|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 154-155
It is high time to incorporate exercise therapy as an adjunct to drug therapy in the management of hypertension
Daha Garba Muhammad
Department of Physiotherapy, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
|Date of Submission||09-Aug-2020|
|Date of Acceptance||24-Sep-2020|
|Date of Web Publication||13-Nov-2021|
Dr. Daha Garba Muhammad
Department of Physiotherapy, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Muhammad DG. It is high time to incorporate exercise therapy as an adjunct to drug therapy in the management of hypertension. Nig J Cardiol 2020;17:154-5
|How to cite this URL:|
Muhammad DG. It is high time to incorporate exercise therapy as an adjunct to drug therapy in the management of hypertension. Nig J Cardiol [serial online] 2020 [cited 2022 May 23];17:154-5. Available from: https://www.nigjcardiol.org/text.asp?2020/17/2/154/330424
I have read a review entitled “Therapeutic exercise for hypertension: An update for exercise prescribers” by Muhammad M, Nuhu JM, Hassan TM, Baba SS, Radda MI, Mutawakkil MM, et al. published in your journal (2020;17:11-20). I would like to thank them and say job well done for this very wonderful review not only for exercise prescribers but for drug prescribers as well and to also make my contributions.
This review if translated into clinical practice will help improve the level of blood pressure control among hypertensive patients in Nigeria as it was shown that blood pressure control was only adequate in 29% of these patients in Nigeria, despite the high adherence level of 77.5% to the drug therapy. Factors contributing to poor blood pressure control include diabetes, female gender, and taking more than three tablets in adequate doses per day. Exercise as an effective means if incorporated into the treatment of hypertensive patients will not only reduce uncontrolled hypertension but also may reduce the number of tablets taken per day and make patients physically active that will prevent them from other cardiovascular diseases with less or no side effect and cost, as cited by Maruf et al. This can be achieved by patient's education or sensitization on the role of exercise in blood pressure control because majority of the patients have poor knowledge and poor practice to exercise, with only few having a positive attitude toward exercise.
The review has also highlighted the effect of different classes of antihypertensive drugs during exercises. Therefore, if exercise is to be used as an adjunct in the management of hypertensive patient, the drug prescriber should consider drug effect on exercise hemodynamics and thermoregulation to guide in choosing an appropriate class because different classes have different effect as suggested by Arita et al. in order to achieve the desired effect.
The long-term hypertensive effect of exercise as shown by the review is linked to the adherence level to the exercise, as such the prescribed exercise should be motivating to the individual in order to maintain good adherence level. Maruf et al. suggested dance as the aerobic exercise to achieve this purpose because dancing is considered a hobby by some people. However, considering the northern part of Nigeria where some people see dancing as a taboo it may not be practicable as such the use of stationary bicycle ergometer, treadmill walking, and their likes may be considered as they offer equal freedom to both genders because walking in the environment may not be practicable to female gender in the said setting and no cultural norms is violated.
Risk assessment should be well considered before the commencement of exercise to determine patients that need monitoring during exercise in order to avoid exercise-exaggerated blood pressure which antihypertensive medications do not have effect on it, which may do more harm than benefit. Blood pressure of 220 and above systolic or 105 and above diastolic during exercise is not normal, as such immediate cessation of exercise is advised. Likewise, it is unsafe to participate in an exercise program with blood pressure as high as 220 systolic or 105 and above diastolic preexercise.
It is high time to include exercise as an adjunct in the management of hypertensive patients to maximize the success of drug therapy. taking into consideration the level of evidence that exist for the inclusion as indicated by this review of Muhammad et al. The risk assessment and utilization of frequency, intensity, type, and time principle should also be considered prior to prescribing the exercise to individual patients.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Yusuff KB, Balogun O. Physicians' prescribing of anti-hypertensive combinations in a tertiary care setting in Southwestern Nigeria. J Pharm Pharm Sci 2005;8:235-42.
Maruf FA, Akinpelu AO, Salako BL. Effects of aerobic exercise and drug therapy on blood pressure and antihypertensive drugs: A randomized controlled trial. Afr Health Sci 2013;13:1-9.
Awotidebe TO, Adedoyin RA, Rasaq WA, Adeyeye VO, Mbada CE, Akinola OT, et al
. Knowledge, attitude and practice of exercise for blood pressure control: A cross sectional Survey. J Exerc Sci Physiother 2014;10:1-10.
Muhammad M, Nuhu JM, Hassan TM, Baba SS, Radda MI, Mutawakkil MM, et al
. Therapeutic exercise for hypertension: An update for exercise prescribers. Nig J Cardiol 2020;17:11-20. [Full text]
Miyai N, Arita M, Miyashita K, Morioka I, Shiraishi T, Nishio I, et al
. Antihypertensive effects of aerobic exercise in middle-aged normotensive men with exaggerated blood pressure response to exercise. Hypertens Res 2002;25:507-14.
Chant B, Bakali M, Hinton T, Burchell AE, Nightingale AK, Paton JF, et al
. Antihypertensive treatment fails to control blood pressure during exercise. Hypertension 2018;72:102-9.