Kruk Piotr J, Nowicki Michał
1Community-Based Health Center in Rząśnia,Rząśnia,Poland.
2Department of Nephrology, Hypertension and Kidney Transplantation,Medical University of Lodz,Lodz,Poland.
Prim Health Care Res Dev. 2018 Nov;19(6):575-583. doi: 10.1017/S1463423618000154. Epub 2018 Mar 22.
Regular physical activity is widely recommended for patients with arterial hypertension as an essential component of lifestyle modification. Much less is known about the impact of physical exercise on the management of treatment of resistant hypertension (RH). The aim was to assess the effect of physical activity program intensified by mobile phone text reminders on blood pressure control in subjects with RH managed in the primary care.
In total, 53 patients with primary hypertension were qualified, including 27 who met the criteria for RH and 26 with well-controlled hypertension (WCH). Ambulatory 24-h blood pressure was monitored and body composition evaluated with bioimpedance and habitual physical activity profile was determined continuously over 72 h with accelerometer. All measurements were performed at baseline and after three and six months. The patients were asked to modify their lifestyle according to American Heart Association Guidelines that included regular aerobic physical activity tailored to individual needs.FindingsPhysical activity in RH increased significantly after six months compared with control subjects (P=0.001). Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the RH group decreased significantly after three months but after six months only office DBP remained significantly lower. After three months 24-h SBP decreased by 3.1±11 mmHg (P=0.08) and DBP by 2.0±6 mmHg (P=0.17) in RH, whereas in WCH respective changes were +1.2±10 and -0.3±6 mmHg. After six months 24-h BP changes were similar.
Individualized structured physical activity program increases physical activity in the treatment of resistant hypertensives in primary care but the effect on 24-h blood pressure is only transient.
对于动脉高血压患者，常规体育活动作为生活方式改变的重要组成部分被广泛推荐。关于体育锻炼对顽固性高血压（RH）治疗管理的影响，人们了解得要少得多。目的是评估通过手机短信提醒强化的体育活动计划对基层医疗中管理的RH患者血压控制的效果。
总共纳入53例原发性高血压患者，其中27例符合RH标准，26例血压控制良好（WCH）。监测动态24小时血压，用生物阻抗评估身体成分，并使用加速度计连续72小时测定习惯性身体活动情况。所有测量均在基线、3个月和6个月后进行。要求患者根据美国心脏协会指南改变生活方式，其中包括根据个人需求进行定期有氧运动。
与对照组相比，RH患者在6个月后身体活动显著增加（P = 0.001）。RH组的诊室收缩压（SBP）和舒张压（DBP）在3个月后显著下降，但6个月后仅诊室DBP仍显著较低。3个月后，RH患者的24小时SBP下降3.1±11 mmHg（P = 0.08），DBP下降2.0±6 mmHg（P = 0.17），而WCH患者的相应变化分别为+1.2±10和-0.3±6 mmHg。6个月后24小时血压变化相似。
个体化结构化体育活动计划可增加基层医疗中顽固性高血压患者治疗期间的身体活动，但对24小时血压的影响只是短暂的。
