What is the pathophysiology of exercise in reducing hypertension?

From the Guidelines

Exercise reduces blood pressure through multiple physiological mechanisms, including improved vascular function, reduced sympathetic nervous system activity, and enhanced parasympathetic tone, with regular aerobic exercise being the most effective type of exercise for reducing hypertension, as suggested by the 2024 ESC guidelines 1. The pathophysiology of exercise in reducing hypertension is complex and involves several key mechanisms. Regular physical activity improves vascular function by enhancing endothelial function, which increases nitric oxide production and promotes vasodilation, directly lowering peripheral resistance. Exercise also reduces sympathetic nervous system activity while enhancing parasympathetic tone, leading to decreased heart rate and blood pressure. Additionally, physical activity helps reduce arterial stiffness, improves insulin sensitivity, and promotes weight loss, all of which contribute to blood pressure reduction. Some of the key benefits of exercise for hypertension management include:

• Improved vascular function and endothelial health
• Reduced sympathetic nervous system activity and enhanced parasympathetic tone
• Decreased arterial stiffness and improved insulin sensitivity
• Promotion of weight loss and improved overall cardiovascular health The most recent and highest quality study, the 2024 ESC guidelines 1, suggests that aerobic exercise is the most effective type of exercise for reducing hypertension, with regular aerobic exercise resulting in systolic blood pressure reductions of up to 7-8 mmHg and diastolic blood pressure reductions of up to 4-5 mmHg. Resistance training, such as dynamic resistance training, can also provide additional benefits when combined with aerobic exercise, particularly for non-white patients with hypertension 1. Overall, the evidence suggests that regular exercise, particularly aerobic exercise, is a highly effective non-pharmacological intervention for reducing blood pressure and managing hypertension, with benefits that extend beyond blood pressure reduction to overall cardiovascular health and well-being 1.

From the Research

Pathophysiology of Exercise in Reducing Hypertension

The pathophysiology of exercise in reducing hypertension involves several mechanisms that contribute to the decrease in blood pressure. Some of the key mechanisms include:

• Neurohumoral adaptations: Exercise has been shown to decrease catecholamines and total peripheral resistance, which can lead to a decrease in blood pressure 2.
• Vascular adaptations: Regular exercise can improve insulin sensitivity and alter the balance of vasodilators and vasoconstrictors, leading to a decrease in blood pressure 2.
• Structural adaptations: Exercise can lead to changes in the structure and function of the blood vessels, which can also contribute to a decrease in blood pressure.

Effects of Exercise on Blood Pressure

The effects of exercise on blood pressure have been studied extensively. Some of the key findings include:

• Aerobic exercise has been shown to reduce blood pressure in both hypertensive and normotensive individuals 3.
• Regular exercise can lead to a decrease in systolic and diastolic blood pressure, with the magnitude of the decrease depending on the intensity and duration of the exercise 4, 5.
• Exercise can also lead to a decrease in blood pressure during exertion and increase physical performance as assessed by maximal oxygen uptake and lactate curves 5.

Types of Exercise and Their Effects on Blood Pressure

Different types of exercise have been shown to have different effects on blood pressure. Some of the key findings include:

• Aerobic exercise, such as brisk walking, has been shown to be effective in reducing blood pressure 6, 3.
• Resistance exercise has also been shown to be effective in reducing blood pressure, although the magnitude of the decrease may be smaller than that seen with aerobic exercise 6, 2.
• The American College of Sports Medicine recommends a combination of endurance and resistance exercise for the prevention, treatment, and control of hypertension 2.

Recommendations for Exercise and Hypertension

Based on the available evidence, the following recommendations can be made:

• Individuals with hypertension should aim to engage in regular aerobic exercise, such as brisk walking, for at least 30 minutes per day, most days of the week 6, 2.
• Resistance exercise can also be beneficial, and can be done 2-3 times per week 6, 2.
• The intensity of the exercise should be moderate, with a goal of achieving 40-60% of oxygen uptake reserve 2.