High blood pressure (HBP) is a strong, independent and etiologically relevant risk factor for cardiovascular and therefore, the leading cause of preventable deaths worldwide. Hypertension has high medical and social costs. Due to its many associated complications, the use of medical services create high costs with medications which represent almost half of the estimated direct expenses. Free distribution of more than 15 medications for HyPERtension and DIAbetes (HIPERDIA program) clearly shows the important role of drugs in the Brazilian Government's effort to tackle these two diseases. Notwithstanding, the prevalence of HBP is rising in parallel with other NCDs. It is known that HBP results from environmental and genetic factors, and interactions among them. Our ancestors were often faced with survival stresses, including famine, water and sodium deprivation. As results of natural selection, the survival pressures drove our evolution to shape a thrifty genotype, which favored/ promoted energy-saving and sodium/water preservation. However, with the switch to a sodium-and energy-rich diets and sedentary lifestyle, the thrifty genotype and ancient frugal alleles, are no longer advantageous, and may be maladaptive to disease phenotype, resulting in hypertension, obesity and insulin resistance syndrome. Lowgrade chronic infl ammation and oxidative stress would be the underlying mechanisms for these diseases. HBP is often associated with unhealthy lifestyles such as consumption of high fat and/or high-salt diets and physical inactivity. Therefore, alternatively to medicine drugs, lifestyle and behavioral modifi cations are stressed for the prevention, treatment, and control of hypertension. A lifestyle modifi cation program (LSM) involving dietary counseling and regularly supervised physical activity ("Move for Health") has been used for decades, in our group, for NCDs primary care. Retrospective (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) data from 1317 subjects have shown the top quartile of blood pressure(142.2/88.5mmHg) differing from the lower quartile (120.6/69.2mmHg) by being older, with lower schooling, lower income and, lower physical activity and aerobic capacity. Additionally, the P75 showed higher intake of CHO, saturated fat and sodium along with lower-diet quality score with a more processed foods. They showed higher body fatness and prevalence of metabolic syndrome along with higher pro-infl ammatory and peroxidative activities and insulin resistance. In this free-demand sample, the HBP rate was 51.2% for SBP and 42.7% for DBP. The rate of undiagnosed HBP was 9.8% and only 1/3 of medicated patients were controlled for HBP. After 10 weeks of LSM the HBP normalization achieved 17.8% for SBP and 9.3% for DBP with a net effectiveness of 8.5% and 2.4%, respectively. The reduction of HBP by LSM was followed by increased aerobic conditioning and reduced intake of processed foods along with decreased values of BMI, abdominal fatness, insulin resistance, pro-infl ammatory and peroxydative ...

diabetes tipo 2 e estilo de vida: o Papel do exercício Físico na atenção Primária e na secundáriaType 2 Diabetes and lifestyle: The role of exercise for primary and secondary careResumo O diabetes mellitus (DM) é visto atualmente como epidemia mundial devido ao grande aumento em sua incidência e prevalência, cujo controle representa um grande desafio para os sistemas de saúde. Assim, ações de intervenção com foco na mudança do estilo de vida necessitam ser implementadas por esses sistemas. Considerando que o exercício e a dieta são os pilares do tratamento do DM, o objetivo desta revisão bibliográfica foi avaliar o papel da mudança do estilo de vida, mais especificamente do exercício físico, na atenção primária e secundária do DM tipo 2. Para tanto, embasou-se em artigos publicados na base de dados Scopus durante o período de 1991 a 2011. As palavras-chave pesquisadas, nas lín-guas portuguesa e inglesa, foram "diabetes mellitus tipo 2", "modificação no estilo de vida" e "papel do exercício físico". De acordo com os referidos artigos, a modificação no estilo de vida por meio da adoção de hábitos alimentares saudáveis, prática regular de exercícios físicos e controle de peso mostra-se altamente eficaz na prevenção, no controle e tratamento do DM tipo 2. Além disso, os exercícios físicos aeróbios, resistidos e combinados evidenciam melhoras no controle metabólico e consequente redução no risco de desenvolver DM tipo 2 e suas complicações. Palavras-chave: diabetes mellitus tipo 2, modificação no estilo de vida, exercício físico.Abstract Diabetes Mellitus (DM) is currently seen as a worldwide epidemic due to the large increase in its incidence and prevalence, which control represents a major challenge for health systems. Thus, interventions focusing changes in lifestyle need to be implemented by those systems. Whereas exercise and diet are the cornerstones of treatment of diabetes, the aim of this review was to evaluate the role of change in lifestyle, specifically physical exercise, in primary and secondary attention of T2DM. For this purpose it was used in the Scopus database, considering the period from 1991 to 2011. The keywords searched in Portuguese and English were "type 2 diabetes mellitus", "change in lifestyle" and "role of physical exercise". In accordance with the above mentioned articles the change in lifestyle by adopting healthy eating habits, regular practice of physical activity and weight control was highly effective in the prevention, control and treatment of T2DM. Furthermore, the aerobic, resistance and combined exercises showed improvements in metabolic control and subsequent reduction in risk of developing T2DM and its complications.

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