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CHAPTER 3 Pre-Exercise Evaluations 47TABLE 3.1. CLASSIFICATION AND MANAGEMENT OF BLOODPRESSURE FOR ADULTS aINITIAL DRUG THERAPYLIFESTYLE WITHOUT WITHBP CLASSI- SBP DPB MODIFICA- COMPELLING COMPELLINGFICATION mm Hg mm Hg TION INDICATION INDICATIONSNormal 120 And 80 EncouragePrehypertension 120–139 Or 80–89 Yes No Drug(s) forantihypertensive compellingdrug indicated indications bStage 1 140–159 Or 90–99 Yes Antihypertensive Drug(s) forhypertension drug(s) compellingindicated indications bOtherantihypertensivedrugs, asneededStage 2 160 Or 100 Yes Antihypertensivehypertensiondrug(s)indicatedTwo-drugcombinationfor most cBP, blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure.Adapted from National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee onPrevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 2003; 3:5233.a Treatment determined by highest BP category.b Compelling indications include heart failure, post–myocardial infarction, high coronary heart disease risk, diabetes,chronic kidney disease, and recurrent stroke prevention. Treat patients with chronic kidney disease or diabetes to BPgoal of 130/80 mm Hg.c Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.Adapted from National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee onPrevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 2003;3:5233.hypertension detection and management (11). Table 3.1 summarizes the JNC7recommendations for the classification and management of BP for adults.The relationship between BP and risk for cardiovascular events is continuous,consistent, and independent of other risk factors. For individuals 40 to 70 years ofage, each increment of 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP doublesthe risk of cardiovascular disease across the entire BP range from 115/75 to 185/115mm Hg. According to JNC7, persons with a systolic BP of 120 to 139 mm Hg or adiastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and requirehealth-promoting lifestyle modifications to prevent cardiovascular disease (2,11).Lifestyle modification—including physical activity, weight reduction (ifneeded), a DASH eating plan (i.e., a diet rich in fruits, vegetables, and low-fatdairy products with a reduced content of saturated and total fat), dietary sodiumreduction (no more than 100 mmol or 2.4 g sodium/day), and moderation of
48 GUIDELINES FOR EXERCISE TESTING • www.acsm.orgalcohol consumption—remains the cornerstone of antihypertensive therapy(2,11). However, JNC7 emphasizes that most patients with hypertension whorequire drug therapy in addition to lifestyle modification require two or moreantihypertensive medications to achieve the goal BP (i.e., 140/90 mm Hg, or130/80 mm Hg for patients with diabetes or chronic kidney disease) (11).LIPIDS AND LIPOPROTEINSThe Third Report of the Expert Panel on Detection, Evaluation, and Treatment ofHigh Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III) outlines theNational Cholesterol Education Program’s (NCEP’s) recommendations for cholesteroltesting and management (Table 3.2) (10). ATP III and subsequent updates bythe National Heart, Lung, and Blood Institute, American Heart Association, andAmerican College of Cardiology identify low-density lipoprotein (LDL) cholesterolas the primary target for cholesterol-lowering therapy (8,10,15). This designation isbased on a wide variety of evidence indicating that elevated LDL cholesterol is aTABLE 3.2. ATP III CLASSIFICATION OF LDL, TOTAL, AND HDLCHOLESTEROL (mgdL 1 )LDL CHOLESTEROL100 aOptimal100–129 Near optimal/above optimal130–159 Borderline high160–189 High190Very highTOTAL CHOLESTEROL200Desirable200–239 Borderline high240HighHDL CHOLESTEROL4060LowHighTRIGLYCERIDES150Normal150–199 Borderline high200–499 High500Very highLDL, low-density lipoprotein; HDL, high-density lipoprotein.a According to the American Heart Association/American College of Cardiology 2006 update (endorsed by the NationalHeart, Lung, and Blood Institute), it is reasonable to treat LDL cholesterol to 70 mgdL 1 (1.81 mmolL 1 ) inpatients with coronary and other atherosclerotic vascular disease (15).NOTE: To convert LDL cholesterol, total cholesterol, and HDL cholesterol from mgdL 1 to mmolL 1 , multiply by0.0259. To convert triglycerides from mgdL 1 to mmolL 1 , multiply by 0.0113.Adapted from National Cholesterol Education Program. Third Report of the National Cholesterol Education Program (NCEP)Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Washington,DC:2002. NIH Publication No. 02–5215.
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