Drugs should not be first line of defense against high blood pressure

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Although most people diagnosed with high blood pressure are given prescriptions, a study in Hypertension: Journal of the American Heart Association says that's not the best way to treat the condition. Instead, a program of regular exercise and weight loss can be more effective and far less risky.

Reducing blood pressure through exercise and weight loss could move many people from Stage 1 hypertension into the "high normal" category and many others from "high normal" to "normal," said study author Anastasia Georgiades, Ph.D., of the department of psychiatry and behavioral science at Duke University Medical Center (DUMC), Durham, North Carolina.

Normal blood pressure is a systolic pressure (top number) less than or up to 130 millimeters of mercury (mmHg) and a diastolic pressure (bottom number) up to 85 mmHg. A blood pressure reading of 130-139 systolic over 85-89 diastolic is in the "high normal" range. A person with systolic pressure between 140-159, and diastolic pressure from 90-99mmHg, is said to have Stage 1 hypertension.

The DUMC research placed particular emphasis on the importance of reducing blood pressure at times of increased mental stress.

"Our results show that exercise and weight loss helped to keep blood pressure lower even when individuals were under mental stress," said Dr. Georgiades. "Like high blood pressure itself, an exaggerated cardiovascular response to mental stress is an additional risk factor for heart disease. By lowering stress-induced blood pressure levels and altering other physiological responses to stress, exercise and weight loss may prevent future damage to blood vessels and the heart."

According to the study, exercise and weight management programs also resulted in health benefits such as a lower heart rate, more efficient pumping of the heart, greater dilation of blood vessels and a higher overall level of fitness.

The 99 individuals who completed the six-month study were divided into three groups of subjects who: combined exercise with a calorie- and fat-restricted weight-loss diet; exercised but didn't follow the weight-loss program; and a control group that did neither.

All participants were moderately overweight men and women aged 29 or older with sedentary lifestyles and blood pressures ranging from 130 to 180 systolic and 85 to 105 diastolic.

For individuals in the exercise/weight loss group, systolic pressure dropped an average of eight points, and diastolic pressure declined by an average of six points. In the exercise-only group, the average systolic reading dropped by 3.5 points and the average diastolic reading by five points. Meanwhile, the control group showed a decrease of two points in the average systolic reading, while the diastolic pressure remained unchanged.

"This study shows that exercise in combination with weight loss is an effective drug-free treatment for elevated blood pressure in mild to moderately obese individuals," concluded Dr. Georgiades.

SOURCES: "Work Off High Blood Pressure with Exercise, Not Drugs," American Heart Association, Aug. 18, 2000.

Hypertension, August 2000.

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