Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland.
Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
Eur J Prev Cardiol. 2022 Feb 19;29(1):205-215. doi: 10.1093/eurjpc/zwaa141.
Treatment of hypertension and its complications remains a major ongoing health care challenge. Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of the population will have hypertension. Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality. Hence, current international guidelines on cardiovascular disease prevention provide generic advice to increase aerobic activity, but physiological responses differ with blood pressure (BP) level, and greater reductions in BP across a population may be achievable with more personalized advice. We performed a systematic review of meta-analyses to determine whether there was sufficient evidence for a scientific Consensus Document reporting how exercise prescription could be personalized for BP control. The document discusses the findings of 34 meta-analyses on BP-lowering effects of aerobic endurance training, dynamic resistance training as well as isometric resistance training in patients with hypertension, high-normal, and individuals with normal BP. As a main finding, there was sufficient evidence from the meta-review, based on the estimated range of exercise-induced BP reduction, the number of randomized controlled trials, and the quality score, to propose that type of exercise can be prescribed according to initial BP level, although considerable research gaps remain. Therefore, this evidence-based Consensus Document proposes further work to encourage and develop more frequent use of personalized exercise prescription to optimize lifestyle interventions for the prevention and treatment of hypertension.
治疗高血压及其并发症仍然是一个重大的持续的医疗保健挑战。欧洲大约 25%的心脏病发作已经归因于高血压，到 2025 年，多达 60%的人口将患有高血压。身体活动不足导致高血压的患病率上升，但进行锻炼或身体活动的患者可以降低中风、心肌梗死和心血管死亡率的风险。因此，目前关于心血管疾病预防的国际指南提供了一般性建议，以增加有氧运动，但生理反应因血压水平而异，更个性化的建议可能会使整个人群的血压降低幅度更大。我们对荟萃分析进行了系统评价，以确定是否有足够的证据来制定一份科学共识文件，报告如何针对血压控制来个性化制定运动处方。该文件讨论了 34 项荟萃分析的结果，这些分析涉及有氧运动、动态抗阻训练和等长抗阻训练对高血压、正常高值血压和正常血压患者的降压效果。作为主要发现，基于运动引起的血压降低幅度的估计范围、随机对照试验的数量和质量评分，荟萃评价有足够的证据表明，可以根据初始血压水平来规定运动类型，尽管仍存在相当大的研究空白。因此，这份基于证据的共识文件提出了进一步的工作，以鼓励和更多地使用个性化运动处方，优化生活方式干预，预防和治疗高血压。
