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No Drugs, No Diet: The New Prescription for Moderate Hypertension, High Cholesterol

June 23, 2021

The American Heart Association’s tough-love recommendation to the millions of Americans with moderate hypertension and high cholesterol, published in a scientific statement earlier this month in the journal Hypertension, urged instant action.

As in: Drop what you’re doing (after reading this story!) and start moving.

Yes, before taking medication or launching into diet modifications, try a different type of prescription that includes 20 to 30 minutes of moderate-intensity exercise a day, aiming for a weekly total of 150 minutes.

“One of the things that’s so unique about blood pressure is that it responds immediately to exercise,” says Amanda Zaleski, an exercise physiologist with the Hartford HealthCare Heart & Vascular Institute’s Department of Preventive Cardiology. “So if I go for a walk, my blood pressure is going to be five to seven points lower than when I started. And this lasts for 24 hours.”

Close to half of adult Americans have hypertension, or high blood pressure, defined as systolic blood pressure (the “top” number) of at least 130 millimeters of mercury or a diastolic blood pressure (the “bottom” number) of at least 80 mmHg. Anyone with blood pressure of 120-139 mmHg/80-89 mmHg is eligible for lifestyle-first treatment.

Cholesterol is measured three ways: LDL (the “bad cholesterol”), HDL (the “good cholesterol”) and total cholesterol.

LDL readings should be less than 100 milligrams per deciliter (mg/dL). A reading of 130-159 mg/dL is borderline high and 160-189 mg/dL is high. HDL levels should be 60 mg/dL or higher. Total cholesterol for adults should be less than 200 mg/dL. Between 200 and 239 mg/dL is borderline high. Anything 240 mg/dL or higher is high.

Close to 29 million adult Americans have total cholesterol levels higher than 240 mg/dL., according to the Centers for Disease Control and Prevention. More than 93 million adults age 20 and older had total cholesterol levels higher than 200 mg/dL in 2015-16.

“Patients should just focus on dong any type of activity they enjoy,” says Zaleski. “There is going to be a proportion of people who may still need a little bit of help from medication. And that’s OK. . . . There’s some evidence that medications work synergistically with exercise and they can magnify each other. It becomes more of a one plus one equals three and this likely translates to superior clinical benefit.”