The place of exercise in the long-term treatment of hypertension

The antihypertensive effects of exercise have been examined in 2 randomized studies of multiple levels of activity. In 12 normal subjects, 1 month's exercise 3 times weekly lowered blood pressure (BP) and vascular resistance. There was only a slightly greater effect after 7 times/week exercise. In most subjects there was a marked reduction in noradrenaline spillover rate, a measure of sympathetic activity. Exercise also improved glucose utilization and lowered plasma cholesterol. Thirteen previously untreated patients with essential hypertension had an average fall in BP of 11/9 and 16/11 mm Hg after 1 month each of 3/week and 7/week exercise respectively, again associated with fall in vascular resistance and a 20-30% reduction in plasma noradrenaline. BP remained lowered by 3/week exercise for 1 year. In patients who had BP controlled with drug for greater than 1 year, exercise 3 times weekly also prevented the redevelopment of hypertension after long-term drug therapy was ceased. Regular exercise is useful in the initial management of patients with mild hypertension. In more severely hypertensive patients, exercise may also be effective after an initial period of drug therapy.