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Should you exercise if you have high blood pressure?

Analysis by Dr. Joseph Mercola Fact Checked

can exercise help lower high blood pressure

Story at-a-glance -

  • Exercise is one form of treatment to reduce high blood pressure and help prevent it from developing; inactivity is a risk factor for it. If you are inactive and have heart disease or another medical condition, check with your health care professional before starting a new exercise program
  • Blood pressure is the measurement of the force of your blood against the walls of your arteries. Primary, or essential, high blood pressure has no underlying cause, while secondary high blood pressure is related to another health condition
  • African-Americans are most vulnerable to high blood pressure; a study with 1,311 African-American participants found moderate to vigorous activity may help reduce the risk of high blood pressure in men and women in this population
  • One study found the combination of endurance and dynamic resistance training most effective in reducing systolic blood pressure. While exercise protects your heart, it is vital that you stop if you feel weak, dizzy or lightheaded, or experience pressure or pain in your chest, neck, arm, jaw or shoulder

Blood pressure is the measurement of the force of your blood as it pushes against the walls of your arteries. Your arteries carry blood from your heart through your body.1 Although blood pressure normally rises and falls throughout the day, consistently elevated blood pressure may damage your arteries and heart.

Cardiovascular disease is the leading cause of death in men and women.2 In 2017 the American Heart Association and the American College of Cardiology released new blood pressure guidelines to address this.3 The guidelines state that blood pressure under 120/80 mm of mercury (mm Hg) is now normal, while 140/90 used to be considered normal.4 The new categories are:5

Blood pressure category Systolic mm Hg (top number) Diastolic mm Hg (bottom number)

Normal

Less than 120

And

Less than 80

Elevated

120 -129

And

Less than 80

High blood pressure stage 1

130 -139

Or

80-89

High blood pressure stage 2

140 or higher

Or

90 or higher

High blood pressure crisis (seek medical care immediately)

Higher than 180

And/Or

Higher than 120

Using those guidelines, the AHA estimated in 2018 that 1 million would have a heart attack or die from coronary heart disease; 795,000 would have a stroke and more than 100 million Americans currently have high blood pressure.6 Endocrinologist Dr. Paul Conlin of the VA Boston Healthcare System and Brigham and Women's Hospital, which is affiliated with Harvard, talked about the new guidelines:7

"Blood pressure guidelines are not updated at regular intervals. Instead, they are changed when sufficient new evidence suggests the old ones weren't accurate or relevant anymore. The goal now with the new guidelines is to help people address high blood pressure — and the problems that may accompany it like heart attack and stroke — much earlier."

High blood pressure may lead to damaged and narrowed arteries, causing them to become less elastic and limiting blood flow.8 This may lead to a reduction in the delivery of nutrients and oxygen to organs and muscles, including the heart, which may lead to heart failure.

Limited oxygen to the brain may lead to strokes, mini-strokes, dementia or mild cognitive impairment.9 The kidneys are susceptible to scarring and kidney failure. The tiny blood vessels in your eyes may also become damaged. This can lead to retinopathy, nerve damage or blindness.10

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Primary or secondary high blood pressure?

If you are diagnosed with high blood pressure, your health care professional will determine whether it is primary (essential) or secondary. About 90% to 95% of those diagnosed with high blood pressure will have the essential type.11

In this case, the underlying cause cannot be determined.12 However, essential high blood pressure is more common in men than women, and African-Americans have twice the risk as Caucasians of experiencing essential high blood pressure.13 African-American women have the highest rates after age 65.

Other risk factors that may increase the potential for essential high blood pressure include14 family history, being overweight or obese, being sedentary, using tobacco and getting too much or not enough potassium. High levels of stress may lead to a temporary increase and excessive alcohol use may damage the heart and lead to high blood pressure.

If a secondary, or underlying health condition, is associated with high blood pressure, treating that condition may help resolve your high blood pressure. A variety of health conditions, medications and substances may lead to secondary high blood pressure, including kidney disease, obstructive sleep apnea, adrenal gland tumors, thyroid problems, pain relievers and illegal drugs.15

Positive effects of exercise with high blood pressure

One of the risk factors associated with essential high blood pressure is inactivity.16 Researchers have found that increasing activity levels may help reduce blood pressure.17 However, the AHA recommends you consult with your health care provider if you have heart disease or any preexisting health condition before you start a new exercise program.18

Physical activity has a positive effect on high blood pressure19 and may help you manage your weight20 and lower your stress level.21 In one study22 researchers compared blood pressure results after exercise in 10 men with uncomplicated primary high blood pressure. They were matched for age and weight and their average pressure was 165/109 mm Hg.

During exercise the mean systolic pressure was identical in both groups. During a 30-minute rest period both groups showed a significant and sustained fall in systolic pressure compared with pre-exercise measurements.23

Researchers’ aim in another study was to evaluate data on blood pressure following acute exercise.24 They evaluated 65 studies to compare the effect on systolic and diastolic blood pressure. What they found was that regardless of several factors, including initial blood pressure, gender or physical activity, there was a significant reduction in blood pressure.

The reductions were greater if the participant was a man who was not taking medication for high blood pressure, if the person was physically active and if the exercise was jogging.25

Regardless of the characteristics and the specific type of activity, the reduction in blood pressure continued for hours following exercise. Reductions were greater when exercise was used as a preventive strategy by people who were physically active and did not take drugs to reduce high blood pressure.26

Exercise in vulnerable populations reduces blood pressure

According to the Mayo Clinic,27 becoming more active may lower systolic blood pressure by up to 9 mm Hg, which is how much you might expect from some blood pressure medications. They point out that in order to keep your blood pressure under control, you have to exercise regularly and that it may take up to 3 months for this to have an impact on your measurements.

One study, funded by several groups including the National Institutes of Health,28 looked into whether exercise has a protective effect on African-Americans. A report was published in the journal Hypertension, describing how researchers examined the association of physical activity in 1,311 participants who did not have high blood pressure at the start of data collection.

All participants lived in Jacksonville, Mississippi, and were evaluated for physical activity, blood pressure and high blood pressure medication use. The participants were followed for about eight years during which there were 650 incident high blood pressure cases.29

After evaluating the data, the researchers came to the conclusion that regular moderate to vigorous activity may help reduce the risk of high blood pressure in African-American men and women.30 Nicole Redmond, Ph.D., an author of the study and medical officer with the Division of Cardiovascular Sciences at NHLBI, a branch of the NIH, commented on the results:31 

“Although the protective effect of exercise had been well-documented in white populations, it really had not been clearly demonstrated for African Americans. This is a wake-up call to African Americans about the need for regular exercise and its importance in preventing high blood pressure.

The good news is that hypertension is a health problem that is both preventable and treatable. We’ve long known that exercise is an important part of controlling blood pressure. Now, thanks to this invaluable finding from the Jackson Heart Study, we can say that the same applies to African American men and women. It’s a potentially lifesaving message that everyone needs to follow.”

Another study32 evaluated whether regular exercise would affect resistant high blood pressure, or measurements that remain above the goal despite interventions, such as using medications from three different classes. Fifty people were enrolled in the study, in which they were engaged in a treadmill exercise program for eight to 12 weeks.

The researchers found the program was well-tolerated and significantly decreased daytime ambulatory blood pressure measurements. They concluded regular exercise may decrease blood pressure even in those who do not respond well to medical treatment.33

Modest activity increase reduces blood pressure

Past studies have evaluated the effect of moderate-to-vigorous activity on blood pressure measurement. In another study34 scientists set out to find how much exercise was needed to reduce blood pressure measurements. They used an eight-week exercise program involving 207 individuals who presented with stage 1 or stage 2 essential high blood pressure who had not been treated with medication.

The groups were set up based on duration and frequency of exercise. The study team accounted for factors such as age, gender, body mass and baseline blood pressure. Their results showed that all four exercise groups experienced a reduction in systolic and diastolic blood pressure at rest.

The group experiencing the highest reduction did 61 to 90 minutes of exercise per week. They did not find a greater reduction in systolic blood pressure with a greater increase in exercise volume.35

It was concluded that participants who were sedentary in the past and experienced high blood pressure may enjoy a clinically significant decrease in measurement with modest increases in physical activity.

Exercise compared to medication for high blood pressure

In an effort to compare the effect of exercise against medication on systolic blood pressure, one team36 analyzed 391 randomized control trials involving 39,742 participants. These were split almost evenly between 197 trials evaluating exercise interventions and 194 evaluating antihypertensive medications.

The researchers did not find any studies comparing exercise against medication directly. Many of the participants had normal blood pressure. Results showed that measurements were lower in those treated with drugs than in those following a structured exercise program.

However, when the analysis was done only on those with a diagnosis of high blood pressure, the researchers found that exercise appeared to be as effective as many of the high blood pressure medications.37 They also found that combining endurance and dynamic resistance was most effective in reducing systolic blood pressure.

The study team reported38 that substituting exercise for medication may be challenging since those with high blood pressure often have other long-term conditions, and that an estimated 40% in many countries are physically inactive. In a podcast, lead author Huseyin Naci, Ph.D., from the London School of Economics and Political Science, commented:39

“We don’t think, on the basis of our study, that patients should stop taking their antihypertensive medications. But we hope that our findings will inform evidence based discussions between clinicians and their patients.

It’s one thing to recommend that physicians start prescribing exercise to their patients, but we also need to be cognisant of the resource implications and ensure that the patients that have been referred to exercise interventions can adhere to them and so really derive benefit.”

Making exercise fun

Let’s face it — if the benefits don’t outweigh the challenges, most will likely not stick with new activities crammed into a day that is already full. The best way to incorporate exercise is to do something you enjoy and make it fun. This initially helps provide the motivation to get moving.

In the U.S. only 22.9% met the guidelines for aerobics and strength training recommended by the CDC in 2015.40 Said another way, 77.1% of adults in the U.S. do not get enough exercise.

One way researchers41 found to motivate participants to exercise was to make it competitive. This didn’t mean Olympic-style competition, but taking advantage of social network exercise programs, which effectively helped increase activity.

You may experience some of the same benefits by exercising with a partner. Researchers from Aberdeen University42 found that working out with a partner may increase the amount of exercise, especially when the partner is emotionally supportive.43

If you love being outdoors, try combining it with exercise you might find enjoyable such as a brisk walk, hiking or biking. If you love listening to audiobooks or music, plug them in while you're using an elliptical machine or climbing the stairs.44

Your local gym and recreation centers will have fitness classes appropriate for your level of fitness. You might also enjoy participating in a team sport or a dance class. Adding variety to your program may help keep you motivated and reduce your chance of injury.45

Exercise helps protect your heart

As you begin a new exercise program pay attention to how you feel. It may take time before your body gets used to exercising, which is normal. While it is expected you’ll breathe harder and sweat during aerobic activity, if you begin to feel short of breath or your heart is beating irregularly or too fast, stop and rest.46

It is also important you stop working out if you experience any weakness, dizziness or lightheadedness. You should stop if you have pressure or pain in your chest, neck, arm, jaw or shoulder.47 If the symptoms do not go away quickly or if they happen more than once, get emergency treatment.

In general, it is better to exercise earlier in the day as exercising before bedtime may interfere with quality sleep. However, if mornings don’t work for you, it's better to work out late than not at all.48

The Nitric Oxide Dump is a short series of exercises you may do anytime during the day to positively affect your blood pressure. The series is designed to release nitric oxide, a soluble gas and free radical stored in the lining of your blood vessels.

It’s made by your body to enhance blood vessel dilation, which means it causes your blood vessels to expand and dilate. This promotes blood flow and lowers your blood pressure. The exercise may be done three times a day with at least two hours between sessions to allow time to restore your nitric oxide reserve.

Hand weights are not necessary or even recommended in the beginning, although you may use them as you get stronger if you'd like. In the beginning it's important to focus on form and speed. There are four movements done in three sets of 10 repetitions. As you become more comfortable, you can increase it up to 20 repetitions.

+ Sources and References