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Are subjective measures the answer to assess physical inactivity on a daily basis in patients with resistant hypertension?

Journal of Human Hypertension volume 35, pages 1180–1182 (2021)Cite this article

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Physical activity (PA) has indisputable benefits to prevent, control, and treat hypertension. An inverse dose–response relationship between PA and incident hypertension has been reported among adults with normal blood pressure and a reduction of the risk of cardiovascular disease progression has been found with increased PA among adults with hypertension [1]. Although vast research and guidelines strongly recommend PA for the prevention and management of hypertension, population levels of PA have remained flat [2]. Estimates indicate that ~25–30% of the global population fails to meet physical PA guidelines [3]. Physical inactivity and sedentary behavior are a persistent public health problem and a major modifiable risk factor worldwide for cardiovascular disease (CVD) and all-cause mortality. The 2018 European hypertension guidelines [4] recommend lifestyle advice, including PA, as a first line treatment for patients with hypertension. Nonetheless, the appropriate and regular assessment of PA is determinant for an effective promotion of active lifestyles. Indeed, the American Heart Association recommends that PA assessment should be a priority in all visits to health settings [2]. Two typically suggested methods for capturing PA levels are self-reports and wearable devices such as accelerometers [2]. Accelerometers allow an objective and continuous measure of PA [5]. However, data collection is very dependent on compliance by the participant to wear the device [5]. Also, the duration of the protocol, equipment cost, and necessary time to download, process and treat all the PA data, make the objective assessment of PA impractical on a daily basis in a clinical practice setting. Self-reported measures, such as questionnaires, are generally feasible and can assess all types of PA, including stationary activities and water activities [6]. They can also cover long time frames. However, PA questionnaires may also over- or underestimate participants’ PA [5, 6]. Some systematic reviews have reported the agreement between accelerometers and self-reported measures and have found weak to moderate correlations in healthy adult populations [5, 6]. The Brief Physical Activity Assessment Tool (BPAAT) is a short, 2-question tool, originally developed to enable family doctors to identify insufficiently active adults [7]. Given the scarcity of consultation time, a fast and easy to apply tool is a key factor for daily use. The BPAAT classification categories showed good construct validity (0.40 ≤ Kappa ≤ 0.64 [7,8,9]; sensitivity = 0.75 95%CI: 0.70–0.79, and specificity = 0.74 95%CI: 0.71–0.77 [9]) in patients with various health conditions, when compared to accelerometry and to other PA questionnaires [9, 10]. Nonetheless, to the best of our knowledge, no data is yet available for participants with resistant hypertension. Hence, this study aims to determine if the BPAAT is a valid instrument to detect inactive patients with resistant hypertension.

In this cross-sectional study, sixty patients, aged between 40 and 75 years, with resistant hypertension (according to the American Heart Association scientific statement [11]) were prospectively recruited from the hypertension outpatient clinic in two hospitals in Portugal. Exclusion criteria were secondary hypertension, evidence of target organ damage, heart failure, acute cardiovascular event in the previous year, peripheral artery disease, renal failure, chronic obstructive pulmonary disease, change of antihypertensive medication in the past 3 months before inclusion in the study, limitations to PA and regular engagement in exercise training. The hospital ethics committee approved the study (N/Ref. 073619, 21/09/2016). The participants provided written informed consent, and all the procedures were conducted according to the Declaration of Helsinki.

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Fig. 1: Physical activity assessment by the Brief Physical Activity Assessment Tool and accelerometry in patients with resistant hypertension.

References

  1. Pescatello LS, Buchner DM, Jakicic JM, Powell KE, Kraus WE, Bloodgood B, et al. Physical activity to prevent and treat hypertension: a systematic review. Med Sci Sports Exerc. 2019;51:1314–23.

    Article  Google Scholar 

  2. Lobelo F, Rohm Young D, Sallis R, Garber MD, Billinger SA, Duperly J, et al. Routine assessment and promotion of physical activity in healthcare settings: a scientific statement from the American Heart Association. Circulation. 2018;137:e495–e522.

    Article  Google Scholar 

  3. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380:247–57.

    Article  Google Scholar 

  4. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021–104.

    Article  Google Scholar 

  5. Skender S, Ose J, Chang-Claude J, Paskow M, Brühmann B, Siegel EM, et al. Accelerometry and physical activity questionnaires—a systematic review. BMC Public Health. 2016;16:515.

    Article  Google Scholar 

  6. Helmerhorst HJ, Brage S, Warren J, Besson H, Ekelund U. A systematic review of reliability and objective criterion-related validity of physical activity questionnaires. Int J Behav Nutr Phys Act. 2012;9:103.

    Article  Google Scholar 

  7. Marshall AL, Smith BJ, Bauman AE, Kaur S. Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med. 2005;39:294–7.

    Article  CAS  Google Scholar 

  8. Puig Ribera A, Peña Chimenis Ò, Romaguera Bosch M, Duran Bellido E, Heras Tebar A, Solà Gonfaus M, et al. Cómo identificar la inactividad física en atención primaria: validación de las versiones catalana y española de 2 cuestionarios breves. Aten Primaria. 2012;44:485–93.

    Article  Google Scholar 

  9. Puig-Ribera A, Martín-Cantera C, Puigdomenech E, Real J, Romaguera M, Magdalena-Belio JF, et al. Screening physical activity in family practice: validity of the Spanish version of a brief physical activity questionnaire. PLoS One. 2015;10:1–16.

    Google Scholar 

  10. Smith BJ, Marshall AL, Huang N. Screening for physical activity in family practice: evaluation of two brief assessment tools. Am J Prev Med. 2005;29:256–64.

    Article  Google Scholar 

  11. Calhoun JonesDW, Textor SC, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008;51:1403–19.

    Article  CAS  Google Scholar 

  12. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30:777–81.

    Article  CAS  Google Scholar 

  13. Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Heal. 2018;6:e1077–86.

    Article  Google Scholar 

  14. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159.

    Article  CAS  Google Scholar 

  15. Ranganathan P, Pramesh CS, Aggarwal R. Common pitfalls in statistical analysis: measures of agreement. Perspect Clin Res. 2017;8:187–91.

    Article  Google Scholar 

  16. Noubiap JJ, Nansseu JR, Nyaga UF, Sime PS, Francis I, Bigna JJ. Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart. 2019;105:98–105.

    Article  Google Scholar 

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Acknowledgements

This work was supported by FEDER Funds through the Operational Competitiveness Factors Program—COMPETE and by National Funds through the Portuguese Foundation for Science and Technology (FCT) within the project “PTDC/DTP-DES/1725/2014”. SL is a PhD fellow supported by the FCT (Grant Ref: SFRH/BD/129454/2017).

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Authors and Affiliations

  1. School of Health Sciences and Institute of Biomedicine—iBiMED, University of Aveiro, Aveiro, Portugal

    Susana Lopes & Fernando Ribeiro

  2. School of Health Sciences, University of Aveiro, Aveiro, Portugal

    José Mesquita-Bastos

  3. Research Center in Sports Sciences, Health and Human Development, CIDESD, University Institute of Maia, Maia, Portugal

    Catarina Garcia & Alberto Jorge Alves

  4. Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal

    Daniela Figueiredo

  5. Cardiology Department, Hospital Infante D.Pedro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal

    José Mesquita-Bastos & Pedro Carvalho

  6. Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal

    José Oliveira

  7. Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal

    José Oliveira

  8. Faculty of Medicine, University of Porto, Porto, Portugal

    Jorge Polónia

  9. Hypertension Unit, ULS, Matosinhos, Portugal

    Jorge Polónia

  10. OncoMove, Associação de Investigação de Cuidados de Suporte em Oncologia—AICSO, Vila Nova de Gaia, Portugal

    Alberto Jorge Alves

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  1. Susana Lopes
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Correspondence to Susana Lopes.

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Lopes, S., Mesquita-Bastos, J., Garcia, C. et al. Are subjective measures the answer to assess physical inactivity on a daily basis in patients with resistant hypertension?. J Hum Hypertens 35, 1180–1182 (2021). https://doi.org/10.1038/s41371-021-00579-4

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