Does regular aerobic exercise lower systolic and diastolic blood pressure in adults with pre‑hypertension or hypertension?

Does Exercise Reduce Blood Pressure?

Yes, regular aerobic exercise significantly reduces blood pressure in adults with pre-hypertension and hypertension, lowering systolic BP by 2-8 mmHg and diastolic BP by 1-5 mmHg on average. 1

Recommended Exercise Prescription

Aerobic Exercise (Primary Recommendation)

Aerobic exercise is the first-line exercise therapy for blood pressure reduction and should form the foundation of any exercise program for hypertension. 1, 2

• Frequency: 3-4 sessions per week minimum, ideally 5-7 days per week 1
• Duration: At least 30-40 minutes per session 1
• Weekly Total: Minimum 150 minutes per week 1
• Intensity: Moderate-to-vigorous intensity (brisk walking, jogging, cycling, swimming) 1

The 2024 ESC Guidelines specifically note that aerobic exercise reduces systolic BP by 7-8 mmHg and diastolic BP by 4-5 mmHg in hypertensive patients. 1 The 2013 AHA/ACC Guidelines provide high-strength evidence (Grade A) that aerobic exercise decreases systolic BP by 2-5 mmHg and diastolic BP by 1-4 mmHg across all BP levels. 1

Resistance Training (Supplementary)

Dynamic resistance training provides additional but smaller BP reductions compared to aerobic exercise. 1, 3

• Frequency: 2-3 days per week 1, 3
• Structure: 8-10 different exercises targeting major muscle groups 3
• Intensity: Low-to-moderate intensity, avoiding maximal isometric exercises 1, 3

Important caveat: Resistance training evidence is weaker than aerobic exercise evidence, particularly in hypertensive populations, and should supplement rather than replace aerobic exercise. 1

Exercise Sessions Can Be Divided

Exercise can be performed continuously for 30 minutes or broken into shorter 10-minute bouts throughout the day with similar BP-lowering effects. 1, 3 This addresses the common barrier of "not having time to exercise" and may improve long-term adherence. 1

Expected Clinical Benefits

• Magnitude of BP reduction: 5-10 mmHg systolic and 2-8 mmHg diastolic with regular adherence 2, 3, 4
• Mortality impact: A 5 mmHg reduction in systolic BP decreases coronary heart disease mortality by 9%, stroke mortality by 14%, and all-cause mortality by 7% 4
• Comparative effectiveness: Meta-analyses show no statistically detectable difference between exercise and drug interventions for mortality outcomes in coronary heart disease and prediabetes 1, 3
• Medication reduction: Regular exercise may allow reduction in antihypertensive medication use in responsive patients 1, 2

Critical Safety Considerations

Medication interactions must be considered when prescribing exercise intensity. Beta-blockers and some other antihypertensive medications blunt heart rate response to exercise, requiring modification of exercise intensity targets. 1, 3, 5

Avoid sudden vigorous physical exertion in hypertensive patients, as this population has increased risk of transient cardiovascular events during abrupt high-intensity activity. 1, 5

Post-Exercise Hypotension Effect

The BP-lowering effect of a single exercise session (post-exercise hypotension) lasts up to 24 hours, which is why daily or near-daily exercise is more effective than exercising only 3-4 days per week. 5, 4

Evidence Quality and Gaps

While the 2015 Mayo Clinic review noted that despite substantial literature on exercise and hypertension, the evidence quality is "less than optimal" with gaps in understanding optimal FITT (Frequency, Intensity, Time, Type) parameters, 1 the consensus across all major guidelines remains consistent: adults with pre-hypertension or hypertension should perform at least 30 minutes of moderate-intensity aerobic exercise on most days of the week, totaling 150 minutes weekly or more. 1, 2

Effectiveness Across BP Categories

Exercise reduces BP in normotensive, pre-hypertensive, primary hypertensive, and even resistant hypertensive individuals. 1, 6, 7, 8 A 2012 randomized controlled trial demonstrated that even patients with resistant hypertension (BP ≥140/90 mmHg despite 3 medications) experienced significant reductions of 6 mmHg systolic and 3 mmHg diastolic with 8-12 weeks of aerobic exercise. 7