High blood pressure is rampant in our society. According to the National Center for Chronic Disease Prevention and Health Promotion, a subdivision of the Centers for Disease Control, about one in three American adults have high blood pressure. High blood pressure increases the risk for heart disease and stroke, both leading causes of death in the United States.
Hypertension is the more technical name to describe persistently elevated blood pressure. Blood pressure is the force of blood against the artery walls and the measure of that force is in the form of a fraction. The top number of a blood pressure is called the systolic pressure which measures the force of the heart’s active pumping action. The lower number of a blood pressure is called the diastolic pressure which measures the heart’s relaxing phase of pumping blood throughout the body. Hypertension can refer to elevated blood pressure readings in any combination: high systolic pressure, high diastolic pressure or high readings of both of these components. Hypertension is indicated when the blood pressure reading is consistently a number equal to, or exceeding, 140 over 90.
Once hypertension develops, it not only increases the risk for many diseases, but it also typically lasts a lifetime. For the person with high blood pressure, it is especially important to take action. Adopting healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure. If lifestyle changes alone are not effective in keeping blood pressure under control, it may be necessary to add blood pressure medications.
Antihypertensive drugs act to reduce blood pressure and pharmacological treatment of hypertension usually starts with beta blockers and diuretics. If these are not effective, a treatment plan usually continues with sympatholytic drugs including vasodilators, angiotensin-converting enzyme (ACE) inhibitors or a combination of drugs.
There are some important things for a massage therapist to know when administering massage to someone on an ACE inhibitor. Examples of commonly prescribed ACE inhibitors are Prinivil, Zestril, Enalapril, Vasotec, Altace and Accupril. According to Jean Wible, RN, BSN, NCTMB, CHTP, author of Pharmacology for Massage Therapy, “The ACE inhibitors dilate the vessels; therefore, the effects of mechanical massage strokes on the blood vessels may be enhanced. Slightly increasing the rate of application and the use of tapotement may ease any problems that could arise, such as weakness or dizziness and fatigue. Because ACE inhibitors also affect the rate of excretion of sodium and water from the body, the use of systemic strokes that increase circulation (i.e., effleurage) is limited in duration.”
Hypotension is the main side effect of the ACE inhibitors that concerns the massage therapist. Here are some massage modifications that will help to prevent an extreme drop in blood pressure for clients on ACE inhibitors.
- Increase rate of application.
- Use tapotement.
- Limit the duration of effleurage.
- Stay with your clients as they sit up after a massage.
Hypertension automatically disqualifies a massage recipient from receiving deep abdominal work. According to Ruth Werner, LMP, NCTMB, author of A Massage Therapist’s Guide to Pathology, “Regardless of whether the client is on blood pressure medication, deep abdominal work is contraindicated for high blood pressure. This is because it is possible to accidentally trip the vasovagal reaction. Unintentionally overstimulating the vagus nerve can result in amplified parasympathetic reactions. This leads to systemic vasodilation and faintness from lack of blood to the brain. Another possibility is that the body would experience a sympathetic rebound effect. Ordinarily a vasovagal reaction is unpleasant but not dangerous — unless the blood vessels are not equipped to handle a rapid demand to dilate and constrict.”
As massage therapists represent an increasingly strong presence in healing, the importance of understanding the Three P’s continues to rise. We are learning that Physiology, Pathology and Pharmacology are all influenced by manual tissue manipulation. It is possible to modify a massage treatment to complement and balance the medication a client takes. This knowledge and subsequent modification in a therapist’s techniques will work not only to the client’s benefit, but also to advance the safety and efficacy of the massage profession.