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Tai chi for htn
Tai Chi reduces BP in those with HTN
Meta-Analysis concluded Tai Chi reduces BP in those with HTN
Long-term Tai Chi practice lowers BP in those with HTN
Zhang Y, Han P, Yin N (2021) Am J Med Sci; 361(5):598-606.
Tai Chi and Qigong reduce BP and nitric oxide in those with HTN
meditation for htn
Meditation and Yoga reduce BP in those with HTN
Mindfulness Meditation reduces BP and stress in those with HTN
A meta-analysis concludes Meditation reduces BP in those with HTN
What do you do ?
WHAT DO YOU DO IF A PATIENT'S BLOOD PRESSURE IS ELEVATED?
- Remeasure on the opposite arm
- Has HTN been diagnosed and has medication been prescribed? Even if there is not a diagnosis or medication listed in the chart, ask the patient to confirm.
- How elevated are the readings? How does the current reading compare to the patient's typical BP readings?
- Are there any other signs/symptoms of HTN? If so, what are they? Ask the patient questions such, "Do you have a headache or blurred vision?" HOWEVER, bear in mind there may be NO symptoms because HTN is THE SILENT KILLER!
- Did the patient miss one or more doses of their medication? Ask the patient, "When do you take your last blood pressure pill?
- Have the correct medications been taken? Ask the patient, "What pill(s) did you take?"
- Is this measurement at rest or post exercise? Ask the patient: "How active have you been so far today?"
- If BP is greater than 160/100, notify the physician and do NOT engage the patient in physical therapy.
- If the patient's BP is very high (e.g., 180/120) then the patient will invariably have moderate or severe symptoms - call 911 and also notify the physician.
WHAT DO YOU DO IF A PATIENT'S BLOOD PRESSURE IS LOW?
- Remeasure on the opposite arm
- How much lower is it than 90/60? How does the current reading compare to their typical BP readings?
- Are there any other signs/symptoms of hypotension? If so, what are they? Ask the patient if s/he is feeling nauseous, confused, etc.
- Is the patient hydrated? Even partial dehydration can lower BP. Ask the patient: "What have had to drink today?"
- Did the patient double-dose his anti-HTN medications? For example, did he take both his new medication and the old one he was supposed to stop?
- In what position was the BP measured? In sitting? Just after sit to stand? Does the patient have a diagnosis of orthostatic hypotension?
- If BP is lower than 90/60, notify the physician, provide education to the patient, and - unless the reading is typical and safe for that particular patient - do not engage the patient in "active" physical therapy.
- If the patient's BP is very low (e.g., 80/50) then s/he will likely become lightheaded when they first stand up and may also e be experiencing severe symptoms. Call 911 and also notify the physician.
John is a 64-yr-old male referred to outpatient PT 2' lumbar pain due to herniated L4-5 disc. This is his 4th PT visit and the 1st time you are seeing him. There is no mention of HTN in the prior PT's notes, but in the referral you notice his comorbidities are HTN and obesity. In addition to a pain medication, he has also been prescribed hydrochlorothiazide (HCTZ).
- What questions do you ask John to determine in which stage of change he is in terms of his HTN?
- What questions do you ask John about his anti-HTN medications?
- What questions do you ask John about his diet? (his obesity is aggravating his herniated disc)
- Was it appropriate to have John engage in a "warm up?" Why or why not?
- What do you say and do after you have measured his BP while he is peddling on the bicycle ergometer?
- What other issues do you consider pertinent and what, if any, questions do you ask?
Patient self-report and Vitals
Vitals at rest: HR 85, respiration 20, BP 140/95, 02 sat 95% (While you are measuring his vitals, you notice a tobacco scent)
While peddling on the cycle ergometer as a "warm up," John stops and states "I'm more tired today. Let's just get to the easy part."
Vitals with exercise: HR 150, respiration 30, BP 160/100, 02 sat 93%.