Physical exercise in hypertensive heart disease: From the differential diagnosis to the complementary role of
Maria Concetta Pastore1, Luna Cavigli1, Gabriele Olivoni1
1Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
Insights
Physical exercise is a key lifestyle modification for managing arterial hypertension (high blood pressure), aiding in prevention and treatment. Personalized exercise plans are crucial for both general patients and athletes with hypertension.
Area of Science:
- Cardiology
- Sports Medicine
- Hypertension Research
Background:
- Arterial hypertension (AH) is a prevalent condition and a major risk factor for cardiovascular disease and mortality.
- Chronic AH leads to detrimental cardiac and arterial remodeling, necessitating early and effective management.
- Physical exercise offers therapeutic benefits for AH by influencing sympathetic tone, the renin-angiotensin-aldosterone system, and endothelial function.
Purpose of the Study:
- To review the multifaceted relationship between hypertensive heart disease and physical exercise.
- To explore diagnostic tools, prevention, and treatment strategies for hypertension, emphasizing exercise's role.
- To address the specific challenges of managing hypertension in athletes, including risk stratification and differential diagnosis.
Main Methods:
- Literature review synthesizing current evidence on physical exercise and arterial hypertension.
- Analysis of the physiological mechanisms through which exercise impacts blood pressure regulation.
- Examination of diagnostic criteria and clinical considerations for differentiating hypertensive heart disease from athlete's heart.
Main Results:
- International guidelines recommend exercise as a primary lifestyle intervention for hypertension.
- Exercise can augment the effects of antihypertensive medications, leading to further blood pressure reduction.
- Accurate risk stratification and tailored exercise prescriptions are vital for athletes with AH.
Conclusions:
- Personalized exercise prescription is essential for optimizing hypertension prevention and treatment.
- Careful evaluation is required for athletes with uncontrolled hypertension to ensure safe participation in sports.
- Distinguishing between hypertensive heart disease and athlete's heart demands comprehensive clinical interpretation.
Abstract:
Arterial hypertension (AH) is one of the most common pathologic conditions and uncontrolled AH is a leading risk factor for cardiovascular disease and mortality. AH chronically causes myocardial and arterial remodelling with hemodynamic changes affecting the heart and other organs, with potentially irreversible consequences leading to poor outcomes. Therefore, a proper and early treatment of AH is crucial after the diagnosis. Beyond medical treatment, physical exercise also plays a therapeutic role in reducing blood pressure, given its potential effects on sympathetic tone, renin-angiotensin-aldosterone system, and endothelial function. International scientific societies recommend physical exercise among lifestyle modifications to treat AH in the first stages of the disease. Moreover, some studies have also shown its usefulness in addition to drugs to reduce blood pressure further. Therefore, an accurate, personalized exercise prescription is recommended to optimize the prevention and treatment of hypertension. On the other hand, uncontrolled AH in athletes requires proper risk stratification and careful evaluation to practice competitive sports safely. Moreover, the differential diagnosis between hypertensive heart disease and athlete's heart is sometimes challenging and requires a careful and comprehensive interpretation in order not to misinterpret the clinical findings. The present review aims to discuss the relationship between hypertensive heart disease and physical exercise, from diagnostic tools to prevention and treatment strategies.
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