從二十四小時動態血壓監測的觀點探討高血壓的運動處方

Using Twenty-Four Hour Ambulatory Blood Pressure Monitoring to Investigate Exercise Prescription of Hypertension

10.6223/qcpe.2601.201203.2002

朱嘉華(Chia-Hua Chu)

運動後低血壓 ； 動態血壓監測 ； 心血管疾病 ； 代謝症候群 ； post-exercsie hypotension ； ambulatory blood pressure monitoring ； cardiovascular disease ； metabolic syndrome

中華體育季刊

26卷1期（2012 / 03 / 01）

11 - 19

繁體中文

高血壓是一種極為常見且嚴重的慢性疾病，其對整體社會經濟負擔及健康之影響甚鉅。然而，目前高血壓患者的自知率、服藥率與控制率仍然屬於不理想的狀態。規律的運動是預防和治療高血壓的策略之一，但仍有25%左右的患者在從事身體活動後並沒有呈現血壓下降的反應，且目前仍有幾個有關於運動在高血壓防治效果上的問題亟待解答，這些問題可以進一步透過24小時動態血壓（ambulatory blood pressure, ABP）監測來加以釐清。24小時ABP監測因可多重連續測量，能夠客觀的反應人體日常活動期間的血壓變化，且相較於臨床血壓亦具有較高的準確性和較小的變異性，與目標器官損害的相關性也較高，因此對於高血壓的診斷和防治具有十分重要的意義。因此，本文擬從24小時ABP監測的觀點來探討高血壓防治的最適運動處方。

Hypertension is an extremely common and serious chronic disease, and its influence on total social economy and health is enormously. However, the rates of perceived self-knowledge, medicine taking and hypertension controlling, remain sub-optimal at present. Even though regular exercise is recommended as a part of hypertension prevention, treatment and control, approximately 25% of hypertensive patients do not exhibit blood pressure reduction associated with exercise training. In addition, several questions regarding the effects of exercise on prevention and treatment of hypertension need to be clarified. These questions can be resolved through twenty-four hour ambulatory blood pressure (ABP) monitoring. Twenty-four hour ABP monitoring plays a significance role in diagnosis, and prevention of hypertension because it provides a repeated measure of hypertension as well as reflects blood pressure fluctuates of activities of daily living. Furthermore, higher relationship has been found between ABP and hypertensive target organ damage as compared to conventional blood pressure. The major aim of this review paper was therefore to investigate exercise prescription of hypertension using 24-hour ABP monitoring.

1. 陳健仁、游山林、白其卉、蘇大成、曾慶孝、簡國龍、黃麗卿 (2003)。台灣地區高血壓、高血糖、高血脂盛行率調查期末報告。取自國民健康局網址http://www.bhp.doh.gov.tw/health91/study-2.htm.
2. World Health Organization. (2004). Cardiovascular disease: Prevention and control. Retrieved from: http//:www.who.int/dietphysicalactivity/publications/facts/cvd/en/.
3. 行政院衛生署中央健康保險局 (2010)。健保公布98 年前十名藥品，三高用藥占八成。取自中央健保局網址http://www.nhi.gov.tw/information/News_detail.asp?News_ID=834&menu=9&menu_id=544.
4. American College of Sports Medicine(2004).Position stand: Exercise and hypertension.Medicine and Science in Sports and Exercise,36,533-553.
5. American College of Sports Medicine.(1993).Position stand: Physical activity, physical fitness, and hypertension.Medicine and Science in Sports and Exercise,25,i-x.
6. Björklund, K.,Lind, L.,Lithell, H.(2000).Twenty-four hour ambulatory blood pressure in a population of elderly men.Journal of Internal Medicine,248,501-510.
7. Blumenthal, J. A.,Siegel, W. C.,Appelbaum, M.(1991).Failure of exercise to reduce blood pressure in patients with mild hypertension. Results of aramdomized controlled, trail..Journal of American Medical Association,206,2098-2104.
8. Cardoso, C. G., Jr.,Gomides, R. S.,Queiroz, C.,Pinto,L. G.,Lobo, F. S.,Tinucci, T.(2010).Acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure.Clinics,65(3),317-325.
9. Chobanian, A. V.,Bakris, G. L.,Black, H. R.,Cushman, W. C.,Green, L. A.,Izzo, J. L.(2003).The seven report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure.Hypertension,42,1206-1252.
10. Cornelissen, V. A.,Arnout, J.,Holvoet, P.,Fagard, R. H.(2009).Influence of exercise at lower and higher intensity on blood pressure and cardiovascular risk factors at older age.Journal of Hypertension,27,753-762.
11. Cox, K. L.(2006).Exercise and blood pressure: Applying finding from the laboratory to the community setting.Clinical and Experimental Pharmacology and Physiology,33,868-871.
12. Eicher, J. D.,Maresh, C. M.,Tsongalis, G. J.,Thompson, P. D.,Pescatello, L. S.(2010).The additive blood pressure lowering effects of exercise intensity on post-exercise hypertension.American Heart Journal,160(3),513-520.
13. European Society of Hypertension(2003).European Society of Cardiology guidelines for the management of arterial hypertension.Journal of Hypertension,21,1011-1053.
14. Ezzati, M.,Lopez, A. D.,Rodgers, A.,Vander Hoorn, S.,Murray, C. J.(2002).Selected major risk factors and global and regional burden of disease.Lancet,360,1347-1360.
15. Folkow, B.(1982).Physiological aspects of primary hypertension.Physiological Reviews,62,347-504.
16. Hagberg, J. M.,Park, J. J.,Brown, M. D.(2000).The role of exercise training in the treatment of hypertension.Sports Medicine,30,193-206.
17. Hamer, M.(2006).The anti-hypertensive effects of exercise: Integrating acute and coronic mechanisms.Sports Medicine,36(2),109-116.
18. Hardman, A. E.(2001).Issues of fractionization of exercise (short vs. long bouts)..Medicine and Science in Sports and Exercise,33,S421-S427.
19. Inbar, G.,Wallace, J. P.,Jastremski, C.(1991).Interaction of intensity and duration on acute post-exercise blood pressure reduction.Journal of Cardiopulmonary Rehabilitation and Prevention,11,320.
20. Itoh, M.,Araki, H.,Hotokebuchi, N.,Takeshita, T.,Gotoh, K.,Nishi, K.(1994).Increased heart rate and blood pressure response, and occurrence of arrhythmias in elderly swimmers.Journal of Sports Medicine and Physical Fitness,34,169-178.
21. Jones, H.,Pritchard, C.,George, K.,Edwards, B.,Atkinson, G.(2008).The acute post-exercise response of blood pressure varies with time of day.European Journal of Applied Physiology,104,481-489.
22. Jost, J.,Weiss, M.,Weicker, H.(1990).Sympatho-adrenergic regulation and the adrenocepter system.Journal of Applied Physiology,68,897-904.
23. Jost, J.,Weiss, M.,Weicker, H.(1989).Comparison of sympatho-adrenergic regulation at rest and of the adrenocepter system in swimmers, long-distance runners, weight lifters, wrestlers and untrained men.European Journal of Applied Physiology and Occupational Physiology,58,596-604.
24. Lehmkuhl, L. A. A.,Park, S.,Zakutansky, D.,Jastremski, C. A.,Wallace, J. P.(2005).Reproducibility of postexercise ambulatory blood pressure in stage Ι hypertension.Journal of Human Hypertension,19,589-595.
25. MacDonald, J. R.,MacDonald, J. D.,Hogben, C. D.(2000).The effects of exercise duration on post-exercise hypotension.Journal of Human Hypertension,14,125-129.
26. Maggio, A. B.,Aggoun, Y.,Martin, X. E.,Marchand, L. M.,Beghetti, M.,Farpour- Lambert, N. J.(2011).Long-term follow-up of cardiovascular risk factors after exercise training in obese children.International Journal of Pediatric Obesity,6(2-2),e603-610.
27. Marceau, M.,Kouame, N.,Lacourciere, T.,Cleroux, J.(1993).Effects of different training intensities on 24-hour blood pressure in hypertensive subjects.Circulation,88,2803-2811.
28. Marconnet, P.,Slaoui, F.,Saltin, M.,Ekblom, J. L.(1984).Pre-exercise, exercise and early post exercise arterial blood pressure in young competitive swimmers versus non swimmers.Journal of Sports Medicine,24,252-258.
29. Molmen-Hansen, H. E.,Stolen, T.,Tjonna, A. E.,Aamot, I. L.,Ekeberg, I. S.,Tyldum, G. A.,Stoylen, A.(2011).Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients.Europen Journal of Cardiovascular Prevention and Rehabilitation,18,5-14.
30. Park, S.,Jastremski, C. A.,Wallace, J. P.(2005).Time of day for exercise on blood pressure reduction in dipping and nondipping hypertension.Journal of Human Hypertension,19,597-605.
31. Park, S.,Rink, L. D.,Wallace, J. P.(2006).Accumulation of physical activity leads to a greater blood pressure reduction than a single continuous session, in prehypertension.Journal of Hypertension,24,1761-1770.
32. Park, S.,Rink, L. D.,Wallace, J. P.(2008).Accumulation of physical activity: Blood pressure reducetion between 10-min walking sessions.Journal of Human Hypertension,22,475-482.
33. Pescatello, L. S.,Guidry, M. A.,Blanchard, B. E.,Kerr, A.,Taylor, A. L.,Johnson, A. N.(2004).Exercise intensity alters postexercise hypotension.Journal of Hypertension,22,1881-1888.
34. Pescatello, L. S.,Kulikowich, J. M.(2001).The aftereffects of dynamic exercise on ambulatory blood pressure.Medicine and Science in Sports and Exercise,33,1855-1861.
35. Pinto, A.,Di Raimondo, D.,Tuttolomonde, A.,Fernandez, P.,Arna, V.,Licata, G.(2006).Twenty-four hour ambulatory blood pressure monitoring to evaluate effects on blood pressure of physical activity in hypertensive patients.Clinical Journal of Sports Medicine,16,238-243.
36. Quinn, T. J.(2000).Twenty-four hour, ambulatory blood pressure responses following acute exercise: Impact of exercise intensity.Journal of Human Hypertension,14,547-553.
37. Taylor-Tolbert, N. S.,Dengel, D. R.,Brown, M. D.,McCole, S. D.,Partley, R. E.,Ferrell, R. E.,Hagberg, J. M.(2000).Ambulatory blood pressure after acute exercise in older men with essential hypertension.American Journal of Hypertension,13,44-51.
38. Tsai, J. C.,Liu, J. C.,Kao, C. C.,Tomlinson, B.,Kao,P. F.,Chen, J. W.,Chen, P.(2002).Beneficial effects on blood pressure and lipid profile of programmed exercise training in subjects with white coat hypertension.American Journal of Hypertension,15,571-576.
39. Van Hoof, R.,Macor, F.,Lijnen, P.,Staessen, J.,Thijs, L.,Vanhees, L.,Fagard, R.(1996).Effect of strength training on blood pressure measured in various conditions in sedentary men.International Journal of Sports Medicine,17,415-422.
40. Waib, P. H.,Goncalves, M. I.,Barrile, S. R.(2011).Improvements in insulin sensitivity and muscle blood flow in aerobic-trained overweight-obese hypertensive patients are not associated with ambulatory blood pressure.The Journal of Clinical Hypertension,13,89-96.
41. Wallace, J. P.(2003).Exercise in hypertension: A clinical review.Sports Medicine,33(8),585-598.
42. Whelton, S. P.,Chin, A.,Xin, X.,He, J.(2002).Effects of aerobic exercise on blood pressure: A meta-analysis of randomized controlled trials.Annals of Internal Medicine,136(7),493-503.
43. World Health Organization, International Society of Hypertension(2003).2003 World Health Organization (WHO)/International Society of Hypertension (ISH) on management of hypertension.Journal of Hypertension,21,1983-1992.
44. Zanchetti, A.,Waeber, B.(2006).Hypertension: Which aspects of hypertension should we impact on and how?.Hypertension,24(Suppl 5),S2-S5.
45. 李桂芹、那開憲、丁梟偉(2004)。如何正確應用動態血壓監測 （上）。中國臨床醫生，32(9)，15-17。
46. 邢燕燕(2008)。碩士論文(碩士論文)。山東省，山東師範大學。
47. 那開憲、朱建國、余平、張桂雲(2010)。應重視動態血壓監測或自測血壓對高血壓的診斷價值。中國臨床醫師，38(5)，3-6。
48. 韓全樂、高竟生、郝冰(2008)。動態血壓監測及其臨床應用進展。中國煤炭工業醫學雜誌，11(1)，125-127。
49. 羅斤汎、陳俊傑、蔡青峰(2007)。24小時動態血壓監測之臨床應用。基層醫學，22(12)，418-423。

1. 謝錦城、張祐華(2013)。運動對心血管疾病的影響。交大體育學刊，5，61-69。