The Journal of the Arkansas Medical Society Med Journal March 2019 Final 2 | Page 15

Table 1. Patient Demographics
Average Age (years)
70.0±4.1
Because of increased use of
these programs, there is further
incentive to investigate the role
that they may play in overall
medication requirements for
patients with CAD.
Number Percent Male Sex - no. (%) 17 (70.83%) Female Sex – no. (%) 7 (29.17%) Ethnicity - White - no. (%) 24 (100.0%) History of MI - no (%) 8 (33.33%) History of Stroke - no. (%) 1 (4.17%) Previous PCI - no. (%) 12 (50.0%) Previous CABG - no. (%) 14 (58.33%) Former Tobacco Use - no. (%) 9 (37.50%) Current Tobacco Use - no. (%) 2 (8.33%) Hypertension - no. (%) 22 (91.67%) Discussion and Conclusion
Hyperlipidemia - no. (%) 19 (79.17%) Type II Diabetes - no. (%) 9 (37.50%) Congestive Heart Failure - no. (%) 4 (16.67%) Peripheral Vascular Disease - no. (%) 9 (37.50%) Atrial Fibrillation - no. (%) 9 (37.50%) Stable Angina - no. (%) 9 (37.50%) More than half of the patients in this study
were able to either discontinue or decrease the
dose of a medication, a result that highlights the
effect that cardiovascular rehabilitation programs
can have on medication requirements for patients
with CAD. Special attention was paid to three
medication classes: antihypertensives, antihyper-
lipidemics, and antidiabetics. These three classes
were chosen as primary areas of focus due to the
known impact that cardiovascular rehabilitation
should have on the risk factors of hypertension,
hyperlipidemia, and type 2 diabetes mellitus.
Note. Age is in average years ± standard deviation. All other values are averages with the raw number
of patients and percentages.
Results
Twenty-four patients met the inclusion crite-
ria for this study. Patient demographics are out-
lined in Table 1.
Patient Characteristics
Average
BMI
before
rehabilita-
tion was 30.34±5.15kg/m, 2 and after was
29.39±5.11kg/m. 2 Average resting heart rate
before the program was 66.08±10.75 beats per
minute, and after the program was 68.13±10.91.
Average resting systolic blood pressure be-
fore rehabilitation was 132.67±16.89mmHg,
and after was 119.75±16.64mmHg. Average
resting diastolic blood pressure before reha-
bilitation was 78.13±7.75mmHg, and after was
71.38±9.93mmHg. Patient characteristics are
outlined in Table 2.
Primary and Secondary Endpoints
Nine out of 24 patients (37.50%) were able
to discontinue at least one antihypertensive, anti-
hyperlipidemic, or antidiabetic medication. Seven
(29.17%) decreased the dose of at least one of
these medications. Two (8.33%) added at least
one of these medication types. One (4.17%) in-
creased the dose of one of these medication
types. Of the patients who discontinued a medica-
tion, the medication most commonly discontinued
first was a calcium-channel blocker.
Before participation in rehabilitation, patients
were taking an average of 2.42±1.56 antihyper-
tensive medications per patient. After participa-
tion, this dropped to 2.13±1.48 per patient, a
decrease shown to be significant (p=0.0316).
Average antihyperlipidemic medications per pa-
tient before rehabilitation was 0.79±0.51. This
decreased to 0.75±1.48 after rehabilitation, a
decrease shown to be insignificant (p=0.3277).
Average antidiabetic medications required before
rehabilitation was 0.5±0.72 per patient. There
was no change in antidiabetic reported for any
patient during the time period of this study. Total
medication requirement for any medication type
before rehabilitation was 9.08±4.35 per patient.
After rehabilitation this decreased to 8.75±4.10,
a decrease approaching significance on analysis
(p=0.0574). These results are outlined in Table 3.
It was shown that the decrease in antihyper-
tensive requirement was statistically significant.
This result is consistent with what would be ex-
pected, as previous research has demonstrated
that proper diet and exercise can play a large role
in lowering systemic blood pressure. 6 A variety of
mechanisms come into play when discussing de-
creases in blood pressure. The dietary portion of
this rehabilitation program likely led to decreased
sodium intake, which has been shown to lower
blood volume. 7 Mechanisms behind decreasing
blood pressure with exercise are less understood,
> Continued on page 208.
Table 2. Patient Characteristics Pre- and Post-exposure
Characteristic
Pre-exposure Post-exposure
BMI(kg/m 2 ) 30.34±5.15 29.39±5.11
Resting Heart Rate (beats per minute) 66.08±10.75 68.13±10.91
Resting Blood Pressure – Systolic(mmHg) 132.67±16.89 119.75±16.64
Resting Blood Pressure – Diastolic(mmHg) 78.13±7.75 71.38±9.93
Note. Characteristics are displayed as average ± standard deviation before rehabilitation
(pre-exposure) and after rehabilitation (post-exposure).
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MARCH 2019 • 207