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Overview of Hypertension

Hypertension is characterized by an increase of systolic and/or diastolic blood pressure. The most common type of hypertension is termed primary or idiopathic. Secondary hypertension is associated with numerous diseases, disorders, and traumatic injuries. The National Institutes of Health define hypertension as systolic blood pressure of over 140 or diastolic pressure over 90 mm Hg. Prehypertension is defined as systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89 mm Hg.1 The most common source of hypertension is from narrowing of the arterioles, which is controlled by the sympathetic nervous system and the rennin-angiotensin system of the kidneys.

Obesity and sedentary lifestyles are major risk factors for developing hypertension. Clients with hypertension experience limited endurance from dyspnea and increased fatigue with activities. Hypertension is controlled by reducing risk factors and drug therapies. Vasodilators comprise a class of drugs that produce peripheral vasodilations, which reduces blood pressure. Beta blockers are drugs that diminish the heart rate response to activities and limit blood pressure and myocardial contractility. Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers reduce the peripheral vascular resistance, and diuretic drugs control the volume of blood.

Risk Factors for Hypertension Affected by an Exercise Program

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Reduced risk of obesity Decreased sedentary lifestyle behaviors
Reduced stress levels Better control of diabetes mellitus

Comorbidities to Consider

  • Hypertension affects multiple organs and increases the risk of atherosclerosis, which leads to damage of the heart and brain tissue.

Client Examination

Keys to Examination of Clients

  • Clients with hypertension should have their blood counts, blood glucose, serum levels of potassium, and cholesterol levels assessed regularly as well as having electrocardiograms.

  • Ask clients about the type and schedule of drug therapies they use for controlling hypertension.

  • Perform frequent monitoring of heart rate and blood pressure during and after exercise sessions.

Recommended Baseline Testing of Fitness Levels

  • Perform walking or cycle ergometer tests to assess aerobic capacity and exercise tolerance.

  • Assess extremity mobility and strength levels before prescribing resistive exercises.

Exercise Prescription


Type: Walking, running, cycling, weight training2,3,4,5

Intensity: Moderate intensity, starting at 40%-60% of maximum aerobic capacity2

Duration: 30 minutes

Frequency: Five times per week

Getting Started

Clients will need at least 10 minutes for warm-up and cool-down during their exercise session. Because different types of drugs are used to control hypertension, the increase in heart rate is not recommended as the sole determinant for measuring the intensity of exercises. Perceived exertion levels are best for grading exercise ...

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