Treatment for preventing or reversing hypertension and cardiovascular aging

Treatment is composed mainly of life-style interventions and medication. The life-style interventions are usually directed to exercise or nutrition. Smoking and excessive alcohol consumption should be avoided. Exercise is one of the most effective factors to prevent or even to reverse stiffening of arteries and the cardiac muscle. There are different opinions of the quantity of the exercise leading to the best results. However, there is evidence that low doses of casual, lifelong exercise does not prevent hypertension and cardiovascular aging dependent stiffening of arteries and the cardiac muscle observed with healthy, sedentary aging. In contrast, 4 to 5 exercise sessions/week throughout adulthood may prevent most of the age-related stiffening. Also it has been found that a single bout of acute aerobic exercise reduces ambulatory blood pressure during 24 hours in medicated and nonmedicated hypertensive adults.

Nutrition is the other important life-style factor. Smoking and excessive alcohol consumption should be avoided. Generally accepted is the Dietary Approaches to Stop Hypertension (DASH) diet, added by significantly reduced sodium intake. The DASH diet emphasizes fruit, vegetables, and low fat dairy products, and includes whole grain, poultry, fish and nuts, and contains only small amounts of red meat, sweets, and sugar containing beverages and decreased amounts of total and saturated fat and cholesterol.

This diet lowers blood pressure substantially both in people with hypertension and those without hypertension, as compared with a typical diet in US. Medication is needed, if life-style interventions are not effective enough. Most often general hypertension medication is used. Genetics and Epigenetics may play a vital role in the efficacy of life-style based interventions as well. For instance, extreme variability exists in individual responses to exercise, and genetics and epigenetics appear to play an important role in determining the extent of these differences. The most promising interventions may be those which incorporate multiple components.

However, for instance, exercise and prescription medication exhibit a variety of biologic interactions whereby one intervention can be critical to the proper prescription of the other. In one direction, exercise has the ability to alter drug pharmacokinetics by altering hemodynamic and metabolic parameters. Conversely, many drug therapies have the ability to impact exercise performance. While these treatments may have negative interactions that must be considered, they may also prove to be beneficial as well like potentially beneficial effects of antihypertensive medications and physical exercise on physical function.

Thus medication and life-style interventions and their combinations must be personalized. It has been found that most of hypertension and cardiovascular aging dependent stiffness of arteries and the cardiac muscle can be prevented by personalized life-style interventions or medication or a combination of them. If the aging of a population can be retarded by 15-20 years, it is, according to the US statistics 2019, possible to save yearly about 130 billion dollars in US and 2 billions in Finland in the costs of cardiovascular diseases in the age group of 45-79 years.

ESSENTIAL REFERENCES

1. Bhella PS, Hastings JL, Fujimoto N et al. Impact of lifelong exercise ”dose” on left ventricular compliance and distensibility. J Am Coll Cardiol. 2014; 64: 1257-1266.

2. Lund Rasmussen C, Nielsen L, Linander Henriksen M et. al. Acute effect on ambulatory blood pressure from aerobic exercise: a randomised cross-over study among female cleaners. European Journal of Applied Physiology 2018; 118: 331-338.

3. Saco-Ledo G, Valezuela PL, Ramìrez-Jimènez M et al. Acute aerobic exercise induces short-term reductions in ambulatory blood pressure in patients with hypertension: asystematic review and meta-analysis. Hypertension 2021; 78: 1844-1858.

4. Sacks FM, Svetkey LP, Vollmer WM et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (Dash) diet. N Engl J Med 2001; 344: 3-10.

5. Filippou CD, Tsioufis CP, Thomopoulos CG et al. Dietary approaches to stop hypertension (Dash) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr 2020; 11: 1150-1160. 6.Buford TW. Hypertension and aging. Ageing Res Rev. 2016; 26: 96-111.