Hypertension: What effect does physical exercise have?

Getting more exercise can help to lower your blood pressure. Whether increased physical activity also effects the risk of developing complications of hypertension has yet to be studied in trials.

Hypertension is the medical name for high blood pressure: it means that the blood vessels are literally under too high a pressure. This does not necessarily cause any noticeable symptoms. Over the years, however, increased blood pressure can damage the heart and the blood vessels, and lead to health problems: people who have hypertension are more likely to have cardiovascular disease, such as heart attacks or strokes. In Germany almost half of all adults have high blood pressure – and it is somewhat more common in men than in women. Most people who have hypertension have what is called essential hypertension. This means that no other disease was found to be causing the increase in blood pressure.

Blood pressure readings consist of two measurements: an upper measurement called systolic blood pressure, and a lower measurement called diastolic blood pressure. People are considered to have a high blood pressure if for at least two measurements taken on different days the upper measurement is over 140 mm Hg, the lower measurement is over 90 mm Hg, or both measurements are high. The unit of measurement “mm Hg” stands for “millimeters of mercury”. You can read more about blood pressure and how it is measured here.

Options for lowering blood pressure

Besides drugs, there are various options for getting your blood pressure down in the long term. One recommendation is to watch your weight or use salt sparingly. You can find out about how weight loss can affect your blood pressure here, and you can read about whether it is worth it to reduce your salt intake here. We also have a description of what benefit different antihypertensive drugs have here.

Doctors also recommend getting regular exercise to have a long-lasting effect on your blood pressure. Trials show that people who do get a lot of exercise are less likely to develop hypertension than people who are inactive.

Evaluating the benefit of physical exercise

The German Institute for Quality and Efficiency in Health Care (IQWiG) – who publish this website – analyzed trials that looked into the benefit that physical exercise has for people with hypertension. They were supported in their work by researchers from the Graz University Hospital (Austria).

The researchers looked for what are referred to as randomized controlled trials. In these types of trials participants are randomly divided into two or more groups. The groups then receive either different treatments or no treatment before they are compared with one another. You can read more about why these kinds of trials are important for analyzing the benefits that different treatments have here. In this case all trials ought to compare these two groups: one group that was advised to do more exercise over a longer period of time, and one group that received no strategies or advice on increasing their level of physical activity. Exercise in these trials meant activities like cycling, running, hiking or swimming.

People who take steps to lower their blood pressure are especially interested in whether their risk of developing complications like heart attacks, strokes or kidney disease, for example, can be lowered long term. For this reason the researchers evaluated the trials in terms of whether more exercise was able to prevent complications or deaths resulting from hypertension and how more exercise influences quality of life. They also recorded how the blood pressure levels changed over time and whether the participants needed less medication to control their blood pressure.

The IQWiG researchers only found trials that had lasted between 6 and 12 months. Overall, about 840 people with high blood pressure took part in the trials. Most of the 8 trials that were found in total had groups of 20 people at the most. Four trials tested what influence regular consultations on increased physical activity had, and whether a recommendation to be more active can move people to act. In the other four trials, participants were given an endurance training program that included activities like fast walking, jogging, bicycling or aerobics. Yet based on these trials, it is not possible to say whether these activities lead to fewer heart attacks or incidences of kidney disease.

Exercise lowers blood pressure

All of the trials looked at how increased exercise effects blood pressure levels. The results indicated that increased physical activity can help lower blood pressure. The amount that blood pressure dropped varied from trial to trial: In most trials systolic blood pressure fell by an average of 5 to 8 mm Hg – for example from 145/80 to 138/80 mm Hg. It is not possible to conclude from these trials that exercise can also lower diastolic blood pressure.

It is still unclear how intensively and how frequently you have to exercise in order to lower your blood pressure by a certain amount. It was not always apparent from the trials by how much participants actually increased their own physical activity. This means that it is possible that not all of them stuck to the recommendations given to them in the trials. This uncertainty makes it difficult to make connections between the level of activity and the resulting drop in blood pressure.

The trials do not reveal whether people who increase their level of physical activity will then also need less medication for lowering their blood pressure. The trials do not provide any conclusive data on possible adverse effects of athletic activity like falls and injuries, either. There has also not been adequate research about the effect on quality of life.

Lack of trials on complications

To assess how physical activity affects the development of disease and life expectancy, trials lasting for several years are needed. Since increased risk of cardiovascular disease usually takes years to develop, this would be the only way to assess the possible effects of any treatment. Yet the researchers did not find any trials that ran over several years to study these kinds of long-term effects.

Even though it is not known whether more exercise influences the risk of complications from hypertension it is worth trying to lower blood pressure by doing more exercise. Because exercise brings other health benefits. You can find more information on possible types of exercise programs, how to make them a part of your daily routine and what benefit they have for different kinds of health problems here.


Author: Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: January 2014. You can find out more about how our health information is updated here.

Note

This health information is a summary of a scientific report published by IQWiG. It is not an assessment of the right to have health care services paid for by statutory health insurance funds in Germany. By law, decisions about paying the costs for diagnostic and therapeutic procedures can only be made by the German Federal Joint Committee (G-BA). The Federal Joint Committee takes IQWiG reports into consideration in its decision-making process. You can find information about the decisions of the German Federal Joint Committee on its English-language website, www.english.g-ba.de.

© IQWiG (Institute for Quality and Efficiency in Health Care)