Exercise and Blood Pressure

Did you know that consistent exercise can be as effective as medication for lowering blood pressure for those with high blood pressure? Plus, exercise is cheaper, can be free, and offers very few serious quality-of-life side effects compared to medication. 

Everyone should be concerned about their blood pressure. High blood pressure is consistently one of the biggest mostly modifiable risk factors for heart and brain-related early death. High blood pressure is also a known risk for back pain, type 2 diabetes, kidney disease, early dementia, and infertility Evidence of causal effects of blood pressure on back pain and back pain on type II diabetes provided by a bidirectional Mendelian randomization study - ScienceDirect + Hypertension and Male Fertility - PMC + Blood Pressure Levels and Risks of Dementia: a Nationwide Study of 4.5 Million People | Hypertension 

Reducing blood pressure is one of the most effective ways to reduce the risk of cardiovascular disease Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies - PubMed + Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis - The Lancet  Everyone should aim for a resting average blood pressure of less than 130/90, with recommendations for even lower a very likely future recommendation for everyone. Here are some resources to best understand these numbers if unsure what they mean or why we aim for these low values. Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta‐analysis - Journal of Internal Medicine - Wiley Online Library + The Optimal Blood Pressure + Systolic Blood Pressure Intervention Trial (SPRINT) and Target Systolic Blood Pressure in Future Hypertension Guidelines - PubMed

Now, many with high blood pressure might be prescribed medication without much emphasis on lifestyle changes including exercise, despite lifestyle factors being responsible for at least 95% of all high blood pressure cases Prevalence of Nutrition and Exercise Counseling for Patients with Hypertension: United States, 1999 to 2000 - PMC Exercise amounts meeting or exceeding the Australian Physical Activity guidelines of 150-300 minute of moderate aerobic exercise and 2 x 30 min strength-based exercise session per week for more than 3 months can lower blood pressure by 5 to 15 mmHg, regardless of your age, with potentially greater reductions over more time of consistent weekly exercise The form of exercise to decrease resting blood pressure in older adults: A systematic review and meta-analysis - ScienceDirect + Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension | European Journal of Preventive Cardiology | Oxford Academic + Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases - Pedersen - 2015 + World Health Organization 2020 guidelines on physical activity and sedentary behaviour | British Journal of Sports Medicine especially when completed in higher intensities when safe The additive blood pressure lowering effects of exercise intensity on post-exercise hypotension - PubMed even in those resistant to blood pressure medication Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension: A Randomized Clinical Trial | Hypertension | JAMA Cardiology | JAMA Network 

The temporary change in blood pressure from small to very high blood pressure depending on the intensity of aerobic and/or strength exercise triggers adaptive changes in your body that lower blood pressure in the long term The impact of the 24-h movement spectrum on vascular remodeling in older men and women: a review - PubMed + Walking for hypertension - PMC You get less of a beneficial effect when physical activity is not intentional, such as for those physically active only for their work ‘I’m active enough in my job.’ Why is occupational physical activity not enough? | British Journal of Sports Medicine.

Here are some more conclusions for those curious for more:

• In terms of prevention, it seems the more exercise you do, the better Physical activity and risk of hypertension: a meta-analysis of prospective cohort studies - PubMed

• How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure - PubMed “no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise.” 

• Completeting both strength and aerobic exercise during the week seems to be better for reducing blood pressure than completing one or the other each week  Dynamic Resistance Training as Stand-Alone Antihypertensive Lifestyle Therapy: A Meta-Analysis - PubMed + What’s the best exercise training to reduce blood pressure? - BJSM + Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials | Hypertension Research

Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis | British Journal of Sports Medicine “We aimed to compare the efficacy of isometric exercise training (IET) versus high-intensity interval training (HIIT) in the management of resting blood pressure (BP)....While both modes are efficacious, IET appears to be the superior mode of exercise in the management of resting BP. However, HIIT may achieve wider physiological benefits, with greater reductions in resting heart rate.”

Continued weekly exercise plus medication, especially “polypills” which is a medication regime of small amounts of different blood pressure medication types, are recommended when lifestyle factors have failed to lower higher levels of blood pressure and/or genetic factors are known to be contributing to higher blood pressure PEER Simplified Cardiovascular Decision Aid +  Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis - The Lancet + Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial - The Lancet + Long-Term Physical Activity Effectively Reduces the Consumption of Antihypertensive Drugs: A Randomized Controlled Trial 

Aggressive blood pressure lowering should be encouraged as every day with high blood pressure has compounding but often “silent” negative effects on your health. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension | European Heart Journal | Oxford Academic + 2020 International Society of Hypertension Global Hypertension Practice Guidelines | Hypertension  

Some other blood pressure-lowering tips:

• Weight loss—Most of the causes of modifiable high blood pressure are related to being overweight or obese. Weight loss significantly reduces blood pressure The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins - PubMed + Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association - PubMed A rough rule is that every kilogram of weight lost can lower blood pressure by 1mmHg. Weight loss is also important to assist type 2 diabetes into remission, which is a condition that increases blood pressure Hypertension and diabetes management | Diabetes Australia. Unfortunately, commonly experienced weight stigma within many pathways of our healthcare system and poorly trained healthcare professionals reduce people's interest in seeking consistent help with lifestyle change and medication that can help with weight loss in the long term. Demystifying Obesity: Understanding, Prevention, Treatment, and Stigmas | Nutrition Reviews | Oxford Academic

• Get consistent high-quality sleep Sleep Duration and Hypertension: Epidemiological Evidence and Underlying Mechanisms - PMC + Sleep Health and Habits + Association between joint physical activity and sleep duration and hypertension in US adults: Cross-sectional NHANES study - ScienceDirect

• Reduce daily stress or plan daily activities like exercise, fun hobbies, or family/social time to improve stress-coping Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings | Hypertension Research + Examining the Role of Psychosocial Stressors in Hypertension - PMC

• Nutrition. Any dietary advice to assist lowering blood pressure aims to facilitate maintaining or meeting a healthy body fat level while reducing sodium salt intake (more dietary salt means more blood volume which increases blood pressure) Sodium and health—concordance and controversy | The BMJ  and increasing dietary potassium where possible, without excessive overconsumption Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men - ScienceDirect + How Potassium Can Help Control High Blood Pressure | American Heart Association + Potassium Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials - PubMed  Plant-based diets with limited daily intake of ultra-processed food, have very positive effects reducing daily sodium salt intake and improving long term blood pressure. Other diets, like the DASH diet, include options low in sodium and high in potassium that can also help lower blood pressure. Avoiding alcohol and increasing fish intake is also helpful for healthy blood pressure Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials - PMC. 

• Don’t smoke Assessing the association between smoking and hypertension: Smoking status, type of tobacco products, and interaction with alcohol consumption - PMC

• Thoroughly manage medical conditions contributing to increased blood pressure, such as sleep disorders, kidney disease, and pregnancy. Managing any health condition will lower the need for medication which also contributes to high blood pressure. 

• Be informed that most oral contraceptives Oral Contraceptive Pills and Hypertension: A Review of Current Evidence and Recommendations | Hypertension and non-steroidal anti-inflammatory intake (ibuprofen) The Effects of Pain and Analgesic Medications on Blood Pressure - PMC, increase blood pressure. 

Want to know more about reducing blood pressure with exercise and lifestyle advice? Book an appointment with one of our physiotherapists for a blood pressure measurement and a thorough lifestyle and exercise discussion to reduce your blood pressure and risk of blood pressure-related early mortality.