The Evidence for Lifestyle Modification in Lowering Blood Pressure in the Elderly

Exercise as medicine: Role in the management of primary hypertension

Primary hypertension affects ∼1 in 5 Canadians and significantly increases the risk of myocardial infarction, stroke, heart failure, and early mortality. Guidelines for the management of hypertension recommend lifestyle modifications (e.g., increased physical activity, smoking cessation, moderate alcohol consumption, improved dietary choices) as the frontline strategy to prevent and manage high blood pressure (BP). In particular, acute and chronic aerobic exercise has consistently been shown to reduce resting and ambulatory BP, with the largest effects in hypertensive patients. Current guidelines recommend 30–60 min of moderate- to vigorous-intensity aerobic exercise 4–7 days per week, in addition to activities of daily living. The role of resistance training in the management of hypertension is less clear, although available data suggests resistance exercise can be performed safely without risk of increasing BP or adverse events. Presently, resistance exercise (8–10 exercises, 1–2 set(s) of 10–15 repetitions, 2–3 days/week) is advocated only as an adjunct exercise modality. Patients desiring to begin an exercise program should complete the Physical Activity Readiness Questionnaire (PAR-Q or PAR-Q+) or as required, the Electronic Physical Activity Readiness Medical Examination (ePARmed-X) or Physician Clearance Form in consultation with their clinician and (or) trained exercise professional. A greater emphasis on utilizing exercise as medicine will produce positive nonpharmacologic benefits for hypertensive patients and improve overall cardiovascular risk profiles.

Self-blood-pressure monitoring--a questionnaire study: response, requirement, training, support-group popularity and recommendations

The objective of this study was to survey hypertensive patients' response to, requirement for and training in self-blood pressure monitoring (SBPM). A total of 222 hypertensives were invited to complete a questionnaire even when not participating in the project. Questions supplied information on demographics, monitoring frequency, convenience of attending the surgery, monitor ownership and preference for and ease of self-monitoring. Comments supplied qualitative data. Training group questionnaires supplied similar data as well as SBPM data before and after training. Of 133 respondents, a higher educated, younger, wider age range wanted to participate (76; 57.2%) and tended to self-monitor. However, only an increase in further education (FE) was associated with an increased probability of participation and inclination to self-monitor in the multivariate analyses. A positive relationship exists between age and frequency in both groups. About a sixth of respondents own monitors and ownership is correlated to FE. Although most patients found it convenient to visit the surgery, the percentage finding it convenient was lower in patients attending training sessions than in the original survey, possibly indicating that independence is important for SBPM. Younger, higher-educated patients tended to self-monitor although FE was again the significant factor. Training increased preference for the idea of SBPM, prospective monitor ownership (64.8% of non-owners) and self-monitoring intention (76.1%). Patients found recording card listed cardiovascular disease (CVD) risks valuable and 69.6% (32) wanted to establish a support group. Comments and interviews indicated haphazard knowledge, routines and uncertainty about SBPM. A standardised procedure including patient assessment, SBPM protocol and lifestyle education is needed for SBPM to be successful.