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Metabolic Risk

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17 Blood Pressure Reduction ➤ 3.7: In individuals with blood pressure above 130/80 mmHg and a ten-year cardiovascular risk <10%, ES suggests lifestyle management to lower blood pressure to <130/80 mmHg and to reduce the risk for ASCVD. (2|⊕⊕⊕ ) Technical Remarks: ▶ Since the 10-year risk is ≤10%, lifestyle intervention is appropriate and preferable to use of medications. ▶ Interventions include weight loss, healthy diet, sodium restriction, enhanced potassium intake, increased physical activity, and moderation of alcohol use. ➤ 3.8: In individuals without a history of ASCVD with metabolic risk who have a 10-year cardiovascular risk of >10% and blood pressure of >130/80 mmHg, ES suggests the use of blood pressure-lowering medication in addition to lifestyle modifications for primary prevention of ASCVD only if lifestyle modification alone has failed. (2|⊕⊕⊕ ) Reducing Progression to Type 2 Diabetes ➤ 3.9: In individuals with prediabetes, ES recommends prescribing lifestyle modification before drug therapy to reduce plasma glucose levels. (1|⊕⊕⊕⊕) ➤ 3.10: In individuals with prediabetes who have limitations to physical activity or are not responding to lifestyle modifications, ES recommends metformin as a first pharmacologic approach to reduce plasma glucose levels. (1|⊕⊕⊕ )

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