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You Asked for It: Question Authority

Nieman, David C. Dr.PH., FACSM

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David C. Nieman, Dr.PH., FACSM, is professor and director of the Human Performance Laboratory, Appalachian State University, in Boone, NC, an active researcher, and author of several textbooks on health and fitness.

Q: I just found out that my blood pressure is 145/95 mm Hg. I don't want to start using drugs. My question is this: can I control my blood pressure through exercise and other changes in my lifestyle?

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A: If you are highly motivated to change your lifestyle and stick with it, there is a good chance that you can achieve normal blood pressure without using drugs. Before describing lifestyle strategies, let's review some basic facts about blood pressure.

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What is High Blood Pressure?

Blood pressure is the force of the blood pushing against the walls of those arteries. The blood pressure is at its greatest when the heart contracts, and it is called systolic blood pressure. When the heart is resting briefly between beats, the blood pressure falls, and it is termed diastolic blood pressure. High blood pressure or hypertension is a condition in which the blood pressure is chronically elevated above normal levels. High blood pressure usually doesn't give early warning signs and for this reason is known as the "silent killer," because it increases the risk for coronary heart disease and other forms of heart disease, stroke, and kidney failure.

According to the latest blood pressure (BP) classifications released by the National Heart, Lung, and Blood Institute, you have "stage 1 hypertension" (1). The standards are summarized in Table 1 and are based upon the average of two or more properly measured, seated blood pressure readings on each of two or more clinic visits. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure concluded that in persons older than 50 years, systolic blood pressure greater than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic blood pressure (1). The risk of CVD beginning at 115/75 mm Hg doubles with each increment of 20/10 mm Hg, indicating that the lower the blood pressure, the better. Systolic blood pressures of 120 to 139 mm Hg, once thought normal, are now considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD.

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Table 1
Table 1
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Prevention and Treatment

Nearly three in ten adults have high blood pressure, a proportion that rises strongly to two in three among the elderly. In societies where salt and alcohol intakes are high, potassium intake from fruits and vegetables is low, and physical inactivity and obesity are the norm, hypertension is common. Physically inactive and unfit individuals have a 20% to 50% increased risk of developing hypertension compared with their more physically active peers (2). Risk of high blood pressure is high among African-American individuals, people with a family history of hypertension, and the elderly.

Good lifestyle habits lie at the foundation of both prevention and treatment of high blood pressure. Major lifestyle modifications shown to lower blood pressure include weight reduction in those who are overweight or obese, adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan which is rich in potassium and calcium, dietary sodium reduction, physical activity, and moderation of alcohol consumption. Table 2 summarizes the lifestyle modifications used to manage hypertension and the expected reductions in systolic blood pressure (SBP) (1).

Table 2
Table 2
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The Exercise Connection

During walking, cycling, swimming, or other aerobic activities, the systolic blood pressure rises strongly. Soon after the aerobic session is over, however, both the systolic and diastolic blood pressure fall below pre-exercise levels as the blood vessels relax and neural changes occur, an effect that can last for nearly an entire day and is most pronounced among hypertensives (3). Over time, as the exercise is repeated, a long-lasting reduction in resting blood pressure is experienced, usually approximately 5 to 7 mm Hg for systolic and diastolic blood pressures. This aerobic exercise benefit is independent of changes in body weight or diet (which can result in greater reductions) and is slightly higher for hypertensives (3). Resistance training performed according to ACSM's guidelines reduces blood pressure, but less effectively than aerobic exercise (3). Thus resistance training can serve as an adjunct to an aerobic-based program for control of high blood pressure.

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Exercise Programming and Precautions

The aerobic exercise program does not have to be too demanding to improve resting blood pressure. In fact, moderate-intensity exercise such as brisk walking may have an even greater blood pressure-lowering effect than higher-intensity training (like running) for some people. The important exercise criterion is frequency: near daily activity helps the body experience the beneficial exercise lowering effects on blood pressure on a regular basis. In ACSM's latest Position Stand on exercise and hypertension, the following exercise prescription was recommended for those with hypertension (3):

* frequency: on most, preferably all, days of the week

* intensity: moderate intensity (40-60% of VO2R)

* time: ≥30 minutes of continuous or accumulated physical activity per day

* type: primarily endurance physical activity supplemented by resistance exercise.

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Overall Recommendation

So my recommendation to you is to achieve ideal weight through a combination of exercise, reduced food intake (using the DASH eating plan as outlined at, and a reduction in salt intake. If you make these lifestyle changes permanent, you should be able to manage your high blood pressure without the need for drugs.

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1. Chobanian, A.V., G.L. Bakris, H.R. Black, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42(6):1206-1252, 2003.

2. Hu, G., N.C. Barengo, J. Tuomilehto, et al. Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland. Hypertension 43(1):25-30, 2004.

3. Pescatello, L.S., B.A. Franklin, R. Fagard, et al. American College of Sports Medicine position stand. Exercise and hypertension. Medicine & Science in Sports & Exercise® 36(3):533-553, 2004.

© 2004 American College of Sports Medicine


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