New Consensus Document Highlights Which Exercises are Best to Lower Blood Pressure

The new consensus document is the first to offer personalized advice on the most effective exercises to lower blood pressure based on a patient's current blood pressure level.

The first personalized advice on the most effective exercises to lower blood pressure (BP) was published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

Published March 24, 2021, the ESC consensus document recommends specific exercises based on an individual’s current BP level.

“Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of the population will have hypertension,” wrote authors led by Henner Hanssen, MD, professor, University of Basel, Switzerland. “Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality.”

Although exercise is known to reduce BP, previous recommendations have mainly focused on the amount of exercise per week, without considering a patient’s starting BP level. For this reason, researchers performed a systematic review of 34 meta-analyses to determine if exercise recommendations could be personalized for BP control.

The consensus document outlines the first exercise priority for lowering BP, followed by alternatives that still achieve reduction but to a lesser extent, in patients with hypertension (HTN), high-normal BP, and normal BP.

Aerobic Exercise is a Priority

Aerobic exercise was found to be the most effective method to lower BP in patients with HTN (BP: ≥140/90 mmHg), including walking, running, cycling, or swimming.

“In people with hypertension, the blood pressure reduction that can be achieved with aerobic exercise is the same, or even slightly more, than taking a single antihypertensive medication,” said Hanssen in an ESC press release.

In patients with high-normal BP (≥130–139/85–89 mmHg), dynamic resistance training was found the most effective. Dynamic resistance training is strength training that typically involves at least 6 large muscle groups where muscle contraction results in movement (eg, lifting weights, squats, push-ups).

In the last group, patients with normal BP levels (<130/84 mmHg), isometric resistance training was most beneficial. This type of exercise involves static contraction of the muscles, such as handgrip exercises or leg extensions.

“Obese individuals are very likely to develop high blood pressure if obesity persists over the years. Healthy individuals with a hypertensive parent are also at risk of developing high blood pressure, as are women who had high blood pressure during pregnancy (gestational hypertension). People in these groups can postpone or even prevent hypertension by exercising,” continued Hanssen in the ESC press release.

Hanssen also added that physical activity should be done regularly to sustain the benefits. “For most exercises, the blood pressure lowering effect lasts for about 24 hours, similar to medication, so it’s best to be active every day if possible,” concluded Hanssen.