[High blood pressure and physical exercise]

Underuse of lifestyle recommendations in hypertension management in France: The Esteban study

Lifestyle recommendations are first‐line elements in the management of arterial hypertension. This cross‐sectional study aimed to analyze the level to which lifestyle recommendations are used in hypertension management in France, using data from the Esteban study, which was implemented by Santé Publique France, France's public health agency, from 2014 to 2016 on a representative sample of the French population. The study sample comprised 440 adult Esteban participants who were aware they had hypertension and were aged 18–74 years old. The main outcomes were the proportion of participants who received lifestyle recommendations in their hypertension management plan, and the proportion of recommendations according to the three following dimensions: physical activity, weight loss, and changes in diet. Over half (57.0%) of the 440 participants declared they did not receive lifestyle recommendations as part of their hypertension management plan in the year preceding the study. Of these, 39.0% did not receive pharmacological treatment either. Physical activity was recommended to 31.8% of sedentary participants and weight loss to 26.8% of participants with overweight or obesity. One‐fifth of the study sample (20.1%) received dietary recommendations. Of these, 69% and 10.7% were advised to limit their salt and alcohol intake, respectively. Lifestyle interventions are too rarely recommended in hypertension management plans in France. Adherence to lifestyle recommendations needs in‐depth discussion not only at the time of diagnosis but also throughout follow‐up.

Combatting Sedentary Lifestyles: Can Exercise Prescription in the Emergency Department Lead to Behavioral Change in Patients?

Introduction

Emergency department (ED) patients with chronic disease are known to benefit from exercise; however, there are few studies examining the prescription of exercise in the ED. We asked, is exercise prescription in the ED feasible and effective?

Methods

In this pilot prospective block randomized trial, consented patients were divided into control and intervention groups. The control group received routine care. The intervention group received combined written and verbal prescriptions for moderate exercise of 150 minutes/week. Both groups were followed up by phone at two months. The primary outcome was achieving 150 minutes of exercise per week. Secondary outcomes included change in exercise and differences in reported median weekly exercise.

Results

Follow-up was completed for 23/28 patients (11 control; 12 intervention). Baseline reported median (with interquartile range) weekly exercise was similar between groups: control 0 (0-0) minutes, intervention 0 (0-45) minutes. There was no difference between groups for the primary outcome at two months (control 3/11; intervention 4/12, relative risk [RR] 1.33 (95% confidence interval [CI] 0.38-4.6; p=1.0). There was a significant increase in median exercise from baseline in both groups, but no difference between the groups (control 75 (10-225) minutes; intervention 120 (52.5-150) minutes; NS). A post hoc comparison of patients actually receiving intervention vs. no intervention revealed a significant increase in patients meeting the primary outcome (no intervention 0/8; intervention 7/15, RR 2.0 (95% CI 1.2-3.4); p=0.05).

Conclusion

The improvement seen in patients receiving the exercise prescription intervention, and the increase in reported exercise in both groups suggests that exercise prescription for ED patients may be beneficial.

Prevalence and factors associated with hypertension in Anonkoi 3, a peri-urban area in Abidjan (Côte d'Ivoire)

Hypertension affects more than a quarter of the world adult population, with ruralurban disparities. In Cote d'Ivoire, the prevalence was 21.7% in 2005. The aim of this study was to determine factors associated with hypertension in a peri-urban community in Abidjan. A cross-sectional study was conducted at Anonkoi 3 a peri-urban area in Abidjan. The sample was of 360 subjects aged 18 and older. Behavioral, anthropometric and blood pressure characteristics were determined using WHO STEPS questionnaire and multivariate logistic regression was performed. Prevalence of hypertension was 18.61%. Subjects were low fruit and vegetable consumption (3.3%), low level of physical activity (64.2%) and abdominal obesity at 40%. The risk of hypertension was significant from age 45, in subjects living with a partner and in those with low level of physical activity. Health education programs are essential to prevent cardiovascular risks.

[Physical activity level and home blood pressure measurement: Pilot study "Acti-HTA"]

While physical activity (PA) is recommended for high blood pressure management, the level of PA practice of hypertensive patients remains unclear. We aimed to assess the association between the level of both PA and blood pressure of individuals consulting in 9 hypertension specialist centres. Eighty-five hypertensive patients were included (59 ± 14 years, 61% men, 12% smokers, 29% with diabetes). Following their consultation, they performed home blood pressure measurement (HBPM) over 7 days (2 in the morning+2 in the evening), they wrote in a dedicated form their daily activities to estimate the additional caloric expenditure using Acti-MET device (built from International physical Activity Questionnaire [IPAQ]). Thus, patients completed a self-administered questionnaire "score of Dijon" (distinguishing active subjects with a score>20/30, from sedentary<10/30). Subjects with normal HBPM value (<135/85 mm Hg) (55% of them) compared to those with high HBPM were older, had a non-significant trend towards higher weekly caloric expenditure (4959 ± 5045 kcal/week vs. 4048 ± 4199 kcal/week, P=0.3755) and score of Dijon (19.44 ± 5.81 vs. 18.00 ± 4.32, P=0.2094) with a higher proportion of "active" subjects (48.9% vs. 34.2%, P=0.1773). In conclusion, our results demonstrate a "tendency" to a higher level of reported PA for subjects whose hypertension was controlled. This encourages us to continue with a study that would include more subjects, which would assess PA level using an objective method such as wearing an accelerometer sensor.

Relationship between blood pressure and physical performance

Background: Changes in blood pressure during subjects’ exercise are individually different. The reasons of these differences are unknown. Aim of the study: The aim of this paper is to investigate the rate of changes in cardiovascular system at rest and at physical load which enhance systolic blood pressure (SBP) = 200 mmHg in people with different physical performance. Material and methods: The studies included 18 soccer players and 14 students who do not practice any sport, whose age, body mass, body height and BMI have been similar, and who at baseline were measured systolic blood pressure (SBPr), diastolic blood pressure (DBPr) and heart rate (HRr). Then, the subjects performed exercise on a cycloergometer with increasing intensity in which at the level of the systolic blood pressure = 200 mm Hg (SBP200) were measured DBP200 and HR200. In terms of resting and exercise time the size of the mean arterial pressure (MAPr, MAP200), pulse pressure (PPr, PP200) and rate-pressure product (DPr, DP200) were calculated. Moreover the power achieved in PWC170 test (W and W/kg) and maximal oxygen uptake (VO2max) (ml/min and ml/min/kg) were also calculated. Results: Soccer players have reached a higher power in PWC170 and higher VO2max and lower HR200 and DP200 (p<0,001), as well as lower values of HRr (p<0,01) than students however SBP, DBP, MAP and PP registered during rest and during exercise did not differ between the groups. Among the players power reached at PWC170 (W) correlate negatively with DP200 – (p<0,05) and VO2max (ml/min; ml/min/kg) also correlated negatively with HRr (p<0,05, p<0,01). Among students power reached at PWC170 (W, W/kg) and VO2max (ml/min, ml/min/kg) correlate negatively with HR200 and DP200. Moreover VO2max (ml/min/kg) correlate negatively with HRr. Conclusions: Studies have shown that, despite differences in physical performance of both groups, there were no significant changes in blood pressure at rest or modified during exercise. However, at extremely high increase in SBP improved economization in function of the heart and circulatory system independent of the size of physical performance of the subjects were observed.