, P. J., & Goodman, J. M. (2014). Exercise as medicine: Role in the management of primary hypertension. Applied Physiology, Nutrition & Metabolism, 39(7), 856-858.
The purpose of this study was to outline the updated guidelines of aerobic and resistance exercises in reducing elevated blood pressure. Recommended exercise includes 30-60 minutes of moderate to vigorous intensity aerobic exercise 4-7 times per week and 1-2 sets of 10-15 repetitions for each muscle group 2-3 days per week. Participating weekly in aerobic and resistance exercises was proven to both acutely and chronically lower blood pressure readings. It was concluded that physical activity, as medicine should be utilized more often to manage blood pressure and reduce the increased reliance on antihypertensive medications.
5.) Moreira, S. R., Cucato, G. G., Terra, D. F., & Ritti-Dias, R. M. (2016). Acute blood pressure changes are related to chronic effects of resistance exercise in medicated hypertensive elderly women. Clinical Physiology & Functional Imaging, 36(3), 242-248.
The purpose of this study was to determine how resistance exercise affects blood pressure. There were 20 medicated women who participated in the study. They underwent an acute resistance exercise bout where blood pressure and heart rate were obtained at rest and for 60 minutes after the resistance exercise. The results of the study determined that resistance exercise is correlated with a significant decrease in systolic and diastolic blood pressure. In conclusion, blood pressure decreased with a single bout of resistance exercise is strongly related to chronic effects of resistance exercise training on blood pressure in medicated hypertensive elderly women.
Special Considerations/ Exercise Limitations/Medications:
1.) Babu, A. S., Padmakumar, R., Maiya, A. G., Mohapatra, A. K., & Kamath, R. (2016). Review: Effects of Exercise Training on Exercise Capacity in Pulmonary Arterial Hypertension: A Systematic Review of Clinical Trials. Heart, Lung And Circulation, 25333-341. doi:10.1016/j.hlc.2015.10.015
The purpose of this study was to determine whether exercise training is beneficial in increasing the quality of life for patients with pulmonary arterial hypertension (PAH). The authors gathered research on this topic, rated the previous studies using the Downs and Black Quality Index to ensure use of high quality articles, and extracted data from these articles to determine effects of exercise on PAH. The results concluded that exercise training in patients with pulmonary hypertension improves functional and exercise capacities. These improvements can also improve daily living in individuals with PAH and can be used in addition to medical treatments.
2.) Cornelissen, V.A., & Smart, N.A. (2013). Exercise training for blood pressure: a systematic review and meta-analysis. Journal of the American Heart Association.DOI:10.1161/JAHA.112.004473
The purpose of this study was to analyze exercise as a variable in the issue of blood pressure and hypertension. Cornelissen and Smart take note of a number of issues in consideration, including the role of ethnicity and gender in one’s susceptibility to hypertension and likeliness of undertaking important training exercises. There are, among others, related factors like access to healthcare and economic status of a group of people. All these factors act as limitations in the ability of an individual to avoid and deal with hypertension. In the end, however, the authors note that both national and international healthcare bodies recommend a change of lifestyle as a key factor for the prevention of hypertension, and also an important part of care. Exercise – among other factors, like eating habits – is an important constituent of lifestyle change.
3.) DiBona, G. (2013). Sympathetic Nervous System and Hypertension. Hypertension, 61, 556-560. http://dx.doi.org/10.1161/HYPERTENSIONAHA.111.00633
As hypertension and obesity become more common among populations, more studies are being completed on whether sympathetic activation is cause or a result of obesity. DiBona’s study focused on the effects of high fat diets and other obesity causing lifestyle choices on two separate groups of animals, dogs and rabbits. He reviewed the side effects and benefits of renal denervation, proving that denervation lowered blood pressure in 95% of his hypertensive, overweight population. The renal denervation not only lowered their overall resting blood pressure but also improved their quality of life through the revision of sleep apnea and other chronic diseases associated with hypertension.
4.) Gitt, A. K., Bramlage, P., Potthoff, S. A., Baumgart, P., Mahfoud, F., Buhck, H., & ... Schmieder, R. E. (2016). Azilsartan compared to ACE inhibitors in anti-hypertensive therapy: one-year outcomes of the observational EARLY registry. BMC Cardiovascular Disorders, 161-10. doi:10.1186/s12872-016-0222-6
The purpose of this study was to compare ACE inhibitors with Azilsartan medoxomil (AZL-M). AZL-M was chosen to study due to the lack of sufficient evidence in comparing it with ACE inhibitors in a clinical setting. The population included 3,849 individuals in Germany who suffered from arterial hypertension. The study was conducted through a randomized control clinical study. The results proved that the blood pressure target of systolic below 140 mmHg and diastolic below 90 mmhg was more easily achieved in the individuals who took AZL-M in comparison to those who took ACE inhibitors. In conclusion, the study found that when compared to ACE inhibitors, AZL-M provides statistically significant improvements in lowering blood pressure.
5.) Wiysonge, C., Bradley, H., Mayosi, B., Maroney, R., Mbewu, A., Opie, L., Volmink, J., (2012) Beta-blockers for Hypertension (Review). Issue 8. Art. No.: CD002003. DOI: 10.1002/14651858.CD002003.pub2.
The purpose of this study was to review the role of beta-blockers as first-line therapy for hypertension. This study consisted of 13 randomized controlled trials of 91,561 participants, in which the participants were given one of the following drugs: a beta-blocker, placebo, diuretic, calcium channel blockers or ACE inhibitors. The results found that beta-blockers had more side effects than any other treatment and more participants were more likely to discontinue the beta-blockers over other treatments like diuretics. Beta-blockers did not seem to make an impact on mortality as a first line defense when compared to beta-blockers. In conclusion, the authors have decided that the evidence found has beta blockers are not the best defense to mortality and morbidity compared to the other drugs in the study.