Ciclo de charlas: Envejecimiento activo y salud de las personas mayores. Tercer Encuentro. La hipertensión en el adulto mayor

En este encuentro, el doctor Walter Espeche, jefe de Sala y de la Unidad Cardiometabólica del Hospital San Martín de la ciudad de La Plata y vice presidente segundo de SAHA, desarrollará diversos aspectos referidos a la Hipertensión Arterial (HA) en el adulto mayor. Como introducción, el profesional aborda cuestiones tales como la importancia de la HA, su prevalencia en Argentina, situación epidemiológica, factores de riesgo, prevalencia de la HA de acuerdo al sexo y edad en la ciudad de La Plata. Más adelante, explicará los siguientes ítems: Hipertensión en el adulto mayor ¿Debo tratar la HTA? ¿Metas de presión? ¿Qué fármacos son los más apropiados? Reducción del riesgo. Tipos de tratamiento. Por último, se analizan problemáticas como: Preocupaciones para bajar la presión en adulto mayor (Curva J, Fragilidad, Hipotensión ortostática, Caídas, Deterioro cognitivo, Corta expectativa de vida) Herramienta simplificada para el screening de fragilidad (FRAIL). Mortalidad en ancianos frágiles institucionalizados. Riesgo de fractura de cadera al inicio del tratamiento antihipertensivo. Poblaciones Especiales: Hipertensión arterial en adultos muy mayores. Principios generales del tratamiento farmacológico. Fármacos con mayor evidencia para el tratamiento de adultos mayores y muy mayores. Conclusiones.

Myocardial work and left ventricular mechanical adaptations following isometric exercise training in hypertensive patients.

PURPOSE: Hypertension is a major risk factor for cardiovascular disease. Isometric exercise training (IET) reduces resting and ambulatory blood pressure; however, few studies have investigated the myocardial adaptations following IET. METHODS: We randomly assigned 24 unmedicated hypertensive patients in a cross-over study design to 4-weeks of IET and control period, separated by a 3-week washout period. Speckle tracking echocardiography was used to measure left ventricular (LV) mechanics, and global myocardial work indices were derived from non-invasive LV pressure-strain loops constructed from global longitudinal strain (GLS) indexed to brachial systolic blood pressure. RESULTS: IET significantly improved GLS (- 2.3 ± 2%, p < 0.001) and global work efficiency (2.8 ± 2%, p < 0.001), and significantly reduced global wasted work (- 42.5 ± 30 mmHg%, p < 0.001) with no significant change during the control period. CONCLUSIONS: This is the first evidence to demonstrate that IET significantly improved cardiac health in a relevant patient population. Our findings have important clinical implications for patients with high blood pressure and support the role of IET as a safe and viable therapeutic and preventative intervention in the treatment of hypertension.

Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension: A Randomized Clinical Trial.

Importance: Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy. Objective: To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension. Design, Settings, and Participants: The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals' hypertension outpatient clinic. Interventions: Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care. Main Outcomes and Measures: The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness. Results: A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, -12.8 to -1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (-5.1 mm Hg; 95% CI, -7.9 to -2.3; P = .001), daytime systolic BP (-8.4 mm Hg; 95% CI, -14.3 to -2.5; P = .006), and daytime diastolic BP (-5.7 mm Hg; 95% CI, -9.0 to -2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (-10.0 mm Hg; 95% CI, -17.6 to -2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group. Conclusions and Relevance: A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population. Trial Registration: ClinicalTrials.gov Identifier: NCT03090529.

Effects of combined training performed two or four times per week on 24-h blood pressure, glycosylated hemoglobin and other health-related outcomes in aging individuals with hypertension: Rationale and study protocol of a randomized clinical trial.

BACKGROUND: Acute blood pressure lowering after exercise seems to predict the extent of blood pressure reduction after chronic exercise training interventions. Based on that, the same weekly amount of exercise performed more frequently could be more beneficial for controlling blood pressure. PURPOSE: To compare the effects of a combined training program (resistance plus aerobic exercise) performed four or two times per week on 24-h ambulatory blood pressure and other health-related outcomes in middle-aged and older individuals with hypertension. METHODS: This study will be a randomized, parallel group, two-arm, superiority trial. Ninety-eight participants aged 50-80 years with a previous physician diagnosis of hypertension will be randomized to perform two or four sessions per week of combined training using the same total weekly overload. Primary outcomes will be 24-h ambulatory blood pressure and glycosylated hemoglobin; secondary outcomes will be endothelial function, physical fitness and quality of life. The outcomes will be assessed at baseline and at the end of 12 weeks period. RESULTS: Our conceptual hypothesis is that a combined exercise program performed four or two times per week with equalized weekly volume/overload will improve all outcomes in comparison to the baseline values, and that reductions in 24-h blood pressure and glycosylated hemoglobin will be more pronounced in the group that trained four times a week than twice. The results of this trial are expected to provide evidences to support that higher weekly frequency of combined training should be emphasized in aging adults with hypertension.

Effects of short-term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients.

We compared the effects of 2-month CPAP or exercise training (ET) therapies on the autonomic balance in moderate to severe obstructive sleep apnea (OSA) through heart rate variability (HRV) analysis. Thirty-nine OSA patients were divided into CPAP (n = 18) and ET (n = 21) groups, being further split into hypertensive and non-hypertensive subgroups. All patients were submitted to continuous ECG recordings for HRV analysis. Hemodynamic parameters were recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. ET decreased systolic arterial pressure in hypertensive and non-hypertensive participants when compared to baseline values, whereas diastolic arterial pressure was decreased only in non-hypertensive ones. CPAP had no effect over hemodynamic parameters in either subgroup. ET significantly increased the HRV parameters SDNN and pNN50 in non-hypertensive participants, while reducing the LF/HF ratio in both subgroups. CPAP significantly decreased SDNN in both subgroups. ET significantly decreased excessive daytime sleepiness in both subgroups, but did not affect sleep quality. CPAP significantly improved sleep quality in both subgroups, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients. In conclusion, while short-term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short-term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non-hypertensive OSA patients.

Eficacia ejercicio basado en el hogar usando una aplicación móvil para mejorar las funciones cognitivas en pacientes con hipertensión: un sencillo diseño experimental / Home based-exercise using mobile application to improve cognitive functions in patients with hypertension: a quesy experimental design

OBJETIVO: El propósito de este estudio fue determinar el efecto del ejercicio en el hogar utilizando una aplicación móvil para mejorar las funciones cognitivas en pacientes con hipertensión. MÉTODOS: Este estudio se realizó utilizando un sencillo diseño experimental con un grupo de prueba previa y posterior en un centro de salud pública ubicado en Java Occidental, Indonesia, de febrero a julio de 2019. Un programa de ejercicios basado en dispositivos móviles era una actividad de caminar en casa todos los días durante un mes. La muestra en el estudio se seleccionó mediante muestreo de conveniencia para adultos mayores de 18 años y diagnosticados con hipertensión. La Evaluación Cognitiva de Montreal (MoCA) se utilizó para medir la función cognitiva. Una prueba t pareada utilizada para analizar datos con el nivel de significancia se estableció en 0.05. RESULTADOS: Un total de 120 participantes se inscribieron en este estudio. La edad media de la muestra fue de 56.42 ± 10.6 años, 70 (58.3%) eran hombres, 61 (50.8%) tenían un nivel educativo más bajo y 77 (64.2%) estaban desempleados. La puntuación media de MoCA mostró una mejoría después de la intervención, de 23.3 ± 3.42 a 26.7 ± 2.78, p = 0.010. Más detalladamente, hubo mejoría después de la intervención en el dominio de nomenclatura (2.930.34 vs. 3.141.06, p = 0.003), atención (2.39 ± 0.68 vs. 3.12 ± 1.04, p = 0.001) y abstracción (1.56 ± 0.49 vs. 2.01 ± 0.89, p = 0.043). CONCLUSIÓN: El uso de una aplicación de ejercicio móvil fue efectivo, fácil de hacer con bajo costo para mejorar la función cognitiva y prevenir la demencia en pacientes hipertensos

EFFECTIVENESS MAIN GOAL: The purpose of this study was to determine the effect of home based-exercise using mobile application to improve cognitive functions in patients with hypertension. METHODS: This study was conducted using a queasy experimental with one group pre-post test design at a public health center located in West Java, Indonesia on February to July 2019. A mobile-based exercise program was a walking activity at home every day for one month. The sample in the study was selected using convenience sampling to adults aged above 18 years old and diagnosed with hypertension. The Montreal Cognitive Assessment (MoCA) was used to measure cognitive function. A paired t-test used to analyze data with the significance level was set at 0.05. RESULTS: A total of 120 participants were enrolled in this study. The mean age of the sample was 56.42 ± 10.6 years old, 70 (58.3%) were male, 61 (50.8%) had lower education level, and 77 (64.2%) were unemployed. The mean score of MoCA showed improved after intervention, from 23.3 ± 3.42 to 26.7 ± 2.78, p = 0.010. In more detail, there were improvement after intervention in domain of naming (2.930.34 vs. 3.141.06, p = 0.003), attention (2.39 ± 0.68 vs. 3.12 ± 1.04, p = 0.001), and abstraction (1.56 ± 0.49 vs. 2.01 ± 0.89, p = 0.043). CONCLUSION: Using a mobile-exercise App was effective, easy to do with low cost to improve cognitive function and prevent dementia in hypertensive patients

Short-Term Effect of Self-Selected Training Intensity on Ambulatory Blood Pressure in Hypertensive Older Women: A Randomized Controlled Trial.

PURPOSE: To investigate the short-term effect of self-selected training intensity (SSTI) on ambulatory blood pressure (BP) in hypertensive older women. PARTICIPANTS AND METHODS: This is a randomized, single-blind, two-arm, parallel-group controlled trial that included 40 medicated hypertensive older women (64.4±3.6 years; resting systolic 118±19 and diastolic BP 68±9 mmHg). SSTI intervention was performed three times per week, 30-50 minutes per session (n=20). The control group participated in health education meetings once per week (n=20). Ambulatory BP (primary outcome) and six-minute walking test performance (secondary outcome) were assessed at baseline and following 8 weeks of intervention. Heart rate (HR), rating of perceived exertion (RPE, 6-20), and affective valence (ie, feeling scale, -5/+5) were recorded during all SSTI sessions. Intention-to-treat and per-protocol analyses were used for data analyses. RESULTS: Fifteen participants from the SSTI group and 17 from the control group completed the study. No differences in ambulatory BP (24-h, awake, and asleep) were observed between SSTI and control groups (intention-to-treat and per-protocol analyses; p>0.05). The SSTI group showed a greater six-minute walking test performance than the control group in the intention-to-treat and per-protocol analyses (p<0.05). The participants exercised at 52±10% of HR reserve reported an RPE of 11±1 and an affective valence of 3.4±1.1 over the 8-week period. CONCLUSION: SSTI is a feasible approach to induce a more active lifestyle and increase health-related fitness in hypertensive older women, although it does not improve BP control over a short-term period.

Efecto de distintos programas de ejercicio aplicados a hombres con hipertensión. Una revisión sistemática / Effect of different exercise programs applied to men with hypertension. A systematic review

La hipertensión arterial es de gran interés por su alta prevalencia a nivel mundial, posibles complicaciones a la salud y muertes asociadas a esta enfermedad. El ejercicio físico regular resulta elemental como parte del tratamiento para su prevención y control; sin embargo, existe controversia respecto cual es el mejor programa en función de tipo, frecuencia, tiempo e intensidad. Por lo que el objetivo del presente trabajo fue analizar la efectividad de distintos programas de ejercicio aplicados en hombres con hipertensión. Los resultados encontrados en las bases de datos: EBSCO, SCOPUS, SCIELO, Web of Science y Pub-med, fueron diez. Concluyendo que distintas modalidades de ejercicio muestran beneficios sobre la presión arterial, tomando en cuenta: intensidad > 65% de la frecuencia cardíaca de reserva, mínimo tres sesiones por semana de entre 30 a 45 minutos con ejercicios aerobios y de fuerza, sin embargo es interesante continuar evaluando el efecto de las modalidades

High blood pressure is of great interest due to its high prevalence worldwide, due health complications and deaths associated with this disease. Regular physical exercise is elementary as part of the treatment for prevention and control; However, there is controversy regarding whish one the best program based on type, frequency, time and intensity. Therefore, the objective of this work was to analyze the effectiveness of different exercise programs applied in men with hypertension. The results found in the databases: EBSCO, SCOPUS, SCIELO, Web of Science and Pub-med, were ten. Concluding that different exercise modalities show benefits on blood pressure, taking into account: intensity> 65% of the reserved heart rate, minimum three sessions per week between 30 to 45 minutes with aerobic and strength exercises, however it is interesting to continue evaluating the effect of the modalities

Hemodynamic Effects of a Multidisciplinary Geriatric Rehabilitation Program.

BACKGROUND: Geriatric rehabilitation programs primarily aim at an increase of mobility and functional autonomy of the elderly. The cardiovascular effects of these programs, however, remain elusive. Since regular physical exercise is associated with numerous beneficial cardiovascular effects including a reduction of blood pressure (BP), the present prospective study investigates the hemodynamic effects of a representative standardized rehabilitation program. METHODS: A total of 74 subjects who were hospitalized in a German university hospital for geriatric rehabilitation were enrolled in the study. Peripheral BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were assessed at admission and before discharge from the hospital. The program contained 4-5 sessions of physical activity of individualized intensity per week (≥30 min/session, eg, walking, cycling, stair rising). RESULTS: The mean age of the study population was 82.4±6.9 years; all patients suffered from arterial hypertension (stage 2-3) with a median number of three antihypertensive drugs. The most frequent cause for admission was injurious falls. The mean duration of the rehabilitation program was 17 days and comprised at least 20 physical activity sessions including occupational therapy. The program led to a significant improvement of mobility (Timed Up & Go 29.5±18.5 vs 19.1 ±9.3 s, p<0.001) and Barthel index of activities of daily living score (46.6±19.1 vs 69.8±16.5, p<0.001). Peripheral systolic BP decreased from 135.4±19.0 mmHg at baseline to 129.0±18.4 mmHg at follow-up (p=0.03), whereas peripheral diastolic BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were not significantly altered (p>0.05 each). CONCLUSION: The present representative standardized geriatric rehabilitation program was able to improve mobility, which showed a mild effect on systolic BP but did not affect 24h-ambulatory BP.

[Blood flow restriction training for people with cardiovascular disease: An exploratory review]. / Entrenamiento con restricción parcial de flujo sanguíneo en personas con enfermedades cardiovasculares: una revisión exploratoria.

OBJECTIVE: To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS: Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION: There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.

Ejercicio físico en pacientes con riesgo cardiovascular: aproximación a la situación desde la farmacia comunitaria / Physical exercise in patients with cardiovascular risk: Approximation to the situation from the Community Pharmacy

INTRODUCCIÓN: el ejercicio físico (EF) es uno de los determinantes de la salud y debe formar parte del tratamiento de pacientes con riesgo cardiovascular. OBJETIVOS: evidenciar el grado de información respecto al EF de pacientes con riesgo cardiovascular (RCV) y de profesionales sanitarios que les atienden. Averiguar si se les ha realizado prescripción de EF. Promover el EF. MATERIAL Y MÉTODOS: estudio descriptivo, observacional y transversal sobre 40 pacientes, a través de una entrevista con hoja de recogida de datos y cuestionario. También se pasa cuestionario a profesionales sanitarios del centro de salud que les atienden. RESULTADOS: el 35 % de pacientes cumple recomendaciones de la Organización Mundial de la Salud (OMS) respecto al EF y 95 % cree que el EF mejoraría sus problemas de salud. La falta de ganas es el motivo principal para no hacer más EF (38,46 %). El 90 % dice no haber recibido prescripción de EF indicando tipo, frecuencia, duración e intensidad. El 78 % de profesionales sanitarios (n = 9) afirma prescribir EF, 55 % dice especificar tipo, frecuencia, duración e intensidad.55 % ve necesaria más formación .89 % piensa que el EF actúa como un medicamento. El 65,4 % de pacientes y 100 % de sanitarios creen que el farmacéutico podría ayudar con la motivación y el seguimiento de un plan de EF. CONCLUSIONES: nuestros pacientes parecen más sensibilizados con el EF que la población general y casi todos saben que es beneficioso para su salud. Les falta motivación para realizar más EF. La inmensa mayoría no ha recibido prescripción de EF aunque los sanitarios afirman hacerlo, sugiriendo discordancia entre conceptos. Falta tiempo y formación en este campo para que tanto la prescripción como el seguimiento de EF sea una realidad

INTRODUCTION: Physical exercise is one of the determinants of health and that should also be part of the treatments of patients with cardiovascular risk. OBJECTIVES: Show degree of information regarding physical exercise of patients with cardiovascular risk and health professionals who attend them. Find out if they have been prescribed physical exercise. Promote EF. MATERIAL AND METHODS: Descriptive, observational and cross-sectional study on 40 patients, through an interview with data collection sheet and questionnaire. Other questionnaire is also passed to health professionals of the health center who attend them. RESULTS: 35% of patients comply with WHO recommendations regarding physical exercise, 95% believe that physical exercise would improve their health problems. Lack of desire is the main reason for not doing more physical exercise (38.46%).90% say they have not received physical exercise prescription indicating type, frequency, duration and intensity .78% of health professionals (n = 9) claim to prescribe physical exercise, 55% say they specify type, frequency, duration and intensity .55% see more training necessary .89% think that physical exercise acts as a medicine.65.4% of patients and 100% of health professional believe that the pharmacist could help with the motivation and follow-up of a physical exercise plan. CONCLUSIONS: Our patients seem more sensitized to physical exercise than the general population and almost everyone knows that it is beneficial for their health. They need more motivation to do more physical exercise. The vast majority have not received a prescription for physical exercise although the health professionals say they do so, suggesting disagreement between concepts. Lack of time and training in this field make the prescription and the follow-up of physical exercise not a reality. DISCUSSION: Citizens know that air pollution affects their health, although they do not receive enough information. The systems used by the administration are not effective and that postulates the community pharmacy as an agent of interest for the distribution of the required information

Effects of Concurrent Training with Elastic Tubes in Hypertensive Patients: A Blind Controlled Randomized Clinical Trial.

BACKGROUND: Concurrent training (CT) has been recommended to minimize the deleterious effects of aging. However, few studies have investigated whether this type of training reduces blood pressure in the elderly. Therefore, our objective was to evaluate the effects of CT on the hemodynamic, cardiorespiratory, and muscle strength responses in medicated hypertensive patients. METHODS: Twenty-three hypertensives (62.65 ± 6.4 years) of both sexes were allocated to the concurrent training group (CTG) or control group (CG). The CTG performed aerobic training (70-85% of reserve heart rate) combined with resistance training with elastic tubes (2sets × 15 repetitions) for 8 weeks. Resting blood pressure (BP), peak oxygen consumption (VO2peak), and right knee and elbow flexion strength were evaluated. RESULTS: A reduction of 6.37% was observed in BP and increases of 16.68% in VO2peak and 16% in muscle strength for right elbow flexion in the CTG compared to CG (p < .05). Intragroup comparisons showed reduction of 5% for BP, and increases of 6.79% for VO2peak, 24.79% for elbow flexion, and 16.47% for knee flexion in the CTG (p < .05), without significant improvement in the CG. CONCLUSION: CT promoted a reduction in BP, and increased cardiorespiratory fitness and muscular strength of the upper limbs in the hypertensive older adults.

Patient-level Predictors of Extent of Exposure to a Community Health Worker Intervention in a Randomized Controlled Trial.

Objective: Community health worker (CHW) interventions have been cited as a best practice for reducing health disparities, but patient-level attributes may contribute to differential uptake. We examined patient characteristics associated with the extent of exposure to a CHW coaching intervention among a predominantly low-income, African American population participating in a randomized controlled trial of hypertension interventions. Design: We conducted a within-group longitudinal analysis of those receiving a CHW intervention from a study conducted between September 2003 and August 2005. We employed mixed effects models to ascertain relationships between patients' characteristics, length of time spent with the CHW, and the number of topics discussed during the intervention. Setting: Baltimore, MD. Participants: 140 patients with a diagnosis of hypertension in the CHW intervention arm. Results: Marital status, stress, depression symptomology, and having multiple comorbid conditions were each independently and positively related to the length of time patients spent with CHWs. An indirect relationship between higher perceived physical health and time spent with the CHW was observed. Patients with multiple comorbid conditions discussed more intervention-related topics, while patients who perceived themselves as being healthier discussed fewer topics. Marital status and extreme poverty were the strongest predictors of the length of time spent with the CHW, while having multiple comorbid conditions was the strongest predictor of the number of coaching topics discussed. Conclusions: Differential exposure to a CHW intervention is influenced by patients' physical, psychosocial, and sociodemographic characteristics.

Effect of telerehabilitation on long-term adherence to yoga as an antihypertensive lifestyle intervention: Results of a randomized controlled trial.

BACKGROUND: and purpose: We aimed to investigate the adherence to yoga as an antihypertensive intervention through telerehabilitation. MATERIALS AND METHODS: In a randomized controlled trial patients were consecutively enrolled and randomly assigned to intervention or control group. Both groups received standardized yoga training during three weeks of inpatient rehabilitation. The intervention group received telerehabilitation after discharge; the control group received the usual care. Data was collected at admission (t1), discharge (t2) and at follow up after six (t3) and 12 months (t4). The primary endpoint was follow-up adherence assessed in an intention-to-treat analysis. RESULTS: 228 male rehabilitation patients (mean age 53.3 ±â€¯5.8 years, mean blood pressure 139.5 ±â€¯10.2/ 86.7 ±â€¯8.0 mmHg) The intervention resulted in significantly increased adherence compared to control group (t3: 40.0% vs. 19.5%, p = 0.001; t4: 36.5% vs. 23.9%, p = 0.038); blood pressure and quality of life improved. CONCLUSION: Telerehabilitation significantly improves yoga adherence maintaining achieved health benefits in the long term.

A Systematically Assembled Signature of Genes to be Deep-Sequenced for Their Associations with the Blood Pressure Response to Exercise.

:Background: Exercise is one of the best nonpharmacologic therapies to treat hypertension. The blood pressure (BP) response to exercise is heritable. Yet, the genetic basis for the antihypertensive effects of exercise remains elusive. Methods: To assemble a prioritized gene signature, we performed a systematic review with a series of Boolean searches in PubMed (including Medline) from earliest coverage. The inclusion criteria were human genes in major BP regulatory pathways reported to be associated with: (1) the BP response to exercise; (2) hypertension in genome-wide association studies (GWAS); (3) the BP response to pharmacotherapy; (4a) physical activity and/or obesity in GWAS; and (4b) BP, physical activity, and/or obesity in non-GWAS. Included GWAS reports disclosed the statistically significant thresholds used for multiple testing. Results: The search yielded 1422 reports. Of these, 57 trials qualified from which we extracted 11 genes under criteria 1, 18 genes under criteria 2, 28 genes under criteria 3, 27 genes under criteria 4a, and 29 genes under criteria 4b. We also included 41 genes identified from our previous work. Conclusions: Deep-sequencing the exons of this systematically assembled signature of genes represents a cost and time efficient approach to investigate the genomic basis for the antihypertensive effects of exercise.

The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVES: Management of hypertension in chronic kidney disease (CKD) remains a major challenge. We conducted a systematic review to assess whether exercise is an effective strategy for lowering blood pressure in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We searched MEDLINE, EMBASE, the Cochrane Library, CINAHL and Web of Science for randomized controlled trials (RCTs) that examined the effect of exercise on blood pressure in adults with non-dialysis CKD, stages 3-5. Outcomes were non-ambulatory systolic blood pressure (primary), other blood pressure parameters, 24-hour ambulatory blood pressure, pulse-wave velocity, and flow-mediated dilatation. Results were summarized using random effects models. RESULTS: Twelve studies with 505 participants were included. Ten trials (335 participants) reporting non-ambulatory systolic blood pressure were meta-analysed. All included studies were a high risk of bias. Using the last available time point, exercise was not associated with an effect on systolic blood pressure (mean difference, MD -4.33 mmHg, 95% confidence interval, CI -9.04, 0.38). The MD after 12-16 and 24-26 weeks of exercise was significant (-4.93 mmHg, 95% CI -8.83, -1.03 and -10.94 mmHg, 95% CI -15.83, -6.05, respectively) but not at 48-52 weeks (1.07 mmHg, 95% CI -6.62, 8.77). Overall, exercise did not have an effect on 24-hour ambulatory blood pressure (-5.40 mmHg, 95% CI -12.67, 1.87) or after 48-52 weeks (-7.50 mmHg 95% CI -20.21, 5.21) while an effect was seen at 24 weeks (-18.00 mmHg, 95% CI -29.92, -6.08). Exercise did not have a significant effect on measures of arterial stiffness or endothelial function. CONCLUSION: Limited evidence from shorter term studies suggests that exercise is a potential strategy to lower blood pressure in CKD. However, to recommend exercise for blood pressure control in this population, high quality, longer term studies specifically designed to evaluate hypertension are needed.

Short-Duration High-Intensity Interval Exercise Training Is More Effective Than Long Duration for Blood Pressure and Arterial Stiffness But Not for Inflammatory Markers and Lipid Profiles in Patients With Stage 1 Hypertension.

PURPOSE: The present study compared the effects of 2 different high-intensity interval training (HIIT) protocols on arterial stiffness, lipid profiles, and inflammatory markers in hypertensive patients. METHODS: Thirty hypertensive (stage 1) patients, aged 48.0 ± 3.2 yr, were randomly allocated to the short-duration HIIT (SDHIIT, n = 10), long-duration HIIT (LDHIIT, n = 10), and control (n = 10) groups. After a 2-wk preparatory phase of continuous mild training, patients in the SDHIIT group performed 8 wk of HIIT including 27 repetitions of 30-sec activity at 80% to 100% of (Equation is included in full-text article.)O2peak interspersed with 30-sec passive/active (10%-20% of (Equation is included in full-text article.)O2peak) recovery. Patients in the LDHIIT group performed 8 wk of HIIT, 32 min/session including 4 repetitions of 4-min activity at 75% to 90% of (Equation is included in full-text article.)O2peak interspersed with 4-min passive/active (15%-30% of (Equation is included in full-text article.)O2peak) recovery. Blood pressure (BP), pulse wave velocity (PWV), inflammatory markers, and lipid profiles were measured before and after training. RESULTS: Significant (P < .05) reductions in systolic blood pressure and PWV were found following 2 training protocols, though, only the changes in PWV following the SDHIIT were significantly different than those in the LDHIIT and control groups. Interleukin-6 and triglycerides decreased and interleukin-10 increased significantly (P < .01) following both HIIT programs, whereas the differences between the 2 training protocols were not statistically significant. C-reactive protein and lipids did not change significantly following HIIT. CONCLUSIONS: Performing HIIT improves systolic blood pressure and inflammatory markers in patients with stage 1 hypertension irrespective of the HIIT intensity and duration, and PWV improvement is intensity related.

Supporting self-management for people with hypertension: a meta-review of quantitative and qualitative systematic reviews.

OBJECTIVES: Globally, healthcare policy promotes supported self-management as a strategy for people with long-term conditions. This meta-review aimed to explore how people with hypertension make sense of their condition, to assess the effectiveness of supported self-management in hypertension, and to identify effective components of support. METHODS: From a search of eight databases (January 1993-October 2012; update June 2017) we included systematic syntheses of qualitative studies of patients' experiences, and systematic reviews of randomized controlled trials evaluating the impact of supported self-management on blood pressure and medication adherence. We used meta-ethnography, meta-Forest plots and narrative analysis to synthesise the data. RESULTS: Six qualitative and 29 quantitative reviews provided data from 98 and 446 unique studies, respectively. Self-management support consistently reduced SBP (by between 2 and 6 mmHg), and DBP (by between 1 and 5 mmHg). Information about hypertension and treatment, home BP monitoring (HBPM) and feedback (including telehealth) were widely used in effective interventions. Patients' perceptions of a disease with multiple symptoms contrasted with the professional view of an asymptomatic condition. HBPM, in the context of a supportive patient-professional relationship, changed perceptions of the significance of symptoms and fostered confidence in ability to self-manage hypertension. CONCLUSION: Our systematic qualitative and quantitative meta-reviews tell complementary stories. Supported self-management can improve blood pressure control. Interventions are complex and encompass a broad range of support strategies. HBPM (with or without telehealth) within the context of a supportive patient-professional partnership can bridge the gap between medical and lay perspectives of hypertension and enable effective self-management.

Prescription of physical activity in the management of high blood pressure in Australian general practices.

This study investigated the prevalence of physical activity prescriptions in the management of high blood pressure (BP), the characteristics of people given these, and whether prescriptions were associated with the physical activity beliefs and practices of patients. A retrospective cohort study was undertaken, involving 365 general practitioners (GPs) from across Australia. The records of up to 20 patients per GP with high BP (N = 6512) were audited to identify physical activity and pharmacological prescriptions over four consecutive consultations. A sub-sample (n = 535) of patients completed a physical activity questionnaire. Physical activity prescriptions were recorded for 42.6% of patients with controlled BP, 39.5% for those with mild hypertension and 35.7% of those with moderate to severe hypertension. These were more likely in patients with cardiovascular disease (OR 1.41, 95% CI 1.23-1.62) and diabetes (OR 1.21, 95% CI 1.04-1.42), and less likely in those with moderate to severe hypertension (OR 0.80, 95% CI 0.69-0.94), aged 75 years and over (OR 0.62, 95% CI 0.51-0.74) and with high cholesterol (OR 0.73, 95% CI 0.57-0.94). Patients receiving a physical activity prescription were more likely to report this behaviour as important for their health and that they had increased their levels of participation. Most patients with high BP are not receiving physical activity prescriptions, and GPs show greater readiness to address this behaviour in patients with existing chronic disease. There is a need for efficacious and practical strategies for promoting physical activity that can be adopted in the routine management of high BP in general practice.