The role of exercise training in the treatment of hypertension - An update

Hypertension is a very prevalent cardiovascular (CV) disease risk factor in developed countries. All current treatment guidelines emphasise the role o f nonpharmacological interventions, including physical activity, in the tre atment of hypertension. Since our most recent review of the effects of exer cise training on patients with hypertension, 15 studies have been published in the English literature. These results continue to indicate that exercis e training decreases blood pressure (BP) in approximately 75% of individual s with hypertension, with systolic and diastolic BP reductions averaging ap proximately 11 and 8mm Hg, respectively. Women may reduce BP more with exer cise training than men, and middle-aged people with hypertension may obtain greater benefits than young or older people. Low to moderate intensity tra ining appears to be as, if not more, beneficial as higher intensity trainin g for reducing BP in individuals with hypertension. BP reductions are rapid ly evident although, at least for systolic BP, there is a tendency for grea ter reductions with more prolonged training. However, sustained BP reductio ns are evident during the 24 hours following a single bout of exercise in p atients with hypertension. Asian and Pacific Island patients with hypertension reduce BP, especially s ystolic BP more and more consistently than Caucasian patients. The minimal data also indicate that African-American patients reduce BP with exercise t raining. Some evidence indicates that common genetic variations may identif y 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 individ uals with exercise training. Some evidence also indicates that exercise tra ining in hypertensive patients may result in regression of pathological lef t ventricular hypertrophy. These results continue to support the recommenda tion that exercise training is an important initial or adjunctive step that is highly efficacious in the treatment of individuals with mild to moderat e elevations in BP.