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Don't Run Straight for Hypertension Pills

April 20, 1998

High blood pressure is often called an "illness of civilization" because it's linked to stress, inactivity, poor diet, smoking and other unhealthy habits endemic to modern life. Yet all too often, when people are diagnosed with high blood pressure, they simply pop a pill and continue doing the dangerous behaviors that contribute to the disease. But new federal guidelines stress the importance of making healthy lifestyle changes to prevent and manage hypertension, which affects more than 50 million Americans.

People whose blood pressure is too high but who have no other disease risk factors should try regular exercise and other lifestyle strategies for at least a year--about twice as long as in previous recommendations--before turning to medications, according to the guidelines, released in November by the National Heart, Lung and Blood Institute.

Even those taking antihypertensive medications should practice healthy habits, say the new guidelines, since these changes may reduce or eliminate the need for drugs.

Regular exercise is among the most powerful of the lifestyle strategies.

"Regular physical activity can lower hypertension in people who have the condition and prevent the development of hypertension in people who don't," says Carlos Crespo, an assistant professor at American University and a contributing author of the NHLBI report.

"When compared with their more active and fit peers, sedentary individuals with normal blood pressure have a 20% to 50% increased risk of developing hypertension."

The new guidelines advise doing "moderately intense" aerobic activity, such as brisk walking, for 30 to 45 minutes on most days of the week.

Most people can safely exercise at that level without seeking a physician's approval, say exercise scientists, who define "moderate" as any activity that increases the heart rate and breathing somewhat but still permits someone to carry on a conversation.

People being treated for high blood pressure or other serious health problems should discuss their exercise with their health care provider.

And Crespo warns against what he calls "the Rambo effect: When you tell people walking is good, they think jogging must be better." While jogging, cycling, swimming and other more strenuous activities may be beneficial, adults who have been sedentary should consult a physician before beginning a program of vigorous exercise.

And when starting any new exercise program, it's important to begin slowly and progress gradually.

"You don't have to exhaust yourself to lower your blood pressure," notes Jim Hagberg, a professor of kinesiology at the University of Maryland and a contributing author of the NHLBI report. "In fact, mild exercises, such as walking, may reduce blood pressure just as much or even more than strenuous activities, such as jogging," Hagberg says.

Exercise generally decreases both the systolic and diastolic blood pressure by about 10 points, he says, in part by improving the functioning of the sympathetic nervous system, which mediates the body's "fight or flight" response. This drop in blood pressure doesn't take years of exercise. "It may even happen as early as three to four weeks after increasing your physical activity levels," Hagberg writes in a new brochure he prepared for the American College of Sports Medicine (ACSM).

One reason exercise is such a powerful weapon against hypertension is that, in addition to directly lowering blood pressure, it also can reduce other risk factors for the disease. "Exercise helps people lose weight, relieve stress and stop smoking," he says.

"People don't die of hypertension," Hagberg notes. "People with hypertension die from cardiovascular disease." And exercise affects many of the risk factors for cardiovascular disease, such as blood cholesterol, blood sugar levels and obesity.

While exercising continually for 30 to 45 minutes may be optimal, even shorter bouts of daily activity--such as taking the stairs or doing housework or yardwork--can be helpful. His favorite guideline is the one established by the ACSM and the Centers for Disease Control and Prevention: Accumulate 30 minutes of moderate activity on most days of the week.

"Remember, something is better than nothing," he notes. "Just get off your duff and do what you can do."

* Fitness runs Monday in Health.

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