Aerobic Exercise Helps Hard-To-Treat High Blood Pressure

"Resistant hypertension persists as a big clinical challenge because the available treatment options to lower blood pressure in this clinical population, namely drugs and renal denervation, show limited success," said Fernando Ribeiro, Ph.D., of the University of Aveiro in Portugal. "Aerobic exercise was safe and associated with a significant and clinically relevant reduction in 24-hour, daytime ambulatory, and office blood pressure."

The study included 53 people ages 40 to 75 with resistant hypertension, all of whom continued taking their blood pressure medications. Twenty-six were randomly assigned to a supervised exercise program that involved walking, cycling, or a combination of the two for 40 minutes, three times a week, for 12 weeks. The other 27 received usual care, including lifestyle advice. Researchers measured the participants’ 24-hour ambulatory blood pressure at the start and end of the study.

Resistant hypertension was defined as having a "mean systolic BP of 130 mm Hg or greater on 24-hour ambulatory BP monitoring and/or 135 mm Hg or greater during daytime hours while taking maximally tolerated doses of at least 3 antihypertensive agents, including a diuretic, or to have a controlled BP while taking 4 or more antihypertensive agents."

Compared with the usual care group, the exercisers lowered their systolic blood pressure (the first number in a reading) by an average of 7.1 points and their diastolic blood pressure (the second number) by 5.1 points. Significant improvements were also observed in cardiorespiratory fitness in the exercise group compared to the control group. 

Aerobic exercise is already recommended as a first-line treatment for high blood pressure. The authors suggest that their findings were published online on August 4, 2021, in JAMA Cardiology confirm the importance of this advice for people with resistant hypertension.

The study was not without several limitations, including having a small sample size and a patient population that mostly has "relatively mild hypertension," Vongpatanasin said, adding, "We don't know whether these findings will apply to patients with more severe hypertension."

Moving forward, it will be important to "investigate why some patients are nonresponders to the exercise intervention and why some are super-responders," study author Ribeiro said.