Aging of the population and the increased prevalence of chronic noncommunicable diseases among older adults are major challenges facing society and the medical community [1]. Among these diseases, systemic arterial hypertension is a significant cause and consequence of disability among older adults [2, 3].
Systemic arterial hypertension is a multifactorial clinical condition characterized by elevated and sustained blood pressure levels. It is often associated with functional and/or structural changes in target organs (e.g. heart, brain, kidneys and blood vessels) and metabolic changes, with a consequent increase in the risk of cardiovascular events [3, 4].
According to the High Blood Pressure Clinical Practice Guideline, 46% of the population has systemic arterial hypertension. In addition, the prevalence increases dramatically with increasing age and is higher in black people than in Caucasians, Asians and Hispanics [5]. Furthermore, the prevalence of systemic arterial hypertension is lower in women than in men up to the fifth decade, but it is higher at the end of life in women than in men [5]. For these reasons, the study of systemic arterial hypertension in older women is an area of growing interest.
The most frequently used treatment for systemic arterial hypertension is antihypertensive medication [6, 7]. However, in the last decades alternative therapies such as physical activity have been gaining notoriety for the important beneficial effects on blood pressure of patients with systemic arterial hypertension [8–10]. Indeed, a plethora of studies showed that physical activity may be a potential nonpharmacological treatment for the improvement of blood pressure in patients with hypertension [11]. Because of these effects, some authors have suggested that exercise may reduce or even replace pharmacological treatment. In this sense, Maruf et al. [12] investigated the effects of aerobic exercise combined with antihypertensive drugs on blood pressure and the number of antihypertensive drugs used by individuals with hypertension. These authors found that the combination of aerobic exercise and antihypertensive drugs reduces the number of antihypertensive drugs needed to achieve blood pressure control and enhances blood pressure control in individuals with hypertension on two antihypertensive drugs. In another study, Dimeo et al. [13] showed that exercise is able to decrease blood pressure even in participants with low responsiveness to medical treatment, and concluded that exercise should be included in the therapeutic approach to resistant hypertension. Reid, Maher, and Jennings [14], showed that 71% of patients submitted to lifestyle management (including physical activity) who had been well controlled on antihypertensive medication were able to remain normotensive and free of drug therapy for 9 months.
From the above, the role of physical activity in the control of blood pressure in individuals with systemic arterial hypertension is indubitable. For this reason, there are many governmental initiatives that aim to encourage the participation of the population in physical activity programs [15, 16]. These initiatives are community physical activity programs characterized by outdoor activities that take place in public spaces, such as squares, beaches and parks. In Brazil, the main concern about these community physical activity programs is the lack of individualization of exercise prescription, in some cases lack of specialized professionals (coaches and/or physical education professionals) to guide and supervise participants, and adequate exercise facilities. Thus, it is reasonable to assume that factors relating to physical training, such as intensity, weekly frequency and volume, are not strictly controlled. As a consequence, the health benefits may not be gained [17]. Specifically, in the case of patients with systemic arterial hypertension, it is expected, in addition to a decrease in blood pressure, a decrease in the amount of antihypertensive drugs used [7, 12].
Given that a myriad of studies showed beneficial effects of physical activity on the blood pressure of individuals with systemic arterial hypertension, physical activity may complement the blood pressure-lowering effects of antihypertensive drugs [12, 18], thereby reducing the number and/or dose of drugs required [7, 12]. This matter is very important because a number of daily antihypertensive drugs tablets intake greater than two has been associated with no adherence to drug therapy [19]. Considering that drugs cost money and may produce negative side effects [20], it is very important to investigate strategies that will lead to a reduction in the daily antihypertensive drugs tablets intake.
Therefore, the aim of the present study was to compare the number of antihypertensive drugs taken by women who have a low level of physical activity with the number of antihypertensive drugs taken by those with a high level of activity. We also wanted to establish how many participants in one group took more than two antihypertensive drugs compared with those participants from the other group. We hypothesized that the higher the habitual physical activity levels the lower the number of antihypertensive drugs used and that these participants would use two or less antihypertensive drugs. It is noteworthy that investigating community physical activity programs has great ecological validity because they reflect real situations and scenarios.