【高血壓英文課件】Positive-Risk-Factors-for-CHD

CasestudyMr.Wongisa48-yearoldmale,salesrepresentativewhotravelsoften170cm,84kg,BMI29HisbrotherjustsufferedfromMIatage40.ConcernedabouthishealthWanttodostartexerciseandloseweightCasestudyMr.Wongisa48-yea1EvaluationClassifyclientaccordingtoRiskStratificationCriteriaACSM/ACP/ACCVPR/AHAIdentifyMajorCoronaryArteryDiseaseRiskFactorsIdentifysignsorsymptomssuggestiveofcardiopulmonarydiseaseIdentifysecondaryriskfactorsObesity,alcoholconsumption,stresslevelsEvaluationClassifyclientacco2CaseStudyRecentlydiagnosedtohavetype2DM,putonDaonilBP160/90mmHgonmetoprolol50mgbdHalfpackadaysmokinghabitduetostressofhisjobHisbrotherjustsufferedfromMIatage40.Cholesterollevel:6.2mmol/l,HDL0.90mmol/l,LDL3.8mmol/lTG:2.4mmol/lNoregularexerciseNosignsorsymptomsofcardiopulmonarydiseaseCaseStudyRecentlydiagnosedt3【高血壓英文課件】Positive-Risk-Factors-for-CHD4【高血壓英文課件】Positive-Risk-Factors-for-CHD5InitialRiskStratificationLowriskMen<45yearsofageandwomen<55yearsofageYoungerindividualswhoareasymptomaticandmeetnomorethanoneriskfactorthresholdModerateriskOlderindividuals(men45yearsofage;women55yearsofage)orthosewhomeetthethresholdfortwoormoreriskfactorsHighRiskIndividualswithoneormoresigns/symptomsorknowncardiovascular,pulmonary,ormetabolicdiseaseInitialRiskStratificationLow6Whatrecommendationsinreferencetomedicalexaminationandtestingpriortoparticipationinanexerciseprogram?A.MedicalexaminationandexercisetestingB.PhysicianSupervisionofexercisetestWhatrecommendationsinrefere7Considerthefollowingcriteriaduringyourevaluation:AgeandgenderModerateVsvigorousexerciseprogramPhysicianpresentduringtestingSubmaximalormaximalgradedexercisetestTypeoftest(treadmill,legergometer,step)AbsoluteandrelativecontraindicationstoexercisetestingConsiderthefollowingcriteri8ACSMRecommendationsfor:Pre-participationscreeningAlgorithmACSMRecommendationsfor:Pre-9ACSMRecommendationsfor:Pre-participationscreeningAlgorithmcont’ACSMRecommendationsfor:Pre-10CardiovascularSystemAssessment Agradedexercisetestmaybehelpfulifapatient,abouttoembarkonamoderatetohigh-intensityphysicalactivityprogram,isathighriskforunderlyingcardiovasculardisease,basedononeofthefollowingcriteria:Age>40years,+/-CVDriskfactorsAge>30yearsandType1or2diabetesof>10years'durationPresenceofanyadditionalriskfactorforcoronaryarterydiseasePresenceofmicrovasculardisease(proliferativeretinopathyornephropathy,includingmicroalbuminuria)PeripheralvasculardiseaseAutonomicneuropathyCardiovascularSystemAssessme11MedicationsMedications12Aconstellationofcardiovascularriskfactorsrelatedtohypertension,abdominalobesity,dyslipidemia,andinsulinresistanceCertaindrugsusedtotreathypertensionmayacceleratetheappearanceofnew-onsetdiabetes.Inparticular,bothβblockersanddiureticshavebeenimplicatedinthiseffect.MetabolicSyndromeAconstellationofcardiovascu13ALLHATInhighriskhypertensivepatients,thediuretic,chlorthalidone,was43%morelikelythantheACEI,lisinopril,toproducediabetes,butwasalso18%morelikelythanthecalciumchannelblocker,amlodipine,toproducethisadverseeffect.HOPEThedevelopmentofnewdiabeteswasreducedby34%(p<0.001)intheramipril-treatedgroup.LIFE(LosartanInterventionForEndpointReductioninHypertension)TheARB,losartan,wasassociatedwitha25%relativeriskreductioninnew-onsetdiabeteswhencomparedwiththeβblocker,atenololVALUE

(TheValsartanAntihypertensiveLong-termUseEvaluation)Valsartan,wasassociatedwith23%RRRinnew-onsetdiabeteswhencomparedwiththecalciumchannelblocker,amlodipine.【高血壓英文課件】Positive-Risk-Factors-for-CHD14ARB/ACEImayhavepositiveeffectsoninsulinactionandpotentiallyplaysameaningfulroleinprotectinghigh-riskhypertensivepatientsfromdevelopingdiabetes.ARB/ACEImayhavepositiveef15MedicationsMetoprololchangedtoACEinhibitors/ARBMetforminStatinMedicationsMetoprololchanged16ExercisestresstestMETSachieved:8.5Peakheartrate:165beatsperminutePeakbloodpressureof200/88mmHg.NoexerciseinducedischemiaExercisestresstestMETSachie17QuestionsPleasewriteaninitialexerciseprescriptionAnyadjustmentsandpracticaltipsinpatientswithDMandHT?QuestionsPleasewriteaniniti18ExerciseprescriptionAddresseachofthefollowingAerobicenduranceStrengthtrainingFlexibilityIncludeeachofthefollowinginyourprescription frequency times/day,days/week Intesnisy 5HRR,%VO2max,%HRmax,%1RM,%MVC,etc Duration warm-up,cool-down,exercisecomponent,restbetweensets,etc Modeofexercise typesofexerciise,stretchingtechniques,resistancetraining,etc Rateofprogression

ExerciseprescriptionAddresse19ACSMandCDCRecommendationAmericanCollegeofSportsMedicine(ACSM)andCentersforDiseaseControlandPrevention(CDC),1995(Pateetal.,1995)Recommendation:Everyadultshouldengageinmoderate-intensityphysicalactivityfor30minutesorlongeronmost,preferablyall,daysoftheweek.Moderateintensityisdefinedas40to60%ofmaximaloxygenconsumption(VO2max).The30-minuteactivitycanalsoconsistofshorterexercisebouts(minimumof10minutes)thatareaccumulatedthroughouttheday(e.g.,walkingtowork,shopping).FinnishMedicalSocietyDuodecim.Physicalactivityintheprevention,treatmentandrehabilitationofdiseases.2004Apr20ACSMandCDCRecommendationAme20ACSMRecommendationforHypertension40-70%ofVO2max,i.e.55-80%ofthemaximalheartrate.Thelowerrangeofintensityissufficientfortheelderly.3or4timesweeklyforatleast30minutesatatimeVariousenduranceexercisemodesaresuitable.Resistancetraining(preferablycircuittraining)shouldnotbetheonlyformofexercisebutshouldbecombinedwithendurancetraining.Trainingatanintensityofabout50%ofthemaximalexerciseperformance(moderate-intensity)issufficientwithregardtorestingbloodpressurereduction(Fagard,2001).FinnishMedicalSocietyDuodecim.Physicalactivityintheprevention,treatmentandrehabilitationofdiseases.2004Apr20ACSMRecommendationforHypert21RehabilitationinCoronaryHeartDisease

Mainlyendurancetraining

atanintensityof50(-60)-75%ofsymptom-limitedVO2max(orheartratereserve,whichisthedifferencebetweenmaximalandrestingheartrate)for30minutes3-4timesweekly(minimum),fullbenefitisobtainedwith5-6times/weekResistancetraininginadditionatanintensityof30-50%(upto60-80%)of1RM(onerepetitionmaximum),12-15repetitions,1-3setstwiceweeklyRehabilitationinCoronaryHea22RecommendationsforPatientsWithType2Diabetes Exerciseprogram:

Type:AerobicIntensity:50-70%ofmaximumaerobiccapacityDuration:20-60minutesFrequency:3-5timesperweekAvoidcomplicationsWarmupandcooldownCarefulselectionofexercisetypeandintensityPatienteducationMonitoringofbloodglucosebypatientandoverallprogrambymedicalpersonnel

PhysicalActivity/ExerciseandDiabetes;Diabetescare,vol.27,supplement1,January2004RecommendationsforPatientsW23RecommendationsforPatientsWithType2Diabetes3. Compliance:MakeexerciseenjoyableConvenientlocationPositivefeedbackfrominvolvedmedicalpersonnelandfamilyPhysicalActivity/ExerciseandDiabetes;Diabetescare,vol.27,supplement1,January2004RecommendationsforPatientsW24..25HypertensionMonit