The Role of Exercise Training in the Treatment of Hypertension

Abstract

Hypertension is a very prevalent cardiovascular (CV) disease risk factor in developed countries. All current treatment guidelines emphasise the role of nonpharmacological interventions, including physical activity, in the treatment of hypertension. Since our most recent review of the effects of exercise training on patients with hypertension, 15 studies have been published in the English literature. These results continue to indicate that exercise training decreases blood pressure (BP) in approximately 75% of individuals with hypertension, with systolic and diastolic BP reductions averaging approximately 11 and 8mm Hg, respectively. Women may reduce BP more with exercise training than men, and middle-aged people with hypertension may obtain greater benefits than young or older people. Low to moderate intensity training appears to be as, if not more, beneficial as higher intensity training for reducing BP in individuals with hypertension. BP reductions are rapidly evident although, at least for systolic BP, there is a tendency for greater reductions with more prolonged training. However, sustained BP reductions are evident during the 24 hours following a single bout of exercise in patients with hypertension. Asian and Pacific Island patients with hypertension reduce BP, especially systolic BP, more and more consistently than Caucasian patients. The minimal data also indicate that African-American patients reduce BP with exercise training. Some evidence indicates that common genetic variations may identify individuals with hypertension likely to reduce BP with exercise training. Patients with hypertension also improve plasma lipoprotein-lipid profiles and improve insulin sensitivity to the same degree as normotensive individuals with exercise training. Some evidence also indicates that exercise training in hypertensive patients may result in regression of pathological left ventricular hypertrophy. These results continue to support the recommendation that exercise training is an important initial or adjunctive step that is highly efficacious in the treatment of individuals with mild to moderate elevations in BP.

Time of day for exercise on blood pressure reduction in dipping and nondipping hypertension

“…8 The nocturnal dipping status in hypertension was confirmed by the two control ambulatory blood pressure monitoring sessions. The reproducibility of the dipping and nondipping hypertension is consistent with the study by Nami and collegues.…”

“…9 On the other hand, Nami and colleagues found a blood Time of day for exercise S Park et al more and somewhat more consistently than younger hypertensive subjects. 8 Different exercise stimuli can produce different blood pressure responses. 9 The mode (cardiovascular), duration (60 min) and intensity (40-60%) of Nami's stimulus 12 were not only similar to ours, but within the guidelines for appropriate exercise treatment.…”

“…Healthy lifestyle modification, including physical activity and exercise, is recommended as the initial treatment option to control hypertension. [4][5][6][7] Even though endurance exercise training lowers blood pressures in hypertensive patients, [8][9][10] approximately 25% of the hypertensive patients do not exhibit blood pressure reduction associated with exercise training. 8 Hypertensive patients who do not exhibit nocturnal dipping (Non-Dippers: defined as o10% reduction in average nighttime blood pressure compared to average daytime blood pressure) 11 have been identified among the nonresponders to exercise training.…”

“…[4][5][6][7] Even though endurance exercise training lowers blood pressures in hypertensive patients, [8][9][10] approximately 25% of the hypertensive patients do not exhibit blood pressure reduction associated with exercise training. 8 Hypertensive patients who do not exhibit nocturnal dipping (Non-Dippers: defined as o10% reduction in average nighttime blood pressure compared to average daytime blood pressure) 11 have been identified among the nonresponders to exercise training. 12 Nami et al 12 reported that aerobic exercise training failed to reduce blood pressure in Non-Dippers while it did reduce blood pressure in hypertensive patients who exhibited nocturnal dipping (Dippers).…”

“…The reduction in blood pressure following a single bout of exercise has been reported to persist for up to 11-12 h under free-living conditions for systolic blood pressure (5)(6)(7)(8) and/or up to 4-8 h for diastolic blood pressure (6-8 mmHg). [13][14][15][16][17] Presenting an exercise treatment prior to the period of highest blood pressure elevation may result in a more attenuated response because greater blood pressure reductions can be found in higher pressures.…”