Complex Exercise Intervention to Normalize Blood Pressure and Nocturnal Dipping in Patients With Hypertension

Prior treatment

• Patients with SBP \>180mmHg or DBP \>110mmHg - drug titration is not allowed during the 12-week program and these patients need early drug treatment
• Patient with DM - these patients will be arranged to have another EIM program especially designed for their DM.
  • Patients with active spinal cord compression or spinal radiculopathy because they may not be suitable to join some exercise
  • patients with atrial fibrillation are excluded because these patients have increased BP variability and may have different dipping behaviour
  • patients with metallic implants or pacemakers are excluded as they are not suitable for MRI

Other illness

• Patients with diagnosed chronic obstructive lung disease and recent stroke (within last 12 months) because other evidence-proven and well-structured programmes are implemented for these patients in the hospital authority in Hong Kong
• Patients on 3 or more medications for hypertension (on maximum tolerable doses) - these patients may have secondary HT and represent a different spectrum of organic diseases

Lab values

• To maximize safety of patients, patients who are relatively contraindicated according to AHA will also be excluded
  • acute myocardial infarction in last 6 months
  • ongoing angina
  • uncontrolled cardiac arrhythmia
  • acute diseases including known active endocarditis/acute pulmonary embolism, pulmonary infarction, deep vein thrombosis, acute aortic dissection, acute myocarditis
  • known aortic stenosis
  • known heart failure
  • known obstructive left main coronary artery stenosis
  • uncontrolled ventricular rates
  • complete heart block
  • known hypertrophic obstructive cardiomyopathy
  • mental impairment that limit co-operation
  • resting blood pressure with systolic blood pressure \>180mmHg or diastolic blood pressure \>110mmHg
  • known anemia with hemoglobin level less than 11gm/dL
  • known uncorrected electrolyte imbalance, and
  • known uncontrolled hyperthyroidism.

Other

• Occupational drivers - because they need to hold their arm still during ABPM and this may be hazardous for drivers
  • night-time workers
  • diagnosed Obstructive Sleep Apnea
• Patients on anti-coagulants - because ABPM may induce bruises

• SBP non-dippers
• self-reported exercise intensity and duration less than the World Health Organization recommendation, which is exercise of moderate intensity less than 150minutes/week OR exercise of vigorous intensity of less than 75 minutes/week
• Used any mobile apps on their phone (because the intervention involve use of apps to monitor and remind regular exercise)