AHA: Bodily exercise must be first-line remedy as BP, LDL are ticking up

In moderate risk patients, physical activity can complement other lifestyle changes such as diet and weight loss.

The American Heart Association (AHA) reminds physicians that lifestyle changes that include increasing physical activity should be the first line of attack when treating patients with mildly or moderately elevated blood pressure and cholesterol levels.

While physical activity is recommended for everyone, regardless of their CVD risk profile, those with mildly elevated blood pressure and LDL cholesterol are an important target group as the AHA says there is an opportunity to prevent or delay the onset of lifelong medical therapy.

“In this middle risk group, the focus is on progression, especially in younger people [CVD] Risk factors so that they are not exposed to them early in life, ”Bethany Barone Gibbs, PhD (University of Pittsburgh, PA), Chair of the AHA Scientific Opinion, told TCTMD. “It is a critical moment. Your blood pressure or cholesterol starts to rise and you do not want to take any medication. It is a really important time to attract people when they are motivated and have a chance to go off and keep medication [their blood pressure or cholesterol] longer in a healthy area. “

The document aims to encourage physicians to speak frequently about physical activity with their intermediate risk patients in cases where lifestyle interventions may be an option. In the United States, approximately 21% of adults meet criteria for lifestyle-only treatment for high blood pressure, while nearly 30% of adults could begin a non-pharmacological, lifestyle-oriented approach to treating high LDL cholesterol.

Patients with “high blood pressure” and stage 1 hypertension as defined by the 2017 American College of Cardiology / American Heart Association guidelines for clinical practice for hypertension, should be treated with a lifestyle-only approach first. This includes patients with systolic blood pressure of 120-129 mm Hg and diastolic blood pressure of less than 80 mm Hg (high blood pressure) and patients at low risk for atherosclerotic cardiovascular disease (ASCVD) with systolic blood pressure of 130-139 or diastolic blood pressure of 80- 89 mm Hg (stage 1 hypertension).

Based on the 2018 Cholesterol guidelines, after a joint decision-making discussion in low-risk patients aged 40 to 75 years with LDL> 70 mg / dl and a low ASCVD risk score, a lifestyle-only treatment approach is an option (< 7.5%) and in patients with LDL > 70 mg / dL, medium ASCVD risk (7.5% to 20%), low coronary artery calcium score (<100 Agatston units), and low exposure to other risk factors.

In the paper published online today in Hypertension, the group of authors describes the average effects of physical activity on blood pressure and cholesterol levels. For example, aerobic exercise lowers systolic blood pressure by approximately 4 mm Hg and LDL cholesterol by 3 to 5 mg / dL. Aerobic activity also increases HDL cholesterol by 1 to 2 mg / dL and lowers triglycerides between 4 and 12 mg / dL. These effects are either comparable, superior or complementary to other interventions for a healthy lifestyle, such as: B. Diet and weight loss.

Gibbs said that in 2018 Physical Activity Guidelines for Americans Hopefully made training a little less daunting for people. Patients are still advised to keep on 300 minutes of moderate physical activity per week – or 150 minutes of vigorous physical activity – but adults are now encouraged to move more and sit less throughout the day.

“These new physical activity guidelines really emphasize how we think about physical activity,” Gibbs said. “A lot of people get the idea that if they don’t run for 30 minutes they won’t work out. [but] the evidence suggests that every bit of physical activity counts. Even taking the stairs a few more times actually has measurable benefits. It would be better to do a 30 minute run, but it is better to take the stairs if the alternative is to do nothing. ”

In the statement, the AHA writing committee also outlines how doctors can help patients adopt and maintain a physically active lifestyle. Gibbs found that fitness trackers objectively monitor physical activity in steps or distance, and can also warn people if they’ve been inactive for too long. “Tracking steps is such an easy way to look at all day activity,” she said. “It’s easy for patients to understand; for clinicians, it’s easy to understand. We know that even increasing your steps 1,000 steps per day has benefits for long-term cardiovascular outcomes. ”

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