Exercise and Hypertension

Abstract

SUMMARY Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of HTN, with exercise being an integral component. Exercise programs that primarily involve endurance activity prevent the development of HTN and lower blood pressure (BP) in adults with normal BP and those with HTN. The BP lowering effects of exercise are most pronounced in people with HTN who engage in endurance exercise with BP decreasing approximately 5–7 mm Hg after an isolated exercise session (acute) or following exercise training (chronic). Moreover, BP is reduced for up to 22 h after an endurance exercise bout (e.g., postexercise hypotension), with the greatest decreases among those with the highest baseline BP. The proposed mechanisms for the BP lowering effects of exercise include neurohumoral, vascular, and structural adaptations. Decreases in catecholamines and total peripheral resistance, improved insulin sensitivity, and alterations in vasodilators and vasoconstrictors are some of the postulated explanations for the antihypertensive effects of exercise. Emerging data suggest genetic links to the BP reductions associated with acute and chronic endurance exercise. Nonetheless, definitive conclusions regarding the mechanisms for the BP reductions following endurance exercise cannot be made at this time. Individuals with controlled HTN and no CVD or renal complications may participate in an exercise program or competitive athletics, but should be evaluated, treated, and monitored closely. Preliminary peak or symptom-limited exercise testing may be warranted, especially for men over 45 and women over 55 yr planning a vigorous exercise program (i.e., ≥ 60% V̇O2R, oxygen uptake reserve). In the interim, while formal evaluation and management are taking place, it is reasonable for the majority of patients to begin moderate intensity exercise training (40–<60% V̇O2R) such as walking. When pharmacologic therapy is indicated in physically active people it should, ideally: a) lower BP at rest and during exertion; b) decrease total peripheral resistance; and, c) not adversely affect exercise capacity. For these reasons, angiotensin converting enzyme (ACE) inhibitors (or angiotensin II receptor blockers in case of ACE inhibitor intolerance) and calcium channel blockers are currently the drugs of choice for recreational exercisers and athletes who have HTN. Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of HTN. The optimal training frequency, intensity, time, and type (FITT) need to be better defined to optimize the BP lowering capacities of exercise, particularly in children, women, older adults, and certain ethnic groups. Based upon the current evidence, the following exercise prescription is recommended for those with high BP: Frequency: on most, preferably all, days of the week Intensity: moderate-intensity (40–<60% of V̇O2R) Time: ≥ 30 min of continuous or accumulated physical activity per day Type: primarily endurance physical activity supplemented by resistance exercise INTRODUCTION Since the 1970s, significant technological and pharmacotherapeutic advances have been made in the treatment and control of cardiovascular disease (CVD) and its associated risk factors. Yet, hypertension (HTN) remains a major public health problem in the United States, with 58.4 million (28.7%) Americans aged 18 yr or older having HTN (systolic blood pressure [SBP] ≥ 140 and/or diastolic blood pressure [DBP] ≥ 90 mm Hg) (11,39,107,137). HTN prevalence is increasing whereas awareness of the condition and control rates is suboptimal (39,107,137). The positive relationship CVD risk and blood pressure (BP) with a BP as as mm Hg and for Hg with normal BP at 55 yr of a risk of HTN The BP of or mm Hg) been to the public health of BP and HTN for people are and effects associated with and with CVD risk factors. For these reasons, the on and of the the of Hypertension and the such as physical activity for the and treatment of HTN. the blood pressure and the treatment for HTN pressure for adults aged 18 and and of this is to an of the current of on exercise and HTN with to and HTN. The of are those by the and of the of on the effects of physical on the BP of exercise in this such as those on blood insulin sensitivity, and are not in this of this are the and of exercise testing in HTN and CVD and the of acute effects of one bout of and chronic effects of a training endurance and resistance exercise on exercise prescription and for with HTN, mechanisms for the effects of acute and chronic exercise, and the current of on exercise and HTN an BP with to to whereas in the and decreases pressure with In HTN defined as ≥ 140 and/or ≥ 90 mm or being on antihypertensive The prevalence of HTN is to be and in the United HTN with and is among men women at but