Exercise Lowers High Blood Pressure
Two recent studies suggest that exercise may be as effective as medications when it comes to lowering high blood pressure. But should you ditch the drugs in favor of moving more? Not necessarily, says Mount Sinai cardiologist Bruce Darrow, MD, PhD. “While boosting your physical activity levels is definitely beneficial for your cardiovascular health, these data shouldn’t be seen as a green light to stop drug therapy,” he cautions.
How Exercise Helps
Blood pressure is measured in millimeters of mercury (mmHg). The top number in a blood pressure reading—called systolic pressure—refers to the amount of pressure in the arteries when the heart is contracting. High systolic pressure is associated with a greater risk of cardiovascular disease and death, but exercise can help reduce systolic pressure. “The benefits of exercise may be due to the fact that it stimulates the release of nitric oxide by cells lining blood vessels, and nitric oxide causes blood vessels to relax,” Dr. Darrow explains. “Exercise also increases levels of HDL, or ‘good’ cholesterol, which helps remove the LDL—‘bad’ cholesterol—that can build up in arteries and contribute to raised blood pressure, though this link is less clear.”
WHAT YOU CAN DO
- Move more, sit less Some physical activity is better than none.
- Work up gradually to meeting or exceeding federal guidelines for aerobic exercise (at least 150 minutes per week at moderate intensity, or 75 minutes per week at vigorous intensity), and also try to do strength-training exercises on two or more days per week.
- If you have a chronic condition, discuss with your doctor what types and intensity of exercise are suitable for you.
Exercise vs. Drugs
It hasn’t been clear how exercise compares with blood pressure-lowering drugs, since there haven’t been any direct head-to-head clinical trials. To get round this, researchers writing in the British Journal of Sports Medicine (BJSM), December 2018, pooled data from 194 trials looking at the impact of drugs on lowering systolic blood pressure, and 197 trials looking at the impact of structured exercise. Altogether, the trials included nearly 40,000 people who engaged in a range of structured exercise programs that included walking, jogging, cycling, swimming, and strength training.
The initial analysis showed that blood pressure was lower in people treated with drugs. However, in a second analysis restricted to participants with high blood pressure, exercise was just as effective as most drugs—both options lowered blood pressure by nearly 9 mmHg.
The second study we reference (Hypertension, Feb. 20) included 67 people age 55 to 80. Most were overweight or obese, and one-third had high blood pressure. Across three days, all of them took part in three physical activity scenarios. In the first, they sat for eight hours and only got up for bathroom breaks; and in the second, they sat for one hour, walked for 30 minutes on a treadmill, and then sat again for 6.5 hours. The third mirrored the second, but participants also took a three-minute walk every 30 minutes during the longer sedentary period. The data showed that the participants’ blood pressure decreased by about 3.4 mmHg when they walked for 30 minutes, and an additional 1.7 mmHg when they also got up and walked every 30 minutes.
Expert Verdict
While the BJSM data look impressive, there are caveats. “Some of the studies that were included in the trial had relatively small numbers of participants, and some people whose blood pressure was high were taking drugs to manage the problem, so it’s possible this partly accounts for the benefits seen with exercise,” Dr. Darrow says. Also, the benefits of exercise weren’t as significant in older adults who exercised—their systolic readings decreased by about half as much as in younger people. “Older adults have stiffer arteries,” Dr. Darrow explains. “This may mean that it’s slightly harder for exercise to improve their artery health.”
One thing Dr. Darrow likes about the Hypertension study is that a 30-minute walk is something most seniors can fit into their day, even if they still work. He notes, however, that the study follow-up was brief. “We also don’t know if the small reductions seen in blood pressure would translate into better long-term health,” he adds. He reiterates that neither of the studies directly compared the effects of exercise with blood pressure drugs. “We would need direct head-to-head randomized controlled trials to clarify this,” he says.
It’s Not “Either-Or”
Overall, Dr. Darrow says that it isn’t a case of either-or when it comes to medications and exercise—rather, see it in terms of “and.” Aim to take your medications as directed, and increase the amount of exercise you get until you met or exceed federal recommendations (see What You Can Do). “If you are taking more than one medication to help you manage high blood pressure, more exercise could help you reduce the number of drugs you need,” Dr. Darrow observes. “Alternately, if you are just nudging over the threshold for hypertension, fully committing to an exercise regimen may mean you don’t have to take blood pressure drugs at all.”
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