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The Role of Physical Activity in the New 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines

      To the Editor:
      We immediately read with great attention and interest the noteworthy and well-performed Brief Observation by Vaduganathan et al
      • Vaduganathan M.
      • Pareek M.
      • Qamar A.
      • Pandey A.
      • Olsen M.H.
      • Bhatt D.L.
      Baseline blood pressure, the 2017 ACC/AHA high blood pressure guidelines, and long-term cardiovascular risk in SPRINT.
      in The American Journal of Medicine, in which the authors evaluated the prevalence and associated cardiovascular prognosis of patients newly reclassified with hypertension based on the lower thresholds included in the new and recently released 2017 American Heart Association and American College of Cardiology guidelines for hypertension in adults
      • Whelton P.K.
      • Carey R.M.
      • Aronow W.S.
      • 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
      compared with the Joint National Committee 7 guidelines.
      • Chobanian A.V.
      • Bakris G.L.
      • Black H.R.
      • et al.
      National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
      Practically speaking, the new guidelines result in a substantial increase in the prevalence of hypertension and in the need of more intensive blood pressure lowering for many adults taking antihypertensive medication, and most of this newly defined population of individuals with hypertension is expected to be manageable with nonpharmacologic interventions. Consequently, the greatest benefit of the guidelines recommendations could be that they emphasize, most likely for young adults, lifestyle interventions, including weight loss, healthy diet, reduced sodium intake, increased potassium intake, curtailed alcohol consumption, and physical exercise.
      Thus, we would like to stress that physical activity should be recommended as a real cornerstone therapy for the primary prevention, treatment, and control of all stages of hypertension;
      • Leggio M.
      • Mazza A.
      • Cruciani G.
      • et al.
      Effects of exercise training on systo-diastolic ventricular dysfunction in patients with hypertension: an echocardiographic study with tissue velocity and strain imaging evaluation.
      that the possible additive or complementary effect of exercise training/cardiorespiratory fitness should always be considered;
      • Cornelissen V.A.
      • Smart N.A.
      Exercise training for blood pressure: a systematic review and meta-analysis.
      and finally that paying attention to the dosing and to individual variations, exercise is so effective that it should be considered as a drug.
      • Leggio M.
      • Fusco A.
      • Limongelli G.
      • Sgorbini L.
      Exercise training in patients with pulmonary and systemic hypertension: a unique therapy for two different diseases.

      References

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        • Pareek M.
        • Qamar A.
        • Pandey A.
        • Olsen M.H.
        • Bhatt D.L.
        Baseline blood pressure, the 2017 ACC/AHA high blood pressure guidelines, and long-term cardiovascular risk in SPRINT.
        Am J Med. 2018; (Epub ahead of print; Feb 5. pii: S0002-9343(18)30097-4)https://doi.org/10.1016/j.amjmed.2017.12.049
        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2017; (Epub ahead of print; Nov 7. pii: S0735-1097(17)41519-1)https://doi.org/10.1016/j.jacc.2017.11.006
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        • et al.
        National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
        JAMA. 2003; 289: 2560-2572
        • Leggio M.
        • Mazza A.
        • Cruciani G.
        • et al.
        Effects of exercise training on systo-diastolic ventricular dysfunction in patients with hypertension: an echocardiographic study with tissue velocity and strain imaging evaluation.
        Hypertens Res. 2014; 37: 649-654
        • Cornelissen V.A.
        • Smart N.A.
        Exercise training for blood pressure: a systematic review and meta-analysis.
        J Am Heart Assoc. 2013; 2: e004473
        • Leggio M.
        • Fusco A.
        • Limongelli G.
        • Sgorbini L.
        Exercise training in patients with pulmonary and systemic hypertension: a unique therapy for two different diseases.
        Eur J Intern Med. 2018; 47: 17-24