p.22 抽出テキスト

Arnett et al 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678 September 10, 2019 e617 CLINICAL STATEMENTS AND GUIDELINES

were seen in stroke and all-cause death at SBP <130 mm Hg and in stroke at DBP <80 mm Hg.S4.4-37 SPRINT (Systolic Blood Pressure Intervention Trial) provides additional support for the use of BP-lowering medications in patients without CVD at SBP levels ≥130 mm Hg.S4.4-34

Antihypertensive drug treatment that is based on overall ASCVD risk assessment combined with BP levels may prevent more CVD events than treatment that is based on BP levels alone.S4.4-67–S4.4-70 These meta-analyses are consistent in concluding that lowering of BP results in larger absolute risk reduction in higher-risk individuals, regardless of baseline treated or untreated BP ≥130/80 mm Hg and irrespective of the specific cause of elevated risk. These analyses indicate that the benefit of

Table 7.  Best Proven Nonpharmacological Interventions for Prevention and Treatment of Hypertension*

Nonpharmacological

Intervention Goal Approximate Impact on SBP

Hypertension Normotension Reference

Weight loss Weight/body fat Best goal is ideal body weight, but aim for at least a 1-kg reduction in body weight for most adults who are overweight. Expect about 1 mm Hg for every 1-kg reduction in body weight. -5 mm Hg -2/3 mm Hg S4.4-2 Healthy diet DASH dietary pattern† Consume a diet rich in fruits, vegetables, whole grains, and low-fat dairy products, with reduced content of saturated and total fat. -11 mm Hg -3 mm Hg S4.4-7, S4.4-8 Reduced intake of dietary sodium Dietary sodium Optimal goal is <1500 mg/d, but aim for at least a 1000-mg/d reduction in most adults. -5/6 mm Hg -2/3 mm Hg S4.4-10, S4.4-12 Enhanced intake of dietary potassium Dietary potassium Aim for 3500–5000 mg/d, preferably by consumption of a diet rich in potassium. -4/5 mm Hg -2 mm Hg S4.4-14 Physical activity Aerobic 90–150 min/wk 65%–75% heart rate reserve -5/8 mm Hg -2/4 mm Hg S4.4-19, S4.4-20

Dynamic resistance 90–150 min/wk 50%–80% 1 rep maximum 6 exercises, 3 sets/exercise, 10 repetitions/set -4 mm Hg -2 mm Hg S4.4-19 Isometric resistance 4 × 2 min (hand grip), 1 min rest between exercises, 30%–40% maximum voluntary contraction, 3 sessions/wk 8–10 wk -5 mm Hg -4 mm Hg S4.4-21, S4.4-78

Moderation in alcohol intake Alcohol consumption In individuals who drink alcohol, reduce alcohol‡ to: Men: ≤2 drinks daily Women: ≤1 drink daily -4 mm Hg -3 mm Hg S4.4-20, S4.4-24,

S4.4-25

*Type, dose, and expected impact on BP in adults with a normal BP and with hypertension. †Detailed information about the DASH diet is available via the NHLBIS4.4-81 and Dashdiet.org.S4.4-82 ‡In the United States, 1 “standard” drink contains roughly 14 g of pure alcohol, which is typically found in 12 oz of regular beer (usually about 5% alcohol), 5 oz of wine (usually about 12% alcohol), and 1.5 oz of distilled spirits (usually about 40% alcohol).S4.4-80

BP indicates blood pressure; DASH, Dietary Approaches to Stop Hypertension; NHLBI, National Heart, Lung, and Blood Institute; and SBP, systolic blood pressure. Reproduced with permission from Whelton et al.S4.4-1 Copyright © 2017, American College of Cardiology Foundation and the American Heart Association, Inc.

Figure 4. BP thresholds and recommendations for treatment. Colors correspond to Class of Recommendation in Table 1. BP indicates blood pressure; and CVD, cardiovascular disease. Adapted with permission from Whelton et al.S4.4-1 Copyright © 2017, American College of Cardiology Foundation and the American Heart Association, Inc.

Downloaded from http://ahajournals.org by on October 7, 2026