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"Sport Medicine Journal" No.5 - 2006
ORIGINAL PAPERS


Bio-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.

Results

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




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 lotAnother 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 16F4 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 conclusions

Not 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 type.

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