关于新的血压指南，健身专业人士知道什么？
What Fitness Pros Need to Know
About New Blood Pressure Guidelines
近半数的美国成年人都被高血压所困扰。怎么办？动起来吧！
Nearly half of U.S。 adults have hypertension。 The good news？ Exercise can help！
新颁布的高血压指南在去年年末成为新闻头条。指南中提到，近半数的美国人患有高血压（之前的调查结果约为三分之一）。对于健身专业人士来说，这份指南很重要，因为规律的锻炼可以很好地控制高血压。我们在此着重介绍这份新的血压指南。
New guidelines on high blood pressure made headlines late last year because they suggest that nearly half of all Americans have hypertension—up from about one-third under previous guidelines。 This is big news for fitness professionals because regular exercise is an excellent tool for regulating blood pressure。 In this issue， we’ll review what you need to know about the new blood pressure guidelines。
新指南颁布的背景
Background on the New Guidelines
美国心脏病学会和美国心脏协会于2017年11月更新了他们的血压指南（见表1）。在新指南的分类中，成年人在静息收缩压130-139mmHg、静息舒张压80-89mmHg时，为1型高血压。新标准将46%的美国成年人定义为高血压。而在旧标准中，有32%的人被定义为高血压（Whelton 等人，2017）。
The American College of Cardiology and the American Heart Association updated their blood pressure guidelines in November 2017 （see Table 1）。 Under the new classifications， a resting systolic blood pressure of 130–139 or a resting diastolic blood pressure of 80–89 indicates stage 1 hypertension。 The new criteria define 46% of U.S。 adults as hypertensive vs。 32% under the old guidelines （Whelton et al。 2017）。
之所以更新血压标准，是因为权威研究显示高血压与很多严重危害健康的疾病高度相关，例如高胆固醇、肾病、中风和心脏病。在冠心病和中风而造成的死亡中，超过一半的人都患有高血压（Whelton 等人，2017）。
The guidelines were updated because so many authoritative studies show a strong association between high blood pressure and serious health risks， such as high cholesterol， kidney disease， stroke and heart disease。 Indeed， more than half of deaths from coronary heart disease and stroke happen to people with hypertension （Whelton et al。 2017）。
接下来，我们会介绍现有对于高血压的研究，并教会大家如何用适度的锻炼和健康的生活方式控制高血压。
Next up， we’ll review current research on high blood pressure and highlight ways to manage it effectively with exercise and lifestyle。
血压和衰老
Blood Pressure and Aging
教练应当告知客户，高血压具有随着年龄的增长呈恶化的趋势（Whelton 等人，2017）。老年人更易患上“单纯性收缩期高血压”，收缩压上升而舒张压不变。在世界范围内，相比于亚洲人和白种人，非裔美国人和西班牙裔更容易患高血压（Whelton 等人，2017）。
It is particularly important for personal trainers to explain to clients that high blood pressure tends to worsen with age （Whelton et al。 2017）。 Aging populations are more prone to “isolated high systolic blood pressure” （Lelbach & Koller 2017）， where systolic pressure is elevated but diastolic pressure is not。 Among population groups， African Americans and Hispanics are more likely to develop hypertension than Asians and Caucasians （Whelton et al。 2017）。
随着年龄的增长，血压逐渐升高主要与动脉粥样硬化有关。由于动脉粥样硬化，大动脉失去弹性，变得更硬、更厚，动脉中斑块逐渐积聚。此外，随着年龄的增长，肾脏的滤过效率和排盐能力降低，循环系统超负荷，进而影响收缩压和舒张压（Lelbach&Koller 2017）。
The gradual rise in blood pressure with age is primarily associated with arteriosclerosis， where large arteries lose elasticity， becoming stiffer and thicker， and with atherosclerosis， the gradual buildup of plaque in arteries。 Aging also reduces the kidneys’ efficiency and ability to excrete salt， causing an unhealthy circulatory-system overload that affects systolic and diastolic pressures （Lelbach & Koller 2017）。
肥胖与高血压
Obesity and High Blood Pressure
在过去的20年中，肥胖导致高血压的风险急剧上升，主要原因是肥胖人群的需要较大的心输出量（心率×每搏输出量）来维持血供，心血管系统负担增大。其他原因还有交感神经系统紊乱（导致动脉收缩）、钠潴留。此外，代谢异常，如葡萄糖耐受不良、前驱糖尿病和2型糖尿病亦会引起高血压（Lelbach&Koller 2017）。
Over the past 20 years， the risk of developing hypertension from obesity has been increasing at an alarming rate。 The main problem is that obesity places a consistent strain on the heart’s cardiac output （heart rate × stroke volume）。 Other factors associated with hypertension and obesity include disturbances in the sympathetic nervous system （causing arteries to constrict）； sodium retention； and metabolic abnormalities such as glucose intolerance， a precursor to prediabetes and type 2 diabetes （Lelbach & Koller 2017）。
运动影响血压的形式
How Exercise Affects Blood Pressure
流行病学研究表明，增加体力活动和训练，即使是少量增加，也会降低血压、缓解高血压症状（Whelton等人，2017）。心血管运动和抗阻训练都可以降低血压，但研究表明有氧运动更有效。新血压指南中建议人们将有氧运动（每周90-150分钟，心率储备的65%-75%）和抗阻训练（每周90-150分钟， 50%-80%的1RM，至少6组全身练习，多组数，每组10次）结合起来，协同降低血压。
Epidemiological studies show that increasing physical activity and fitness—even by small amounts—reduces blood pressure and hypertension （Whelton et al。 2017）。 Personal trainers should inform clients that both cardiovascular exercise and resistance training can reduce blood pressure， though research suggests cardio is more effective。 The report on the new blood pressure guidelines recommends cardio （90–150 minutes a week at 65%–75% of heart rate reserve） plus resistance training （90–150 minutes a week at 50%–80% of one-repetition maximum [multiset training with at least six total-body exercises， 10 repetitions per set]）。
对血压正常的成年人来说，有氧运动可使其平均血压值下降2至4mmHg。而对于成人高血压患者，其血压数值平均下降5至8mmHg（Whelton等，2017）。需要注意的是，血压的降幅有大有小，波动很大。因为研究数据来自多种人群，其锻炼方式也不同。
On average， aerobic exercise produces a 2- to 4-point decrease in blood pressure in adult patients with normal BP and a 5- to 8-point drop in adults with hypertension （Whelton et al。 2017）。 Note that decreases in blood pressure vary widely； these numbers represent averages from studies that include multiple populations and differing exercise protocols。
有氧运动通过降低肾上腺素和去甲肾上腺素水平来降低血压，相应地减少动脉收缩。有氧运动还可以增强血管功能，并引起动脉结构对其的结构性适应（Lelback&Koller 2017）。上述生理学适应会改善血液循环，潜在地促进静息血压的下降。
Cardiovascular exercise brings down blood pressure by reducing epinephrine and norepinephrine levels， which in turn decreases artery constriction。 Cardio also enhances blood vessel function and generates structural adaptations in arteries （Lelback & Koller 2017）。 All of these changes improve blood circulation， potentially causing resting blood pressure to drop。
饮食与高血压
Diet and Hypertension
新血压指南指出，DASH饮食方法（Dietary Approaches to Stop Hypertension ，终止高血压膳食疗法）可以帮助降低血压。 DASH鼓励人们减少钠、饱和脂肪、总脂肪和酒精的摄入量，多吃水果、蔬菜、全谷物和低脂乳制品，低碳水化合物和素食主义也有助于降低血压（Whelton等，2017）。
The new blood pressure guidelines note that the DASH diet （Dietary Approaches to Stop Hypertension） can help reduce blood pressure。 DASH encourages people to consume less sodium， saturated fat， total fat and alcohol and eat more fruits， vegetables， whole grains and low-fat dairy products。 It appears that low-carbohydrate and vegetarian diets can also help to reduce blood pressure （Whelton et al。 2017）。
新血压指南建议，日均钠摄入量应少于1500毫克，并建议大多数成年人每天至少降低1，000毫克的钠摄入。有关降低血压的其他方法，请参考“不吃药降低血压（Reducing Blood Pressure Without Drugs）”一图。
On sodium intake， the new guidelines suggest an optimal goal of less than 1，500 milligrams per day and call for a reduction of at least 1，000 mg per day for most adults。 See “Reducing Blood Pressure Without Drugs” for other potential ways to reduce blood pressure。
血压的重要性
Blood Pressure Really Matters
健身专业人士需要帮助客户认请高血压的危险——尤其是中老年人（见表2）。我们要帮客户制定全面的血压管理计划。从长远来看，他们的寿命可能都由它决定。
Fitness professionals need to help clients understand the dangers of high blood pressure—especially for people who are middle-aged or older （see Table 2）。 You can’t go wrong by helping clients develop comprehensive strategies to manage blood pressure。 In the long run， their lives may depend upon it。
- 附录
参考文献References
Lelbach， A。， & Koller， A。 2017。 Mechanisms underlying exercise-induced modulation of hypertension。 Journal of Hypertension Research， 3 （2）， 35–43。
Whelton， P.K。， et al。 2017。 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention， Detection， Evaluation， and Management of High Blood Pressure in Adults。 Hypertension。 doi.org/10.1161/HYP.0000000000000065。
作者：Zachary Fennel and Len Kravitz， PhD
译者：周李明非
