Hypertension and exercise

Resistant hypertension is a major risk factor for cardiovascular disease and is the most common risk factor present among subjects who develop cardiovascular events. The high prevalence of hypertension is due to in part to lifestyle factors. Hypertension in the context of overweight and obesity indicates a higher potential for cardiovascular disease than is associated with either risk factor alone.

Hypertensive heart disease is a constellation of abnormalities that includes left ventricular hypertrophy (LVH), systolic and diastolic dysfunction, and their clinical manifestations including arrhythmias and symptomatic heart failure. The classic paradigm of hypertensive heart disease is that the left ventricular (LV) wall thickens in response to elevated blood pressure as a compensatory mechanism to minimize wall stress (Drazner 2011).

Positive lifestyle modifications, including weight loss and increased physical activity, contribute significantly to blood pressure control. Several studies suggesting that significant reductions in blood pressure after aerobic exercise programs of mild to moderate intensity may be more effective in lowering blood pressure than high exercise intensity.

Evidence suggests that the blood pressure response to exercise is modulated by fitness. Exercise capacity has been shown to be inversely related to exercise blood pressure and to LV mass (Kokkinos, Pittaras et al. 2007). Increased exercise capacity is associated with lower mortality in hypertensive individuals.

Vatten et al. examined the relationship between high blood pressure and physical activity on cardiovascular mortality. They found that cardiovascular mortality increased continuously with increasing blood pressure, and risk was higher in men and women with no physical activity compared with those who reported high physical activity. High activity combined with increasing pressure, however, yielded higher risk than high activity combined with normotensive pressure. Their results support the hypothesis that cardiovascular health of individuals with moderate hypertension will benefit from regular physical exercise (Vatten, Nilsen et al. 2006).