Exercise and Hypertension

Abstract

Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of HTN, with exercise being an integral component. Exercise programs that primarily involve endurance activities prevent the development of HTN and lower blood pressure (BP) in adults with normal BP and those with HTN. The BP lowering effects of exercise are most pronounced in people with HTN who engage in endurance exercise with BP decreasing approximately 5-7 mm HG after an isolated exercise session (acute) or following exercise training (chronic). Moreover, BP is reduced for up to 22 h after an endurance exercise bout (e.g.postexercise hypotension), with greatest decreases among those with highest baseline BP. The proposed mechanisms for the BP lowering effects of exercise include neurohumoral, vascular, and structural adaptations. Decreases in catecholamines and total peripheral resistance, improved insulin sensitivity, and alterations in vasodilators and vasoconstrictors are some of the postulated explanations for the antihypertensive effects of exercise. Emerging data suggest genetic links to the BP reductions associated with acute and chronic exercise. Nonetheless, definitive conclusions regarding the mechanisms for the BP reductions following endurance exercise cannot be made at this time. Individuals with controlled HTN and no CVD or renal complications may participated in an exercise program or competitive athletics, but should be evaluated, treated and monitored closely. Preliminary peak or symptom-limited exercise testing may be warranted, especially for men over 45 and women over 55 yr planning a vigorous exercise program (i.e. > or = 60% VO2R, oxygen uptake reserve). In the interim, while formal evaluation and management are taking place, it is reasonable for the majority of patients to begin moderate intensity exercise (40-<60% VO2R) such as walking. When pharmacological therapy is indicated in physically active people it should be, ideally: a) lower BP at rest and during exertion; b) decrease total peripheral resistance; and, c) not adversely affect exercise capacity. For these reasons, angiotensin converting enzyme (ACE) inhibitors (or angiotensin II receptor blockers in case of ACE inhibitor intolerance) and calcium channel blockers are currently the drugs of choice for recreational exercisers and athletes who have HTN. Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of HTN. The optimal training frequency, intensity, time, and type (FITT) need to be better defined to optimize the BP lowering capacities of exercise, particularly in children, women, older adults, and certain ethnic groups. based upon the current evidence, the following exercise prescription is recommended for those with high BP: Frequency: on most, preferably all, days of the week. Intensity: moderate-intensity (40-<60% VO2R). Time: > or = 30 min of co...

The impact of changes in leisure time physical activity on changes in cardiovascular risk factors: results from The Finnmark 3 Study and SAMINOR 1, 1987–2003

“…This is in accordance with data from NHANES III [30], showing that average SBP in the US population increased throughout life, while DBP decreased after 60 years of age. The American College of Sports Medicine recommends dynamic aerobic endurance training for at least 30 min daily to prevent hypertension [31], and randomized control studies repeatedly show that exercise reduces SBP and DBP [32]. There seems to be strong evidence for an effect of physical activity interventions on blood pressure not only among hypertensive but also among normotensive and prehypertensive individuals [33].…”

Prevalência de hipertensão arterial em militares jovens e fatores associados

“…6 On the other hand, physical activity, at high and regular levels, tends to reduce blood pressure values. 13,14 The objective of the present study was to estimate the prevalence of arterial hypertension in a young military population and the associated factors.…”

Efeitos sequenciais do treinamento aeróbio sobre o sistema renina-angiotensina em núcleos autonômicos de ratos normotensos e hipertensos.

“…A redução da PA de indivíduos hipertensos reduz a morbidade e mortalidade, melhorando substancialmente a qualidade de vida (CHOBANIAN et al, 2003;PESCATELLO et al, 2004). O tratamento clássico da hipertensão inclui diversas terapias farmacológicas como o uso de diuréticos, simpatolíticos, vasodilatadores, bloqueadores de canais de cálcio, e diferentes inibidores do SRA, como os inibidores da renina e da ECA, além de bloqueadores dos receptores AT 1 da Ang II (CHOBANIAN et al, 2003;PAULIS;UNGER, 2010).…”

“…Observações recentes também têm indicado que, além da terapia com fármacos, o tratamento da hipertensão deve incluir modificações no estilo de vida, dentre as quais se destacam a restrição da ingestão de sal e álcool, a perda de peso corporal, e principalmente a realização de atividade física regular (CHOBANIAN et al, 2003;CLÉROUX;FELDMAN;PETRELLA, 1999;PESCATELLO et al, 2004).…”

“…Por outro lado, a prática regular de exercícios físicos apresenta diversos efeitos benéficos para a saúde, o que tem sido extensivamente confirmado pela literatura experimental (AMARAL; SMIDT et al, 2005;TAYLOR et al, 2007) e clínica (CHOBANIAN et al, 2003;PESCATELLO et al, 2004). Diversos estudos têm demonstrado que quanto maior o nível de aptidão física, menor o risco cardiovascular (BLAIR et al, 1995;CHOBANIAN et al, 2003).…”