[Physical activity, blood pressure and hypertension]

Both dynamic predominantly isotonic and static or isometric exercise increase blood pressure, but pressure reaches higher levels during static effort. One should be aware, however, that blood pressure may rise considerably when hypertensive patients perform dynamic exercise. The response of blood pressure to exercise is rather variable from patient to patient, but this variability does not provide independent prognostic precision when pressure at rest is taken into account. Blood pressure per se adversely affects maximal aerobic power, which is related to an impaired maximal stroke volume that can be ascribed to the high afterload or to impaired ventricular filling at high heart rate. Dynamic, relatively intense physical training, performed at least 3 times 30 minutes per week for 1 to 8 months, has been shown to reduce blood pressure, particularly in hypertensive patients. After training, blood pressure was also reduced when measured during exercise and during daytime ambulatory monitoring. Physical training can therefore be advocated in the management of the hypertensive patient. Finally, when prescribing antihypertensive medication to exercising patients, one should be aware that some drugs, particularly beta-blockers and diuretics, may reduce exercise performance or even impair the conditioning response.