| ORIGINAL
PAPERSBio-computational
solutions for identification, correction and prophylaxis of
cardiovascular risk factors II Taina
Avramescu
University of Craiova
Bio-computational
solutions for identification, correction and prophylaxis of
cardiovascular risk factors I - click!
Abstract.
Athletes
are
usually thought to be free of
cardiovascular disease and hypertension because of their apparently
high level of fitness. Indeed, the overall prevalence of high blood
pressure in these groups is approximately 50 percent lower than in
the general population.However, the risk of
hypertension
is increased in some athletes and physically active patients,
including blacks, the elderly, persons who are obese, and those with
diabetes, renal disease, or a family history of hypertension.
Athletes who have systemic hypertension may be at risk for
complications when exercise causes their bloodpressures
to rise even higher. Almost 80 percent of adolescents found to have a
blood pressure above 142/92 mm Hg during a presports-participation
physical examination eventually develop chronically elevated blood
pressure. All athletes and physically active patients should be
screened for hypertension. If the condition is diagnosed, appropriate
treatment should be started to reduce the risk of morbidity and
mortality associated with cardiovascular disease. A thorough
understanding of the pathophysiology of the condition, especially as
it relates to the effects of exercise, can help physicians recommend
the most effective pharmacological and nonpharmacological therapies.
Skillful management of blood pressure can help hypertensive patients
continue to exercise and compete safely, while guarding against the
development of long-term complications. Key
words: physical exercise, cardiovascular disease,
high blood
pressure. The
repartition of the cases related to subjects’ number, age,
type of
the practised sports and the level of performance was the following:
Football:-
seniors 80 sportsmen, male, middle age 25,2 years, 19 cases with
cardiovascular pathology (affecting), 9 cases with pre HTA, 6 cases
with HTA grade I.- juniors 40
sportsmen, male, middle age 14,3 years, 12 cases with
cardiovascular pathology, 10 cases with pre HTA, 2 cases with HTA
grade I.
Handball:
-
seniors 20 sportsmen, male, middle age 27,8 years, 6 cases with
cardiovascular pathology, 5 cases with pre HTA, one case with HTA
grade I.- juniors 25
sportsmen, male, middle age 12,4 years, 8 cases with
cardiovascular pathology, 5 cases with pre HTA.
Boxing:
-
seniors 20 sportsmen, male, middle age 24,5years, 7 cases with
cardiovascular pathology, 5 cases with pre HTA, 2 cases with HTA
grade I.
Tennis:
-
juniors 25
sportsmen, 10 males, 15 females, middle age 11,1 years, 6
cases with cardiovascular pathology, 4 cases with pre HTA.
Volleyball:
-
seniors 28 sportsmen, male, middle age 23,5 years, 5 cases with
cardiovascular pathology, 3 cases with pre HTA.- juniors 40
sportsmen, 20 males, 20 females, middle age 14,3 years, 8
cases with cardiovascular pathology, 4 cases with pre HTA.
Semifond athletics
(athletics long distance race):- juniors 25
sportsmen, 7 males, 18 females, middle age 14,3 years, 4
cases with cardiovascular pathology, 2 cases with pre HTA.
The
incidence of preHTA and HTA in our studied lot is shown in the
following table (table3). We
noticed that the maximum incidence of preHTA and HTA at seniors was
registered for boxing and handball (35%), and the minimum incidence
for volleyball (14,3%). For juniors the high blood pressure was
maximum for football (in football case) (30%) and minimum for
semifond athletics(athletics long distance race) (8%) and volleyball
(7,5%). Also
it must be remarked that for volleyball, tennis and athletics lots
were registered only cases of pre HTA
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Table
3. The repartition of the pre HTA and HTA cases
related to
subjects’ number, age, type of the practised sports and
level of performance
| Sports
| Level
| Nr.
sub |
Middle
age
| Sex
| Nr. cases
pre
HTA
| Incidence
specific
lot
| Nr. cases
HTA/
stage
| Incidence
specific lot | Another
cardiovascular
affections/nr. cases |
| Football
| seniors
| 80
| 25,2
| M
| 9
| 11,2%
| 5/ std. 1
1
std.1-2
| 7,5%
| Physiological
BRDI grade I - 6 cases.
Physiological
systolic breath – 4 cases.
EKG
repolarization disorders – 5 cases.
Hyperkinetic
syndrome - 2 cases. |
| juniors
| 40
| 14,3
| M
| 10
| 25%
| 2/
std. 1 |
5%
| Extrasystolic
supraventriculare arrhythmia; spasmophilia-1 case.
ESV
arrhythmia; apexian systolic breath grade I/II -1 case.
Innocent
BRDI -4 cases.
Physiological
systolic breath -6 cases.
PVM
without mitral regurgitation-3 cases.; PVM with fine mitral
regurgitation-1 case. |
| Handball
| seniors
| 20
| 27,8
| M
| 5
| 25%
| 2/ std. 1
| 10%
| Physiological
systolic breath grade I – 3 cases.
EKG
repolarization disorders-3 cases.
Innocent
BRDI –3 cases. |
| juniors
| 25
| 12,4
| M
| 5
| 20%
| 2/
std. 1 |
8%
| Innocent
BRDI -4 cases.
Physiological
systolic breath-5 cases. |
| Volleyball
| seniors
| 28
| 23,5
| M
| 4
| 14,3%
| -
| -
| Innocent
BRDI -2 cases.
Physiological
systolic breath-1 case.
EKG
repolarization disorders-1case. |
| juniors
| 40
| 14,3
| 20M
20F
| 3
| 7,5%
| -
| -
| Sinusale
tachycardia- 2 cases.
Vegetative nervous
disorder-2 cases.
Physiological BRDI-2
cases.
BAV grade II type I
functional | | Boxing
| seniors
| 20
| 24,5
| M
| 5
| 25%
| 2/
std. 1 |
10%
| EKG
repolarization disorders-3cases.
Innocent
BRDI-2 cases. |
| Tennis
| juniors
| 25
| 11,1
| 9M
16F | 4
| 16%
| -
| -
| Innocent BRDI-3
cases.
Physiological
systolic breath-2 cases.
PVM
without mitral regurgitation-2 cases.
| | Semifond
athletics
| juniors
| 25
| 14,3
| 7M18F
| 2
| 8%
| -
| -
| Extrasistolic
supraventricular arrhythmia; spasmophilia-2 cases.
Apexian
systolic breath grade I/II -1 case.
Physiological
systolic breath-3 cases. |
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<The
HTA treatment for sportsmen must be realized only after a good
knowledge of hemodynamic answer during exercise. Initially it
included non-pharmacological measures regarding the life style
modification which can be useful for the pre HTA control. If these
measures aren’t efficient for the sportsmen that continue to
make
effort it can be associate a pharmacological treatment such as
selective beta inhibitors, calcium inhibitors or diuretics. There are
less indicated the ACE inhibitors, the unselective inhibitors or the
alpha 1 inhibitors. The therapy associated with the hypertension
stage and the type and the intensity of the effort can allow the continuation
of the sportive activity. The exercise with some particularities can
be also a prophylactic and therapeutic factor for HTA. The low HTA
can be treated by non pharmacological methods for 6 months. If the
blood pressure values become normal these methods will continue to
remain. If the TA is not modified (changed) these measures will be
associated with antihypertensive pharmacological therapy (minimum
doses). The therapy with diuretics is less indicated for long
distance race athletics because of the hypovolemie or hyposodium
risk. If is necessary a beta inhibitor, it will be preferred an
alpha-beta combination. After the normal blood
pressure values are restored, the therapy will continue for 6-12
months, afterwards it can be tried the reduction of the doses. If the
blood pressure values are not normal under treatment is necessary to
increase the dose or to associate another antihypertensive. The
doctor must take notice about the side effects of the medication over
effort tolerance and the anti-doping rules.The
second objectiveis the elaboration of a
cardiovascular
diseases prophylaxis strategy which refers to the control of the risk
factors. The prophylaxis of cardiovascular diseases will be the most
important, both by identification of the possible risk factors, and
by establishing a causal relation of these one with the
cardiovascular diseases on lots of age and sex, by their avoidance at
young patients by establishing a correct life style and not only by
treating them. This one will be successful if the population will
understand and sustain the necessity of changing the life style, diet
and the way of food preparation, and the avoidance of the tobacco,
alcohol and sedentariness, knowing the benefits of a change life
style.
Discussions
and conclusionsNot
any increase of the blood pressure values represents the hypertensive
disease and need treatment. Even the moderate, labile HTA need
additional investigations: laboratory examinations, pulmonary
radiography, renal echography, repose and effort ECG. If the TA
values are a little high the blood pressure is measured 3 times in
two different occasions and it’s evaluation is making by
checking-up at 4-6 weeks. When the values remain normal is considered
that it is not HTA, there is a check-up at 6 months and a year, the
patient is not receiving medication only indications about the
decrease of effort intensity or about the elimination of the
releasing factors. If the values are a little or medium increased the
patient is informed, the necessary investigations are made and
general measures are applied with periodic check-up at 2-3 months,
evaluating the risk, etiology, severity and treatment. The
purpose of any antihypertensive treatment is to reduce the TA values
and in this way to prevent the apparition of the secondary organ
lesions. Theoretically, the treatment must be applied to all persons
with permanent increased TA values in order to prevent the
installation of ischemic cardiopathy and AVC (cerebral vascular
accident). The general line of therapeutic conduct is the following:
1.
The pre hypertension and labile, easy systolic arterial hypertension
with diastolic values under 95-105 mmHg present at the sportsman with
vegetative nervous disorder who has no other health problems needs
paraclinical investigations and medical supervision during a specific
effort. No pharmacological treatment is used but is indicated a
prophylactic and non pharmacological treatment consisting in:
-
low sodium diet ; there are allowed 3g/day, knowing that a
gram
of kitchen salt contains approximately 400 mg sodium. This
desideratum(wish) is realized by not adding salt in cooked food,
avoiding conserves, salami and sausages, different sorts of cheese,
pickles, olives, meat jelly and milk. For taste it can be add in food
potassium salt. -
to reduce the weight excess (low caloric diet avoiding fats and
sweets); -
moderate physical effort;-
to avoid the central nervous system excitants (alcohol, tobacco,
coffee, cola);-
to eliminate the stress and nervous tension;-
to monitories the blood pressure(TA) in dynamic by the team doctor
during repose and specific effort.2. If an
infectious focus exists, if it is a great physical/psychic
solicitation, in these mentioned cases the interpretation of the high
values of blood pressure(TA) become more reserved and is needed a
period without effort for the eradication of the infectious focus or
for the reorganization of the training programme that needs great
solicitation. 3. If the
examinations showed dates that indicate infectious states,
cardiopathys, renal, endocrinological affections, the investigations
are amplified, are needed other exploration stages
that include renal functional tests, arteriography, hormonal dosing.
These sportsmen are unable for performance sports, therefore the
effort is contra-indicated. If the affections are treatable and the
blood pressure become normal with time, the sportsmen can practise
again the physic exercises. In conclusion the high values of blood
pressure must be interpreted in clinical and anamnesis context and
the interdiction for performance sports depends on the etiology,
effort capacity, hemodynamic implication and the practiced effort
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