STRESS MANAGEMENT OF HYPERTENSIVE PATIENTS BY PHYSIOTHERAPY

 Faiza Jabbar (Doctor of Physical Therapy, GCUF)

STRESS MANAGEMENT OF HYPERTENSIVE PATIENTS BY PHYSIOTHERAPY

ABSTRACT

Today, hypertension (HTN) is the most prevalent condition all over the world and becoming a threat to life as causing CVDs, Stroke, and death. High blood pressure is due to the loss of rigidity in blood vessels, caused by multiple factors based on primary or secondary hypertension. The objective of this review article is to determine the causes of hypertension, how stress causes hypertension, and the management of stress through non-pharmacological therapy. I use different search engines; Google Scholar, Pub Med, and Science direct to review this article. It focuses on the role of physical therapy in the management of stress such as meditation therapy and relaxation techniques besides the use of drugs to control hypertensive crisis.

Keywords: hypertension, causes, stress-induced hypertension, stress rehabilitation, yoga, massage therapy, relaxation techniques, exercise & hypertension.

INTRODUCTION

➢ HYPERTENSION: Blood pressure (BP) is the lateral pressure exerted on the wall of elastic arteries and it is essential for the distribution of blood to metabolic tissues in need of oxygen and nutrient. Elevated BP or hypertension (BP equal to or above 140/90) is often considered a silent killer and is a risk factor for cardiac, neuronal, and renal damage. (Getu, 2020).

➢ GLOBAL EPIDEMIOLOGY OF HYPERTENSION

Hypertension increases the mortality rate as it causes ischemic heart attack and renal failure. Although, it remains clinically undiagnosed until complications arise. Worldwide, it affects 40 % of adults over the age of 25 years and it is the global leading risk factor for death and disability. (Leung et al., 2017).

With the use of antihypertensive drugs (diuretics, ACE inhibitors, and beta-blockers) global mean blood pressure remain constant or decrease over the past four decades. But the prevalence of hypertension is high in low and middle-income countries, variation in the level of risk factors for hypertension such as high sodium intake, low potassium intake, obesity, alcoholic consumption, physical inactivity, and unhealthy diet may explain the regional diversity of prevalence of hypertension. (Mills et al., 2020).

Fig.1. Everything you need to know about hypertension- (MNT) Medical News Today Felman, A. (2019).

➢ CLINICAL FEATURES OF HYPERTENSION

Usually, the symptoms and findings as the result of hypertension include headache, dizziness, nausea or vomiting, disturbed vision, irritability, hyperactivity, facial nerve palsy, convulsions, changes in the state of consciousness, personality change, anxiety, tachycardia, frequent sweating, dyspnea, polyuria, polydipsia, weakness, and weight loss. (Gruskin, 1974).

The presence of arterial hypertension has a drastic effect on mental health. There is an association between hypertension and depressive symptoms, but it varies depending on the time since diagnosis. (Villarreal‐Zegarra & Bernabe‐Ortiz, 2020).

Fig.2. Clinical guidelines for High Blood Pressure- AASM (American Academy of Sleep Medicine) Theffron (2020).

➢ CAUSES OF HYPERTENSION

Primary hypertension also is known as essential hypertension is caused by some risk factors including; smoking, being overweight, lack of physical activity, high salt intake, alcoholic consumption, older age, genetics, and stress.

Secondary hypertension is due to some organic diseases as follows;

Renal

Endocrine

Vascular system

Metabolic

Neurologic

Drug-Related

Miscellaneous (Li, 2020).

Fig.3. Mohammed et al., (2020). Etiology of Hypertension and its Association with Obesity in the Pediatric Population.

➢ STRESS AND HYPERTENSION

Stress is defined as an unclean variable, which can major likely to cause high blood pressure. Stress as emotional stress, psychological stress, sociocultural stress, and occupational stress are contributing to complications of hypertension.

In fight or flight response, the sympathetic nervous system activates mostly observed in acute psychogenic stress which is responsible for the elevation in the blood pressure associated with increased heart rate and visceral vasoconstriction that exceeds muscular vasodilation which in turn causes high cardiac output (Shapiro, 1979).

• Genetic and Environmental factors concerning Stress-Induced Hypertension

It is considered as the genes and environmental factors underlying the physiological systems mediating stress response of heart, vasculature, and kidney including (sympathetic nervous system,

the renin-angiotensin-aldosterone system, sodium reabsorption, and endothelial system) increases the vulnerability to stress and leads to hypertension (Imumorin et al., 2005).

➢ STRESS MANAGEMENT

✓ YOGA Therapy

✓ Massage Therapy

✓ Relaxation Techniques

✓ Exercise Therapy

1. YOGA Therapy 

Yoga is a general term that encompasses controlled breathing, physical posture, strengthening exercises, and meditation. (Li & Goldsmith, 2012). • YOGA as a therapeutic intervention Although yoga is historically a spiritual discipline, it has also been used clinically as a therapeutic intervention. Types of medical conditions have included psychological diseases (e.g. depression, anxiety), cardiovascular diseases (e.g. hypertension, heart disease), respiratory disorders (e.g. asthma), diabetes, and a variety of other diseases are treated by yoga therapy. (Khalsa, 2007). • Steps of Yoga The following are the eight steps or limbs of yoga: Yama- (Codes of restraint, abstinences, self -regulation), Niyama-(self-training, Observances, practices), Asana-(Posture of meditation), Pranayama- (breath and prana expansion, regulation, control), Pratyahara-(Withdrawal of the senses, bringing inward), Dharana-(Concentration), Dhyana-(Meditation), Samadhi-(Deep absorption, meditation in its higher state, the state of perfected concentration). (Kapatel, 2020).

• Role of Yoga or Meditation in Stress Management

Antihypertensive drugs have side effects and are expensive. Noncompliance with medication is very common among hypertensive patients due to various reasons. Antihypertensive drugs alone cannot control blood pressure. Physical and mental relaxation is very important for maintaining blood

pressure. (Indian express bureau, 2004). Savasana (yoga) therapy relaxes the body and facilitates normal blood circulation without obstruction and it is one of the important techniques to control blood pressure. (Srivastava, 2007).

Fig.4.Yoga for Stress management in adults- Slide Serve, Uriel (2014).

2. Massage Therapy

Though drug therapy remains the mainstay of HTN management, several non- pharmacologic lifestyle modifications have been shown to help delay the onset of HTN in those with mildly elevated BP, as well as augmenting effects of drug therapy. Besides massage, multiple other supporting therapies, including acupuncture, yoga, meditation, and Tai Chi, among several others, have been reported to lower BP in those with hypertension and prehypertension. Indeed, some types of massage therapy (trigger point therapy and sports massage) may even raise BP compared with others (Swedish massage). (Krinock et al., 2020).

3. Relaxation Techniques

As hypertension is a chief complaint, so it is important to manage stress either by pharmacological or physical therapy. There are several relaxation techniques in managing stress include: Broota

relaxation technique (yoga exercises combined with autosuggestion), Jacobson's progressive relaxation technique (a muscle relaxation technique), Shavasana (passive relaxation with a yogic posture), helps to reduce the symptoms of hypertension. (Broota et al., 1995).

4. Exercise Therapy

• Role of Exercise Therapy in managing hypertension and CVDs

According to the study, Dr. Mark Tarnopolsky, MD, Ph.D. stated that “a person can slow the speed at which they age by exercising regularly.” It is widely accepted that regular physical activity is beneficial for cardiovascular health. Frequent exercise is associated with a decrease in cardiovascular mortality as well as the risk of developing cardiovascular disease. Physically active individuals have lower blood pressure, low risk of diabetes, and normal body weight. Physical exercises include; Endurance training, Resistance training, and Isometric exercises that can be used for lowering blood pressure. Even though moderate levels of exercise are more helpful in reducing the risk of cardiovascular diseases, it is suggested that continued high levels of exercise (e.g., marathon running) could have harmful effects on cardiovascular health. (Paffenbarger et al., 2018).

• Life Style Modifications

Change your sedentary lifestyle to active for cardiac health. Diet must contain fibers and avoid bad cholesterol. Diet with low sodium intake, moderation in alcohol consumption, tobacco cessation, and regular physical activity to maintain normal body weight are universally recommended in all patients with hypertension.

LIMITATIONS

There is a significant research-practice gap for understanding and influencing the role of exercise for patients with hypertension. This review provides recommendations for future research and consensus-based recommendations that promote exercise as a principle therapy for patients with hypertension.

CONCLUSIONS

Hypertension is a silent killer. Cardiopulmonary physiotherapy is an integral part of health service. Evidence supports that exercise is a keystone for hypertension control, then why it is not being utilized? This is the time, physiotherapists must emerge and show their potential to beat primary disorders like hypertension, where even pharmacological management fails.

ACKNOWLEDGMENTS

Special thanks to our respected Dr. Amna Khalid (Research officer at GCUF), Sir M. Ahsan ul Haq (Researcher), and concepts of science academy.

AUTHOR’S DETAIL

Faiza Jabbar (DPT)

College of Physical Therapy, GCUF.

Reviewed & Edited by

Dr. Saima Jabbar.

M.Phil scholar, University of Lahore.

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