One in three people in the UK have high blood pressure2. For more facts and figures, click here.

"Hypertension affects more than 40% of adults worldwide1 and is strongly associated with coronary artery disease, stroke, and heart failure.2 The prevalence of hypertension in older adults is high (ie, ~70%-80%),3 and increasing hypertension diagnoses in children and adolescents have been observed in recent years.4 " (Rêgo et al, 2019)

Causes of Hypertension

There isn’t always a known cause of high blood pressure, but in most cases, it's due to diet, lifestyle or a medical condition. Sometimes hypertension is genetic and it can also worsen with age.

Known causes include drinking too much alcohol, smoking, being overweight, not doing enough exercise, and consuming too much salt. Other causes of secondary hypertension include kidney disease, diabetes, and some medicines, such as oral contraceptives and some over-the-counter and herbal medicines.

Effects on the exercise response

Studies have documented a consistent 10 to 20 mmHg reduction in systolic BP during the initial 1 to 3 hours following 30 to 45 min of moderate intensity dynamic exercise in individuals with hypertension1.

Effects of exercise training

Longitudinal studies show that endurance training may result in an average reducion of about 5 to 7 mmHg on both systolic and diastolic BP in persons with stage I or II hypertension1 (ie >140mmHg).

Management and medication

It is recommended that individuals make the following lifestyle modifications: lose weght, limit alcohol, complete >30min aerobic activity on most days, reduce salt intake, eat a diet rich in fruit and vegetables, and stop smoking1. There are a number of medications that are used to treat hypertension and some can have an effect on the response to exercise. Beta-blockers amongst others reduce the heart rate response to submax and maximal exercise1.

Exercise testing

Individuals with hypertension can be tested with standard eercise testing protocols, however, those with additional coronary risk factors, and males older than 45, and females older than 55 should perform a test with ECG monitoring before conducting a vigorous exercise program1.

Exercise Programming

Individuals with high BP (>180/110) should only begin exercising once undergoing drug therapy. Large, muscle aerobic activities are recommended aiming to complete >30min of physical activity per day on most days of the week. The intensity should be at 40-60& of HRpeak or RPE of 11-13/20. Individuals should aim to complete 700 kcal/week of actiity, building up to 2000 kcal/week over a number of months1. Resistance training can be used only to supplement aerobic training and should utilise lower resistance and higher repetitions (eg 1 set of 8-12 reps at 60-80% of 1RM)1


Did you know that one in four people have hypertension? And with recent changes to diagnostic criteria in major clinical practice guidelines, the prevalence is only going to increase. With concerns about the cost, effectiveness, and potential for side effects of antihypertensive drugs, isn’t it time we looked beyond the pharmacy shelves to lower blood pressure?

On this episode, Dr. Huseyin Naci PhD (T: @huseyinnaci2) joins BJSM’s Daniel Friedman (T:@ddfriedman) to discuss his recently published BJSM meta-analysis that compares the effectiveness of exercise and antihypertensive medications on lowering blood pressure [See Naci, H. et al. (2018) below].


  1. American College of Sports Medicine (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics. (Ch38, p107-113)

  2. www.bpassoc.org.uk/mediacentre/Factsandfigures

Further Reading

American Heart Association (2004) Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women Circulation.109: 672 - 693.

Dikalov, S., Itani, H., Richmond, B., Arslanbaeva, L., Vergeade, A., Rahman, S. J., ... & Dikalova, A. (2019). Tobacco smoking induces cardiovascular mitochondrial oxidative stress, promotes endothelial dysfunction, and enhances hypertension. American Journal of Physiology-Heart and Circulatory Physiology, 316(3), H639-H646. https://journals.physiology.org/doi/prev/20190104-aop/abs/10.1152/ajpheart.00595.2018

Ehrman, J., Gordon, P., Visich, P.S., Keteyianby, S. (2009) Clinical Exercise Physiology (2nd Ed). Champaign IL: Human Kinetics

Fantin, F., Macchi, F., Giani, A., & Bissoli, L. (2019). The importance of nutrition in hypertension. Nutrients, 11(10), 2542. https://doi.org/10.3390/nu11102542

Gielen, S., Laughlin, M. H., O’Conner, C., & Duncker, D. J. (2015). Exercise training in patients with heart disease: review of beneficial effects and clinical recommendations. Progress in cardiovascular diseases, 57(4), 347-355.

Hacke, C., Nunan, D., & Weisser, B. (2018). Do exercise trials for hypertension adequately report interventions? A reporting quality study. International Journal of Sports Medicine, 39(12), 902-908. DOI: 10.1055/a-0649-1040

Kelley, G.A. Kelley, K.A. and Tran, Z. (2001) Aerobic Exercise and Resting Blood Pressure: A Meta-Analytic Review of Randomized, Controlled Trials Prev Cardiol. 4(2): 73–80. [full text]

Naci, H., Salcher-Konrad, M., Dias, S., Blum, M. R., Sahoo, S. A., Nunan, D., & Ioannidis, J. P. (2018). How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br J Sports Med, bjsports-2018. http://dx.doi.org/10.1136/bjsports-2018-099921

Pescatello, L. S., MacDonald, H. V., Ash, G. I., Lamberti, L. M., Farquhar, W. B., Arena, R., & Johnson, B. T. (2015, June). Assessing the existing professional exercise recommendations for hypertension: a review and recommendations for future research priorities. In Mayo Clinic Proceedings (Vol. 90, No. 6, pp. 801-812). Elsevier. https://doi.org/10.1016/j.mayocp.2015.04.008

Pescatello, L. S., MacDonald, H. V., Lamberti, L., & Johnson, B. T. (2015). Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Current Hypertension Reports, 17(11), 87. https://doi.org/10.1007/s11906-015-0600-y

Rêgo, M. L., Cabral, D. A., Costa, E. C., & Fontes, E. B. (2019). Physical exercise for individuals with hypertension: It is time to emphasize its benefits on the brain and cognition. Clinical Medicine Insights: Cardiology, 13, 1179546819839411. https://doi.org/10.1177/1179546819839411

Rossi, A., Dikareva, A., Bacon, S. L., & Daskalopoulou, S. S. (2012). The impact of physical activity on mortality in patients with high blood pressure: a systematic review. Journal of Hypertension, 30(7), 1277-1288.

Semlitsch, T., Jeitler, K., Hemkens, L. G., Horvath, K., Nagele, E., Schuermann, C., ... & Siebenhofer, A. (2013). Increasing physical activity for the treatment of hypertension: a systematic review and meta-analysis. Sports Medicine, 43(10), 1009-1023.

Sharman, J. E., La Gerche, A., & Coombes, J. S. (2015). Exercise and cardiovascular risk in patients with hypertension. American Journal of Hypertension, 28(2), 147-158.

Sharman, J. E., Smart, N. A., Coombes, J. S., & Stowasser, M. (2019). Exercise and sport science Australia position stand update on exercise and hypertension. Journal of human hypertension, 33(12), 837-843. https://doi.org/10.1038/s41371-019-0266-z

Smart, N. A., Gow, J., Bleile, B., Van der Touw, T., & Pearson, M. J. (2020). An evidence-based analysis of managing hypertension with isometric resistance exercise—are the guidelines current?. Hypertension Research, 43(4), 249-254. https://doi.org/10.1038/s41440-019-0360-1

Suggested Web Sites

NICE Guidelines. https://www.nice.org.uk/guidance/ng136

Blood Pressure Association. www.bpassoc.org.uk

American Heart Association. Click here

British Heart Foundation -https://www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure