Calm Before the Storm?
Monday January 18, 2010
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High blood pressure is the No. 1 attributable risk factor for death in the world, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
It’s important to note that a primary change in the Seventh Report, released in 2003, is an updated classification of BP, prehypertension, says Dorian Rose, PT, PhD, research assistant professor, Department of Physical Therapy, University of Florida, Gainesville. “This ‘prehypertension’ is not a diagnosis, but a category to help us identify individuals who can benefit from intervention and perhaps avoid ever having the diagnosis of hypertension.”
The National Health and Nutrition Examination Survey indicates that at least 50 million Americans have high blood pressure warranting some form of treatment.
Essential Lifestyle
Essential hypertension is high blood pressure in which there is no known direct cause present, and accounts for 95% of cases, according to Rose. Although essential hypertension is frequently associated with risk factors such as obesity, lack of physical exercise, aging, race, and family history, it is largely attributable to lifestyle, which can be modified.
Physical therapy can, therefore, play a big role in managing risk factors. “We teach the importance of an active lifestyle, cardio activities three to five times a week, managing stress, no smoking, eating a reasonable diet,” says Abbey Jones, MPT, staff therapist at Banner Good Samaritan Medical Center, Phoenix, in the cardiovascular/cardiothoracic and neurosurgical ICUs. “Education of the patient and family includes teaching them the signs and symptoms of a problem, and the dangers of an unhealthy lifestyle.’”
Will Gibbs, MD, is medical director of the department of orthopedics and rehabilitation at New York Hospital Medical Center of Queens. “You can’t change risk factors such as your genetics, sex, or race,” he says. “But there are things you can modify, including obesity, salt intake, regular medical care, smoking, alcohol, and medications.”
High blood pressure is called the silent killer, Gibbs says. “Therapists need to be cognizant of patients who are coming to therapy for something unrelated but who have hypertension.”
Hypertensive Emergency
Hypertension is a comorbidity for many of the patients seen by Jones. “Physical therapy is usually called in to assess strength, mobility, tolerance, and safety awareness,” Jones says.
But hypertension may not be present as a relatively benign comorbidity — sometimes, BP can rapidly rise, leading to a hypertensive emergency, also known as a hypertensive crisis, which can result in irreversible organ damage, stroke, or heart attack. Patients and family members need to know symptoms to watch for that might signal another crisis, Rose says, including diastolic BP over 120 mmHg, anxiety, dyspnea, and severe headache.
Red flags include sweating, redness, altered mental status, headache, chest pain, shortness of breath, numbness or weakness, nausea, seizure, and blurred vision.
Close monitoring of vitals is still critical, though. “When a patient goes from supine to sitting, or from sitting to standing, we’re monitoring vitals,” Rose says. “If everything is clear and we ask them to walk 10 feet, we’re monitoring vitals. We also want the patient to clue in to symptoms, so in addition to monitoring, we are asking how they are feeling. ‘Are you dizzy? Do you feel nauseated? What is two plus two?’”
Peggy Brill, PT, OCS, of Brill Physical Therapy in Manhattan teaches post-crisis patients to gradually increase activity. “When they are exercising, they should be able to talk,” she says. “We build up capacity and endurance. We’ll get them doing something aerobic as soon as we can. In the beginning, walking the hall twice is aerobic. Do that twice a day for 10 minutes, then add five minutes each week until you can walk an hour. Then walk more vigorously. Your heart responds and develops more smooth muscle.”
Rose points out that some more strenuous forms of exercise such as jogging or running are not necessarily more effective in controlling BP. “Moderate activity can lower systolic BP by 4 to 8 mmHg,” Rose says. For those with essential hypertension, moderate-intensity exercise corresponding to 40 to 60 of VO2R maximizes benefits and minimizes possible adverse effects. This corresponds to approximately level 12 to 13 on the Borg RPE scale.
Motivational Pressure
Whether managing essential hypertension or recovering from a hypertensive emergency, patients need encouragement to exercise. “We encourage them to begin walking, and educate them on the Borg Rating of Perceived Exertion scale to monitor their intensity,” Rose says. Since most of these patients are on medications that affect their BP, this subjective scale can be vital in assessing the effects of activity.
“We educate patients and families on risks and benefits,” Jones says. “Life or death may be dramatic, but how about quality of life? ... The benefits of improving your cardiovascular system [are] that you can breathe easier and feel better.” •
Melissa Gaskill is a contributing writer for Today in PT.
It’s important to note that a primary change in the Seventh Report, released in 2003, is an updated classification of BP, prehypertension, says Dorian Rose, PT, PhD, research assistant professor, Department of Physical Therapy, University of Florida, Gainesville. “This ‘prehypertension’ is not a diagnosis, but a category to help us identify individuals who can benefit from intervention and perhaps avoid ever having the diagnosis of hypertension.”
The National Health and Nutrition Examination Survey indicates that at least 50 million Americans have high blood pressure warranting some form of treatment.
Essential Lifestyle
Essential hypertension is high blood pressure in which there is no known direct cause present, and accounts for 95% of cases, according to Rose. Although essential hypertension is frequently associated with risk factors such as obesity, lack of physical exercise, aging, race, and family history, it is largely attributable to lifestyle, which can be modified.
Physical therapy can, therefore, play a big role in managing risk factors. “We teach the importance of an active lifestyle, cardio activities three to five times a week, managing stress, no smoking, eating a reasonable diet,” says Abbey Jones, MPT, staff therapist at Banner Good Samaritan Medical Center, Phoenix, in the cardiovascular/cardiothoracic and neurosurgical ICUs. “Education of the patient and family includes teaching them the signs and symptoms of a problem, and the dangers of an unhealthy lifestyle.’”
Will Gibbs, MD, is medical director of the department of orthopedics and rehabilitation at New York Hospital Medical Center of Queens. “You can’t change risk factors such as your genetics, sex, or race,” he says. “But there are things you can modify, including obesity, salt intake, regular medical care, smoking, alcohol, and medications.”
High blood pressure is called the silent killer, Gibbs says. “Therapists need to be cognizant of patients who are coming to therapy for something unrelated but who have hypertension.”
Hypertensive Emergency
Hypertension is a comorbidity for many of the patients seen by Jones. “Physical therapy is usually called in to assess strength, mobility, tolerance, and safety awareness,” Jones says.
But hypertension may not be present as a relatively benign comorbidity — sometimes, BP can rapidly rise, leading to a hypertensive emergency, also known as a hypertensive crisis, which can result in irreversible organ damage, stroke, or heart attack. Patients and family members need to know symptoms to watch for that might signal another crisis, Rose says, including diastolic BP over 120 mmHg, anxiety, dyspnea, and severe headache.
Red flags include sweating, redness, altered mental status, headache, chest pain, shortness of breath, numbness or weakness, nausea, seizure, and blurred vision.
Close monitoring of vitals is still critical, though. “When a patient goes from supine to sitting, or from sitting to standing, we’re monitoring vitals,” Rose says. “If everything is clear and we ask them to walk 10 feet, we’re monitoring vitals. We also want the patient to clue in to symptoms, so in addition to monitoring, we are asking how they are feeling. ‘Are you dizzy? Do you feel nauseated? What is two plus two?’”
Peggy Brill, PT, OCS, of Brill Physical Therapy in Manhattan teaches post-crisis patients to gradually increase activity. “When they are exercising, they should be able to talk,” she says. “We build up capacity and endurance. We’ll get them doing something aerobic as soon as we can. In the beginning, walking the hall twice is aerobic. Do that twice a day for 10 minutes, then add five minutes each week until you can walk an hour. Then walk more vigorously. Your heart responds and develops more smooth muscle.”
Rose points out that some more strenuous forms of exercise such as jogging or running are not necessarily more effective in controlling BP. “Moderate activity can lower systolic BP by 4 to 8 mmHg,” Rose says. For those with essential hypertension, moderate-intensity exercise corresponding to 40 to 60 of VO2R maximizes benefits and minimizes possible adverse effects. This corresponds to approximately level 12 to 13 on the Borg RPE scale.
Motivational Pressure
Whether managing essential hypertension or recovering from a hypertensive emergency, patients need encouragement to exercise. “We encourage them to begin walking, and educate them on the Borg Rating of Perceived Exertion scale to monitor their intensity,” Rose says. Since most of these patients are on medications that affect their BP, this subjective scale can be vital in assessing the effects of activity.
“We educate patients and families on risks and benefits,” Jones says. “Life or death may be dramatic, but how about quality of life? ... The benefits of improving your cardiovascular system [are] that you can breathe easier and feel better.” •
Melissa Gaskill is a contributing writer for Today in PT.
To comment, e-mail pteditor@gannetthg.com.
Monday January 18, 2010