Study in polluted Taiwan shows regular exercise still prevents high blood pressure

People who regularly exercise are at a lower risk of high blood pressure, even if they live in highly polluted areas, found a new research, since the risk-benefit relationship between air pollution and physical activity is a major concern as more than 91% of people worldwide live in areas where air quality fails to meet World Health Organization (WHO) guidelines.

The paper published in the American Heart Association’s flagship journal Circulation, is based on a study of more than 140,000 adults without high blood pressure in Taiwan, who are followed for five years. Researchers classified the weekly physical activity levels of each adult as inactive, moderately active or highly active.

Researchers also classified level of exposure to fine particulate matter (PM2.5) as low, moderate and high. PM2.5 is the most commonly used indicator of air pollution. High blood pressure was defined as 140/90 mm Hg, though the American Heart Association 2017 Guideline defines high blood pressure as 130/80 mm Hg.

Exercise helps despite high pollution 

Study author Xiang Qian Lao, an associate professor at the Jockey Club School of Public Health and Primary Care at The Chinese University of Hong Kong in Shatin, said: “While we found that high physical activity combined with lower air pollution exposure was linked to lower risk of high blood pressure, physical activity continued to have a protective effect even when people were exposed to high pollution levels. The message is that physical activity, even in polluted air, is an important high blood pressure prevention strategy.”

Highlights of the study show that people who are highly active and exposed to low levels of pollution had a lower risk of developing high blood pressure, whereas those who were inactive and exposed to highly polluted air had a higher high blood pressure risk.

High risk levels

Each increase in PM2.5 level was associated with a 38% increase in risk of incident hypertension, whereas each increase in physical activity level lead to a 6% lower risk of hypertension, suggesting that reducing air pollution is more effective in preventing high BP.

Regardless of pollution level, people who exercised moderately had a 4% lower risk of high blood pressure than those who didn’t exercise. People who exercised at a high level had a 13% lower risk of high blood pressure than those who don’t.

The findings of this study are limited to air pollution because it only included people living in Taiwan, where ambient air was moderately polluted (the annual PM2.5 concentration was 2.6 times of the limit recommended by the World Health Organization).

High salt intake associated with doubled risk of heart failure

High salt intake is associated with a doubled risk of heart failure, according to a 12-year study in more than 4 000 people presented today at ESC Congress.1

“High salt (sodium chloride) intake is one of the major causes of high blood pressure and an independent risk factor for coronary heart disease (CHD) and stroke,” said Prof Pekka Jousilahti, research professor at the National Institute for Health and Welfare, Helsinki, Finland. “In addition to CHD and stroke, heart failure is one of the major cardiovascular diseases in Europe and globally but the role of high salt intake in its development is unknown.”

This study assessed the relationship of salt intake and the development of heart failure. Estimation of individual salt intake is methodologically demanding and therefore suitable population-based cohorts are rare. This study used 24 hour sodium extraction, which is considered the gold standard for salt intake estimation at individual level.

This was a prospective follow-up study of 4 630 randomly selected men and women aged 25 to 64 years at baseline who participated in the North Karelia Salt Study and the National FINRISK Study between 1979 and 2002 in Finland. Baseline data collection included a self-administered questionnaire on health behaviour, measurements of weight, height and blood pressure, a venous blood sample for laboratory analysis, and collection of a 24 hour urine sample.

At the study site, nurses measured urine volume and took a 100 ml sample for laboratory analysis. One gram of salt intake was calculated as equal to 17.1 mmol sodium excretion.

The study cohort was followed up for 12 years through computerised register linkage to National Health Records. Cases of incident heart failure were identified from the Causes of Death Register, the Hospital Discharge Register and drug reimbursement records. The association of salt intake in quintiles (<6.8g, 6.8-8.8g, 8.8-10.9g, 10.96-13.7g and >13.7g/day) and the risk of an incident new heart failure event was estimated.

During the follow-up, 121 men and women developed new heart failure. In an age, sex, study year and area adjusted model, hazard ratios in the 2nd, 3rd, 4th and 5th salt intake quintiles, compared to the 1st one, were: 0.83, 1.40, 1.70 and 2.10. After further adjustment for systolic blood pressure, serum total cholesterol level and body mass index the hazard ratios were: 1.13, 1.45, 1.56 and 1.75, respectively.

Prof Jousilahti said: “The heart does not like salt. High salt intake markedly increases the risk of heart failure. This salt-related increase in heart failure risk was independent of blood pressure.”

“People who consumed more than 13.7 grams of salt daily had a two times higher risk of heart failure compared to those consuming less than 6.8 grams,” he continued. “The optimal daily salt intake is probably even lower than 6.8 grams. The World Health Organization recommends a maximum of 5 grams per day and the physiological need is 2 to 3 grams per day.”

Prof Jousilahti concluded: “Studies in larger, pooled population cohorts are needed to make more detailed estimations of the increased heart failure risk associated with consuming salt.”