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Should exercise be considered as an alternative to drug treatment in patients with low-risk mild hypertension?
  1. James P Sheppard
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
  1. Correspondence to Dr James P Sheppard, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; james.sheppard{at}phc.ox.ac.uk

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High blood pressure affects one in five adults globally1 and is a major risk factor for cardiovascular disease. Clinical guidelines have traditionally recommended that patients with a sustained clinic blood pressure of ≥140/90 mm Hg be considered for lifestyle or pharmacological intervention, depending on their underlying risk of cardiovascular disease.2 However, recent guidelines from the American College of Cardiology/American Heart Association (ACC/AHA)3 recommended that doctors begin antihypertensive treatment at lower thresholds, based on the results from the Systolic Blood Pressure Intervention Trial (SPRINT).4 This study showed that aggressive treatment to systolic levels below 120 mm Hg can reduce the risk of cardiovascular disease compared with standard targets.4 These recommendations are controversial because they apply the results from a trial which enrolled high-risk individuals, to much larger populations of low-risk patients where there is, as yet, no evidence to support prescription of antihypertensive treatment. Indeed, for patients with low cardiovascular disease risk and ‘mild’ hypertension (ie, sustained blood pressure between 140/90 and 159/99 mm Hg), …

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