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June 11, 2021

Exercise should be first line of defence against elevated blood pressure

Healthcare experts have recommended exercise as a first-line treatment for mild to moderate-risk blood pressure and cholesterol.

By GlobalData Healthcare

High blood pressure and cholesterol are major risk factors for cardiovascular diseases, including stroke and heart disease. In a scientific statement published in the journal Hypertension in early June, the American Heart Association (AHA) and American College of Cardiology (ACC) recommend exercise as the first-line treatment for patients with mild to moderate-risk blood pressure and cholesterol. This is an update to their current guidelines, which broadly suggest lifestyle-only approaches, such as smoking cessation and alcohol moderation, to prevent and treat these risk groups.

GlobalData epidemiologists expect a decline in the diagnosed prevalent cases of major cardiovascular diseases, such as coronary artery disease (CAD) and acute ischaemic stroke (AIS), should the AHA/ACC modify current recommendations to reflect exercise as the first line of treatment in patients with mild to moderate cardiovascular disease risk factors.

According to the AHA/ACC statement, increasing exercise has health benefits that are better than, comparable to or complementary to other recommended lifestyle changes, such as smoking cessation, alcohol moderation and dietary modifications. To provide updated guidance, Gibbs and colleagues synthesised previous work examining the impacts of increased physical activity on lowering blood pressure and cholesterol. Lifestyle-only treatment is currently recommended for the estimated 21% of US adults with moderate hypertension but low cardiac risk scores, as well as the 28% with moderate levels of low-density lipoprotein (LDL) cholesterol, informally known as ‘bad’ cholesterol, more than 70mg/dL.

The ultimate goal of reducing elevated blood pressure or cholesterol is to decrease a patient’s risk of potentially life-threatening health outcomes, such as CAD and AIS. In the US, GlobalData epidemiologists forecast 13 and seven million diagnosed prevalent cases of CAD and AIS respectively last year, with both expected to increase from now to 2027 (as shown in Figure 1). If widely adopted, these updated recommendations could help mitigate two major risk factors for CAD and AIS, namely elevated blood pressure and LDL cholesterol, and thus lead to prevalent cases below the current forecast.

The benefits of exercise are well-established. Gibbs and colleagues emphasise that even a little physical activity is better than none and further recommend that patients explore familiar and enjoyable exercise routines. GlobalData epidemiologists suggest that future studies should examine the impact of physical activity as the first-line treatment for patients with elevated blood pressure and cholesterol, including any effects on related health outcomes.

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