The Reply

Abstract

We recently applied the lower blood pressure thresholds included in the 2017 American College of Cardiology/American Heart Association high blood pressure guidelines1 Whelton PK Carey RM Aronow WS Casey Jr., DE Collins KJ Dennison Himmelfarb C DePalma SM Gidding S Jamerson KA Jones DW MacLaughlin EJ Muntner P Ovbiagele B Smith Jr., SC Spencer CC Stafford RS Taler SJ Thomas RJ Williams Sr., KA Williamson JD Wright Jr., JT 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2018; 71: e127-e248https://doi.org/10.1016/j.jacc.2017.11.006Crossref PubMed Scopus (0) Google Scholar to participants enrolled in SPRINT (Systolic Blood Pressure Intervention Trial).2Vaduganathan M, Pareek M, Qamar A, Pandey A, Olsen MH and Bhatt DL. Baseline Blood Pressure, the 2017 ACC/AHA High Blood Pressure Guidelines, and Long-Term Cardiovascular Risk in SPRINT. Am J Med. 2018 (in press).Google Scholar We estimated that this recent iteration of clinical practice guidelines would be expected to increase the prevalence of hypertension and identify a greater proportion of patients who will ultimately experience adverse cardiovascular events. Broad-scale cardiovascular risk reduction strategies are thus needed to lessen this potential population-level burden of cardiovascular disease. We entirely agree with Leggio and colleagues,3Leggio M Caldarone E Lombardi M D'Emidio S Severi P Bendini MG Mazza A Fusco A The Role of Physical Activity in the New 2017 ACC/AHA Blood Pressure Guidelines.Am J Med. 2018; (in press)PubMed Google Scholar who highlight the central role of non-pharmacologic interventions, including physical activity, in achieving blood pressure targets in clinical practice. Indeed, in the standard treatment arm of the SPRINT trial, we found that patients newly reclassified as having hypertension based on the 2017 American College of Cardiology/American Heart Association guidelines were younger with higher body mass index compared with those identified in prior guidelines.2Vaduganathan M, Pareek M, Qamar A, Pandey A, Olsen MH and Bhatt DL. Baseline Blood Pressure, the 2017 ACC/AHA High Blood Pressure Guidelines, and Long-Term Cardiovascular Risk in SPRINT. Am J Med. 2018 (in press).Google Scholar Non-ideal body weight and physical inactivity are highly prevalent, modifiable public health risks. Physical activity is a core health behavior included in the American Heart Association's My Life Check - Life's Simple 7 and is known to have dose-dependent cardiometabolic health benefits, yet less than a quarter of US adults meet current physical activity recommendations. A recent scientific statement focused on the practical promotion of physical activity in clinical, workplace, and community settings.4Lobelo F Rohm Young D Sallis R Garber MD Billinger SA Duperly J Hutber A Pate RR Thomas RJ Widlansky ME McConnell MV Joy EA Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association.Circulation. 2018; 137: e495-e522https://doi.org/10.1016/j.jacc.2017.11.006Crossref PubMed Scopus (2616) Google Scholar Physical activity can be reliably assessed, prescribed, and tailored to at-risk individuals and will serve as a key adjunctive measure to pharmacological interventions in meeting current blood pressure targets and advancing cardiovascular health.