ACC/AHA 2017 Exercise Recommendations May Not Be Enough to Prevent Hypertension

This article was originally published on PracticalCardiology.com.

Jason Nagata, MD

A new study suggests patients may need twice the current recommended level of physical activity to prevent hypertension.

The analysis, which was conducted by investigators at the UCSF Benioff Children’s Hospitals, found 5 hours per week of physical activity was a more appropriate recommendation for preventing hypertension than the ACC/AHA recommendation of 150 minutes per week.

"Nearly half of our participants in young adulthood had suboptimal levels of physical activity, which was significantly associated with the onset of hypertension, indicating that we need to raise the minimum standard for physical activity," said Jason Nagata, MD, of the UCSF Division of Adolescent and Young Adult Medicine, in a statement. "This might be especially the case after high school when opportunities for physical activity diminish as young adults transition to college, the workforce and parenthood, and leisure time is eroded."

Using the 2017 American College of Cardiology/American Heart Association guidelines for physical activity, investigators hoped to develop a greater understanding of adherence to physical activity guidelines among young adults and the incidence of hypertension later in life. To do so, investigators designed their study as an analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study participants, which provided prospective data related to physical activity levels in early adulthood and incidence of hypertension approximately 30 years later.

In addition to establishing a recommendation of 150 minutes per week of moderate-intensity aerobic activity (300 exercise units [EU]), the ACC/AHA guideline also lowered the threshold for hypertension to 130/80 mmHg. Investigators hoped to use pooled logistic models to estimate associations of meeting the minimum guideline recommendation of 150 minutes or twice the minimum guideline recommendation (600 EUs) with hypertension later in life, after adjusting for factor including but not limited to sex, race, family history of hypertension or cardiovascular disease, years of education, smoking status, alcohol use, and BMI.

Of the 5115 patients included in the CARDIA study, 5114 provided consent for inclusion beyond baseline examinations and were included in the current analysis. Of these, 51.6% were Black and 45.5% were men. By the age of 60, 73.1% of participants in the CARDIA study had developed hypertension.

Baseline analyses revealed physical activity rates were lowest among Black women from the ages of 18-60 years. In contrast, Black men reported the highest levels of physical at 18 years but this declined considerably from young adulthood to the end of middle age.

In adjusted models, each EU decrease in physical activity score at 18 years of age was associated with 4% (95% CI, 1-7; P=.002) greater odds of developing hypertension. Additionally, each 1-unit reduction per year in physical activity score was associated with 2% (95% CI, 1-3; P=.001) greater annual odds of developing hypertension.

Further analysis indicated meeting twice minimum physical activity guidelines at 18 years (OR, 0.82; 95% CI, 0.71-0.93; P=.002) and throughout the course of the follow-up (OR, 0.78; 95% CI, 0.66-0.91; P=.002) was associated with lower odds of developing hypertension. Investigators also pointed out having high levels of physical activity at 18 and dramatic subsequent losses, which were defined as an annual loss of more than 2.5 EUs per year, was associated with 4 times greater odds of developing hypertension (aOR, 4.11; 95% CI, 2.58-6.52).

"Teenagers and those in their early twenties may be physically active but these patterns change with age. Our study suggests that maintaining physical activity during young adulthood—at higher levels than previously recommended—may be particularly important,” added senior investigator Kirsten Bibbins-Domingo, MD, PhD, of the UCSF Department of Epidemiology and Biostatistics.

This study, “Physical Activity and Hypertension From Young Adulthood to Middle Age,” was published in the American Journal of Preventive Medicine.