ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Table 5.1 – Classification of blood pressure according to measurements taken casually or at the doctor's office in individuals aged 18 years and older 146 Classification SBP (mmHg) DBP (mmHg) Normal ≤ 120 ≤ 80 Pre-hypertension 121-139 81-89 Stage 1 hypertension 140-159 90-99 Stage 2 hypertension 160-179 100-109 Stage 3 hypertension ≥ 180 ≥ 110 When SBP and DBP are in different categories, the BP classification should assume the higher one Isolated systolic hypertension is determined when SBP ≥ 140 mmHg and DBP < 90 mmHg, and should be classified into stages 1, 2, or 3 BP: blood pressure; DBP: diastolic blood pressure; SBP: systolic blood pressure. 5. Arterial Hypertension 5.1. Introduction AH is the most prevalent chronic disease in the world, affecting approximately one-third of the adult population. BP is maintained by several factors, particularly the intravascular volume, cardiac output, peripheral vascular resistance, and the elasticity of arterial vessels. Among the various regulatory mechanisms, RAAS – involving the renal system – has significant participation; an imbalance in this complex regulatory system, however, can result in chronic elevation of BP levels, known as AH. AH is one of the most important CV risk factors, as hypertensive individuals present much more atherosclerosis, leading to CVA, HF, coronary disease, peripheral vascular insufficiency, and kidney disease. 145 Although we have efficient drugs with few adverse effects, the worldwide control of this condition still leaves much to be desired, since we are dealing with completely asymptomatic disease, a fact that makes care adherence very difficult. According to the 7 th Brazilian Guideline of Arterial Hypertension, an individual is hypertensive when his or her SBP and diastolic blood pressure (DBP) are equal to or higher than 140/90 mmHg (Table 5.1). 146 Figure 5.1 shows the flowchart for the diagnosis of hypertension. The genesis of primary AH is multifactorial, with genetic and environmental influences. Although the genetic mechanisms involved are still obscure, there is evidence that children of hypertensive individuals have a greater chance of becoming hypertensive. However, the environmental aspect has an essential role in the development of AH. As the individual ages, the prevalence of AH increases significantly; therefore, detecting predisposing factors is important to prevent this critical CV risk factor properly. Besides family history, age, ethnicity, and insulin resistance, there are also environmental factors related to the development of AH that can be modified, such as obesity, psychosocial aspects, diet, sodium intake, sedentary lifestyle, and alcohol consumption. 5.2. Physical Activity and Hypertension Epidemiological studies suggest that regular aerobic physical activity can be beneficial in preventing and treating hypertension, as well as reducing CV risk and mortality. A meta-analysis with 93 articles and 5,223 individuals showed that aerobic training, dynamic resistance, and isometric resistance reduce SBP and DBP at rest by 3.5/2.5, 1.8/3.2, and 10.9/6.2 mmHg, respectively, in the general population. 147 Resistance training, but not other types of training, further reduces BP in hypertensive individuals (8.3/5.2 mmHg). Regular physical activity of lower intensity and duration reduces BP less than moderate or vigorous training but is associated with a decrease in mortality by at least 15% in cohort studies. 148,149 This evidence suggests that hypertensive patients should be advised to practice dynamic aerobic exercise of moderate intensity (walking, running, cycling, or swimming) for at least 30 minutes 5 to 7 days per week. The practice of resistive exercises 2 to 3 days per week could also be recommended. Also, healthy adults could benefit from gradually increasing moderate aerobic physical activity to 300 minutes per week, vigorous aerobic physical activity to 150 minutes per week, or an equivalent combination of the two, ideally with supervised daily exercise. 6,9 The impact of isometric exercises on BP and CV risk is less well established. Table 5.2 demonstrates the classification of physical activity intensity and the levels of absolute and relative intensity. Table 5.3 shows the v goals to prevent and treat AH. Table 4.1 – Recommendations on how to approach overweight and obese adults Recommendation Recommendation grade Level of evidence Reference Weight loss is recommended for overweight and obese individuals to improve their CV risk profile I B 2,9,128 Counseling and interventions addressing lifestyle, including caloric restriction, aimed at achieving and maintaining weight loss are recommended for overweight and obese adults I B 2,9,128 Calculate the BMI and anthropometric measures during medical appointments to identify overweight and obese adults with the purpose of intervention I C 2,9,128 Measure the waist circumference to identify individuals with higher cardiometabolic risk IIa B 2,9,128 BMI: body mass index; CV: cardiovascular. 812