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Hypertension (HT) is a major public health problem. Complications, including stroke, coronary artery diseases, renal diseases, make it one of the principal factors that can be modified to reduce medical risk burden. Today, it is well established that physical activity (PA) can reduce the risk of developing HT, and helps in HT control, alone or in association with drug therapy. The mechanisms underlying the effects of PA on blood pressure (BP) remain poorly understood. A decrease in peripheral arterial resistance and a more effective adaptation of cardiac output during effort have been reported. Improvements in vascular endothelial and neuro-vegetative dysfunctions are also involved. Genetic and environmental factors may slightly influence the impact of physical training on blood pressure. In elderly subjects, it seems that the impact of PA is not as great and mainly affects diastolic pressure.
Many scientific societies have thus recommended increased PA as a first-line intervention for preventing and treating HT. PA is particularly appealing because it also has favourable effects on other cardiovascular disease risk factors. The effect of endurance training is comparable to, if not greater than that generated by medical monotherapy: average BP reduction with regular endurance exercise is reported to be 7.4/5.8 mm Hg. Resistance training also has a favourable but lesser effect on resting BP. PA is thus a low-cost intervention with few adverse effects if undertaken according to recommended guidelines.
Recommendations for the prescription of exercise should be based on the patient's age, physical capacities and preferences, BP, and overall cardiovascular disease risk factors, including other comorbidities. Patients over 50 or with cardiovascular risk factors will benefit from a previous maximal exercise test. Recommendations for optimal efficacy include 30 minutes of moderate intensity exercise (50-70% of maximum HR), for at least 5 days a week, and, if possible, resistance training twice a week. Recommendations for participation in competitive sports in athletes with HT are based on risk stratification, and evaluation may comprise exercise tests and echocardiography.