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 5.2 – Classification of physical activity intensity and examples of levels of absolute and relative intensity 9 Classification Absolute intensity Relative intensity Intensity MET Examples % HRmax Talk test Light 1.1 – 2.9 Cycling (< 4.7 km/h), light domestic chores. 50 – 63 Moderate 3.0 – 5.9 Fast walking (4.8–6.5 km/h), slow-cycling (15 km/h), decorating, vacuuming, gardening, golf, tennis (in pairs), ballroom dancing, water aerobics. 64 – 76 Breathing is faster but compatible with complete sentences. Vigorous ≥ 6.0 Running, cycling (> 15 km/h), heavy gardening, swimming, tennis. 77 – 93 Breathing is heavier, incompatible with a comfortable conversation. Metabolic equivalent (MET) is the energy expenditure of an activity divided by the resting energy expenditure: 1 MET = 3.5 mL O 2 kg -1 min -1 oxygen consumption (VO 2 ). HR: heart rate; % HRmax: percentage of the maximum heart rate measured or estimated (220-age). Adapted from the 2016 European Guidelines On Cardiovascular Disease Prevention In Clinical Practice. 9 Table 5.3 – Physical activity to prevent and treat hypertension 147,151-153 Intervention Objective Approximate impact of SBP Hypertension Normotension Aerobic • 90 to 150 min/week • 65 to 75% of HR reserve -5/8 mmHg -2/4 mmHg Dynamic resistance • 90 to 150 min/week • 50 to 80% 1 rep maximum • 6 exercises, 3 sets/exercise, 10 repetitions/set -4 mmHg -2 mmHg Isometric resistance • 4 × 2 min (handgrip), 1 min of rest between exercises, 30 to 40% of maximum voluntary contraction, 3 sessions/week • 8 to 10 weeks -5 mmHg -4 mmHg 5.3. Psychosocial Factors Some psychosocial factors, such as work and family stress, depression, anxiety, hostility, and type D personality, as well as low socioeconomic and cultural status, increase the risk for AH – and consequently CVD – and reduce the adherence to a healthy lifestyle and drug treatment. On the other hand, CVD also increase the risk of manifesting these psychosocial factors, indicating a bidirectional and robust relationship. 154 Moreover, the prevalence of CVD and AH is higher in developing countries, where the control rate of these diseases tends to be poor, decreasing life expectancy and increasing the pathologies and frailties related to aging. 155 Several prospective studies and systematic reviews have addressed socioeconomic status, showing that low schooling and income, low-status jobs, as well as living in poor residential areas are associated with the increase in BP levels and consequently CV risk. 156,157 Individuals with mood and personality disorders present an increase in the incidence and worsening of the prognosis of CVD, especially among those with depression or anxiety. 157 Similarly, personality traits associated with hostility or distress also worsen the prognosis. 158 The management of psychosocial stress with several existing techniques, among themmeditation, music therapy, yoga, and slow breathing, can be crucial in preventing and controlling BP. In general, such techniques can mildly reduce BP levels in hypertensive individuals. 159,160 5.4. Diets that Promote the Prevention and Control of Arterial Hypertension In 2017, the Global Burden of Disease Group considered unhealthy diet as one of the main as risk factors for premature death and disability. 161 Adjustments in the diet of individuals with normotension (NT) or pre-hypertension (PH) have the potential of reducing BP and preventing AH. 162 National and international guidelines recommend that all patients with PH or AH reduce their sodium intake and consume adequate amounts of fresh fruit, vegetables, and low-fat dairy products. 163 Furthermore, these documents emphasize the importance of maintaining body weight and waist circumference within the normal range. 164 Many dietary patterns have been proposed to prevent and control AH, as well as maintain global and CV health. Among the dietary models proposed, with different levels of evidence and effectiveness to prevent and control AH, we highlight the Dietary Approaches to Stop Hypertension (DASH), low-fat, high-protein, low-carbohydrate, moderate carbohydrate, low- glycemic index/low-glycemic load, low-sodium, vegetarian/ vegan, Mediterranean, paleolithic, Nordic, and Tibetan 165 (Chart 5.1). A meta-analysis of 67 studies published between 1981 and 2016 compared the effects of these dietary patterns on patients with PH and AH. DASH, Mediterranean, low-carbohydrate, paleolithic, high-protein, low-glycemic index, low-sodium, and low-fat were significantly more effective in reducing 813