Aislinn Antrim, Associate Editor

The first step to address mild to moderately elevated blood pressure and cholesterol in otherwise healthy adults should be advising them to sit less and move more, according to a new scientific statement published in 

An estimated 21% of adults in the United States have systolic blood pressure between 120- and 139-mm Hg, or diastolic blood pressure between 80- and 89-mm Hg, according to the American Heart Association (AHA). Both of these values are abnormally high and meet the American College of Cardiology (ACC)/AHA High Blood Pressure Guideline criteria for lifestyle-only treatment for elevated blood pressure.

Similarly, the scientific statement authors estimated that 28% of adults in the United States have an LDL cholesterol score above 70 mg/dL and otherwise meet criteria for low risk of heart disease or stroke. This patient population would meet the 2018 ACC/AHA Cholesterol Treatment Guidelines criteria for lifestyle-only treatment, which includes increased physical activity, weight loss, improving diet, smoking cessation, and moderating alcohol intake.

“The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks,” said Bethany Barone Gibbs, PhD, FAHA, chair of the statement writing group, in a press release. “The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity.”

Increasing physical activity has been shown to result in clinically meaningful reductions in both systolic and diastolic blood pressure, typically with an average reduction of 3- or 4-mm Hg. Similar improvements have been seen with blood cholesterol, according to the press release. The statement emphasized research demonstrating that physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to those who are not physically active.

According to the AHA, a “prescription” for increased exercise includes several steps. Health care providers should screen patients about their physical activity at every interaction, whether by asking a few questions or by having patients use a wearable device. Health professionals should also provide ideas and resources for supporting patients to improve and sustain regular physical activity.

Importantly, providers should help patients find activities that they enjoy and should provide ideas for early success in order to optimize the patient’s chances of implementing a life-long change. Similarly, encouraging and celebrating small improvements and increases in physical activity, such as walking more or taking the stairs, can keep patients motivated.

“Even small initial increases of 5 to 10 minutes a day can yield health benefits,” Gibbs said in the press release.

To improve overall health, the US Department of Health and Human Services 2018 Physical Activity Guidelines for Americans recommend that individuals participate in either a cumulative 150 minutes of moderate intensity aerobic exercise or 75 minutes of vigorous aerobic activity weekly, in addition to 2 or more strength training sessions each week.

“In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit—and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus—the message that we must be relentless in our pursuit to ‘sit less and move more’ throughout the day is more important than ever,” Gibbs concluded.

“Prescription” to sit less, move more advised for mildly high blood pressure & cholesterol [news release]. American Heart Association; June 2, 2021. 

https://newsroom.heart.org/news/prescription-to-sit-less-move-more-advised-for-mildly-high-blood-pressure-cholesterol?preview=9fe0

Articles

Health care professionals can help patients improve mild to moderate hypertension and elevated cholesterol by encouraging them to find activities they enjoy and celebrating small improvements.

Improving Blood Pressure, Cholesterol With Increased Physical Activity

Switching to a high-deductible health plan (HDHP) is not associated with changes in asthma exacerbations or asthma medication use when medications are exempted from the deductible, according to research results published in 

Clinical guidelines for pediatric asthma recommend the use of controller medications, though the investigators noted in a statement that adherence to these medications is generally suboptimal. Not taking medications as prescribed can lead to exacerbations, and high out-of-pocket costs have been associated with decreased controller medication use and adverse asthma outcomes.

Most research on HDHPs has focused on adult patients, according to the statement.

The new study, however, examined how enrollment in HDHPs may affect asthma controller medication use and exacerbations in children.

The study population included children ages 4 to 17 and adults ages 18 to 64 and was drawn from a commercial, large national database. Participants had persistent asthma and switched from traditional plans to HDHPs during a 24-month study period.

The investigators found that compared with those who remained in traditional plans, children who switched to HDHPs experienced small decreases in annual 30-day fills for inhaled corticosteroid-long-acting beta agonist medications but not for other controller medications.

Adults switching to HDHPs did not have significant reductions in 30-day fills for any asthma controller medications, according to the statement.

“One challenge of insurance design is balancing affordable coverage with access to necessary care for chronic conditions for both children and adults,” team leader Alison Galbraith, MD, MPH, associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute in Boston, said in the statement. “Our findings highlight the potential protective effect of exempting asthma medications from the deductible in high-deductible health plans.”

The investigators found no statistically significant differences in asthma-related emergency department visits, medication adherence, or oral steroid bursts for either adults or children.

Future areas of research could focus on the impact of value-based insurance designs on asthma control and medication adherence, Galbraith said.

“Asthma is a major cause of preventable disease burden for both children and adults,” she said. “Policy makers should consider adopting value-based designs and other policies exempting important medications for asthma and other chronic conditions—which might prevent adverse clinical outcomes—from the deductible.”

Asthma Medication Use and Exacerbations. Press Release. Harvard Pilgrim Health Care Institute; May 25, 2021. Accessed May 26, 2021. 

https://www.populationmedicine.org/press/GalbraithJAMAPeds0521

Individuals who switched to high-deductible health plans had small decreases in annual 30-day fills for inhaled corticosteroid-long-acting beta agonists but not for other controller drugs.

HDHPs Do Not Affect Asthma Exacerbations, Medication Use for Children

Americans who are fully vaccinated against the coronavirus disease 2019 (COVID-19) no longer need to wear masks when outside alone, with members of their household, or when attending small outdoor gatherings, according to new CDC guidelines released Tuesday.

When choosing activities and debating whether to wear a mask, the guidelines said Americans should consider how COVID-19 is spreading in their community, the number of people they will be around, and whether the activity will be outside. Outdoor visits and activities are still safer than indoor options, for both vaccinated and unvaccinated people, although the guidelines said fully vaccinated individuals can safely participate in some indoor events.

The CDC maintained its earlier recommendations for some safety measures, however, such as advising vaccinated adults to continue wearing masks and staying socially distanced when at outdoor performances or sporting events, when visiting indoor shopping malls or movie theaters, and anywhere where the vaccination and health status of nearby people is unknown. Regardless of vaccination status, the guidelines said people should still avoid large gatherings, crowds, and spaces that are not well ventilated.

The guidelines listed a wide range of activities and where vaccinated and unvaccinated people would be safest, less safe, and least safe. Although all activities were deemed “safest” for fully vaccinated people with masks, unvaccinated people with masks were only considered “less safe” or “least safe.”

Some indoor, less safe activities for unvaccinated people with a mask included visiting a barber or hair salon; going to an uncrowded, indoor shopping center or museum; riding public transport with limited occupancy; and attending a small, indoor gathering of people from multiple households. Some activities deemed “least safe” for unvaccinated people—even with mask-wearing—include going to an indoor movie theater; attending a full-capacity worship service; singing in an indoor chorus; eating at an indoor restaurant or bar; and participating in an indoor, high intensity exercise class.

Both vaccinated and unvaccinated people can walk, run, or bike outdoors with members of their household or attend small, outdoor gatherings with fully vaccinated family and friends without a mask, according to the guidelines. Fully vaccinated people do not need to wear masks to attend a small, outdoor gathering with fully vaccinated or unvaccinated people, although unvaccinated people should still wear masks at these events. Vaccinated people also do not need to wear a mask when dining at an outdoor restaurant with friends from multiple households, although the guidelines said they should wear a mask when attending a crowded, outdoor event.

CDC; Choosing Safer Activities. April 27, 2021. Accessed April 27, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/participate-in-activities.html

Americans who are fully vaccinated against COVID-19 no longer need to wear masks when outside alone, with members of their household, or when attending small outdoor gatherings.

CDC Officials Loosen Mask Guidelines

Abbott’s BinaxNOW Rapid Antigen Self Test will soon be available on shelves at Walgreens in an effort to expand access to testing, according to a press release from Walgreens.

The test received FDA emergency use authorization for OTC, non-prescription, asymptomatic use of the BinaxNOW Self Test for the detection of COVID-19 infection on March 31, 2021. The new indication allows patients with or without symptoms to access the test without a prescription, and Walgreens is one of the first mass retailers to make the test widely available, the company announced in a press release.

COVID-19 testing goes hand-in-hand with vaccination efforts, with on-site COVID-19 testing available at more than 5500 Walgreens pharmacies. By May, the press release said they plan to expand testing to 6000 drive-thru sites, with half of these offering the rapid Abbott ID NOW COVID-19 test.

“Even as vaccines become more widely available, COVID-19 testing remains a critical tool to keep our communities safe,” said John Standley, president of Walgreens, in the press release. “The addition of this over-the-counter test in-store will help ensure our customers have access to testing solutions when and how they need it—at home or at one of our conveniently located testing sites.”

The BinaxNOW Self Test allows users to self-administer the test using a short nasal swab rather than the deep nasopharyngeal swabs used in prescription tests, and results are available in 15 minutes. According to the press release, the BinaxNOW test is the most studied rapid antigen in the United States following its approval for professional use in August 2020. The test has the same format and technology as a professional test and will be available in a 2-count box to meet the FDA’s serial testing requirements for non-prescription, OTC purchase, according to the press release.

Patients should test themselves twice with at least 36 hours between tests, according to the manufacturer’s instructions for use. It can be used on children as young as 2 years old when samples are collected by an adult. Notably, individuals who test negative should still be cautious, including following social distancing and mask-wearing guidelines, and individuals who test positive should follow the latest CDC guidelines.

“The BinaxNOW Self Test opens the door for Americans to buy an accurate and affordable test on their own terms, when and where they need it,” said Andrea F. Wainer, executive vice president of rapid and molecular diagnostics at Abbott, in the press release. “Together with vaccines and like-minded partners such as Walgreens, we can help people get back to doing what they love—like spending time with friends and family.”

Walgreens Makes Abbott’s BinaxNOW COVID-19 Self Test Available Over-The-Counter at Stores Nationwide [news release]. Walgreens; April 19, 2021. 

https://news.walgreens.com/press-releases/walgreens-makes-abbotts-binaxnow-covid-19-self-test-available-over-counter-at-stores-nationwide.htm

The test received FDA emergency use authorization for OTC, non-prescription, asymptomatic use for the detection of COVID-19 infection on March 31, 2021.

Aislinn Antrim, Associate Editor

Articles

Improving Blood Pressure, Cholesterol With Increased Physical Activity

HDHPs Do Not Affect Asthma Exacerbations, Medication Use for Children

CDC Officials Loosen Mask Guidelines

Walgreens To Begin Selling OTC COVID-19 Rapid Antigen Test