What is the recommended workout regimen for secondary hypertension?

Exercise Recommendations for Secondary Hypertension

For patients with secondary hypertension, regular aerobic exercise for 30 minutes of moderate-intensity dynamic activity on 5-7 days per week, complemented with dynamic resistance training 2-3 times per week, is recommended as part of a comprehensive management approach. 1

Aerobic Exercise Recommendations

• Moderate-intensity aerobic exercise (walking, jogging, cycling, yoga, or swimming) for 30 minutes on 5-7 days per week, totaling at least 150 minutes weekly 1
• Aerobic interval training (alternating short bursts of intense activity with recovery periods) can also effectively reduce blood pressure 1
• Exercise intensity should target 40-70% of maximum oxygen uptake for optimal blood pressure reduction 2
• Aerobic endurance training has been shown to reduce resting systolic and diastolic blood pressure by 3.0/2.4 mmHg overall and by 6.9/4.9 mmHg in hypertensive participants 1

Resistance Training Recommendations

• Dynamic resistance training (force development associated with movement) 2-3 times per week 1
• This type of training has shown significant blood pressure reduction and improvements in metabolic parameters 1
• Isometric resistance exercises are not recommended due to limited evidence 1

Clinical Benefits

• Regular physical activity is associated with approximately 20% decrease in mortality in cohort studies 1
• Exercise can reduce systolic blood pressure by 5-7 mmHg and diastolic blood pressure by 4-5 mmHg in hypertensive patients 1
• Even moderate-intensity exercise has been shown to reduce blood pressure in patients with severe hypertension 1
• Regular exercise improves endothelial function, platelet activation, and inflammatory response beyond just blood pressure reduction 3

Important Considerations

• Exercise should be part of a multimodal approach that includes other lifestyle modifications such as:

  • Salt restriction to 5-6g per day 1
  • Weight reduction to achieve a BMI of 25 kg/m² 1
  • Adoption of a DASH or Mediterranean diet rich in fruits, vegetables, whole grains, and low-fat dairy 1
  • Moderation of alcohol consumption (≤2 standard drinks/day for men, ≤1 for women) 1
  • Smoking cessation 1

• For patients with secondary hypertension, it's crucial to identify and treat the underlying cause (such as primary aldosteronism, pheochromocytoma, or obstructive sleep apnea) alongside exercise therapy 1

• Beta-blockers may not be the ideal antihypertensive medication for patients engaged in regular exercise programs due to their effects on exercise performance 2

Implementation Approach

• Begin with lower intensity and shorter duration, gradually increasing both over weeks as tolerance improves 4
• For overweight or obese hypertensive patients, aim for caloric expenditure of 300-500 kcal per day and 1000-2000 kcal per week 4
• Walking is associated with fewer musculoskeletal injuries compared to jogging and may be preferable for many patients 5
• Consider referral to an exercise specialist for proper exercise prescription and supervision, especially for patients with severe hypertension 6

Regular exercise should be prescribed as adjunctive therapy even for patients requiring pharmacological treatment for secondary hypertension, with the exception of those receiving beta-blockers where exercise capacity may be limited 5, 2.