Exercise: a therapeutic modality to treat blood pressure in resistant hypertension

Abstract

Background: Thirteen percent of deaths worldwide are attributed to blood pressure above the normal range, or hypertension. Activation of the sympathetic nervous system plays a predominant role in blood pressure elevation. A phenotype of hypertension, referred to as resistant hypertension, occurs when the goal blood pressure is not achieved when using three or more medications, including a diuretic. A sleep disorder, obstructive sleep apnea, is also associated with increased sympathetic activity and as well, is strongly associated with resistant hypertension. However whilst the use of a continuous positive airway pressure device during sleep is effective in eliminating the breath pauses in people with obstructive sleep apnea, it does not address the hypertension. Alternative therapeutic modalities are thus warranted. One such therapy, exercise, has been shown to have a positive influence on blood pressure in hypertensive and normotensive individuals and may potentially be used as a therapeutic modality to reduce blood pressure in individuals with resistant hypertension.

Objectives: The purpose of this review was to explore the evidence in support of exercise as a valuable therapeutic modality to reduce blood pressure in adults with resistant hypertension.

Major findings: All types of exercise have been shown to reduce blood pressure in hypertensives and normotensives. Aerobic exercise has the greatest effect on reducing blood pressure in individuals with resistant hypertension and thus also reduces morbidity and mortality risk.

Conclusions: Exercise has been shown to reduce blood pressure in hypertension and resistant hypertension and is an effective, safe modality.

Keywords:

• Resistant hypertension
• obstructive sleep apnea
• physical activity
• exercise

Disclosure statement

The authors declare no conflict of interest.

Additional information

Notes on contributors

Suranga Dassanayake

Mr. Suranga Dassanayake is undertaking a PhD at School of Physiotherapy, University of Otago in the field of cardiorespiratory physiotherapy and exercise. He previously worked as a university academic with 10 years of research experience.

Gisela Sole

Dr Margot Skinner is the primary supervisor of the PhD project. She is the Deputy Dean at the School of Physiotherapy, University of Otago, with 27 years of research experience. Her research has focussed on the fields of cardiorespiratory physiotherapy, sleep health and non-communicable diseases.

Gerard Wilkins

Assoc. Prof. Gerry Wilkins, from Department of Medicine, Dunedin School of Medicine, University of Otago is an experienced clinical academic cardiologist and expert coronary and vascular physician whose research has included outcomes of introducing new techniques into the field.

Margot Skinner

Assoc. Prof. Gisela Sole is currently the Associate Dean, Undergraduate studies at the School of Physiotherapy, University of Otago. Her research to date has focussed on outcomes of musculoskeletal injury, exploring long term effects of injury and pain on physical performance and quality of life, and the beliefs of patients and health professionals in managing injuries.