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High blood pressure? Exercise can help

a closeup of feet dressed in walking shoes

Generally speaking, you will be diagnosed as having high blood pressure when your average blood pressure during a typical day is 140/90 mmHg or higher. As you probably know, untreated or uncontrolled high blood pressure can lead to heart attack or stroke, but it can also contribute to poor vision, dementia, and kidney damage, among other effects.

Many people's high blood pressure can be improved with improved diet or medications - or both - and sometimes more than one medication is required. But there are those who have what we doctors call "resistant hypertension." These folks are those whose blood pressure remains at 130 (systolic - the top number in a reading) during the day while still taking at least three different types of antihypertensive medications.

Sometimes these folks can get good control with 4 or more medications, but contrary to what seems to be popular belief, good physicians do not like to have our patients on too many medications unless it is absolutely necessary. The risk of interactions and negative side effects goes up with every added pill or capsule.

One of the things we do recommend to those with high blood pressure is that they exercise. Yet what evidence there is for exercise's effectiveness in those with resistant hypertension is either inadequate - one study lacks details so it can not be replicated - or overly specific - the study compares walking on a treadmill with water-based exercise.

A team of researchers in Portugal designed a study that focused on men and women at least 40 years of age who had been diagnosed with resistant hypertension, recruiting them from two different hospitals' outpatient clinics (JAMA Cardiol doi:10.1001/jamacardio.2021.2735).

Fifty-three men and women completed the 12-week study: a randomized controlled trial. Half of the participants were assigned to a usual care group - the control group of those who continued their medical care according to their doctors' recommendation - or the exercise group. Those in the exercise group also continued to take their medications and continue their usual care with their physicians: they simply added moderate aerobic exercise to their routine.

Participants in the exercise group started their 3-day-per-week exercise regimen with 20 minutes of either cycling on a stationary bike or walking on a treadmill, with 10 minutes each of warm-up and cool-down. As the study continued, the exercise was increased in length and intensity until the participant was walking or riding for up to 40 minutes at 70% of their VO2 max. The upper limit for the amount and intensity of exercise was modified as needed for each participant.

After 12 weeks of regular exercise, the authors found that those in the control group actually increased their systolic blood pressure slightly: by 0.9mm, on average.

Those in the exercise group, on the other hand, reduced their systolic blood pressure by an average of 6.2mm.

Further, those in the exercise arm of the study improved their cardiorespiratory fitness by an average of 14% and decreased their resting heart rate (another sign of improved cardiorespiratory fitness).

What this means for you

We've been seeing more and more research showing that regular exercise of even moderate amounts can have a significant positive impact on your health. You don't need a bunch of complicated or expensive equipment or a gym membership: walking is probably the cheapest form of exercise you can perform. If walking is a challenge for you, here are some tips for How to exercise with disabled or weak legs from Jacques Courseault, MD.

First posted: August 25, 2021