Aerobic Exercise Reduces BP in Resistant Hypertension

Anna Goshua

August 06, 2021

Aerobic exercise may help reduce blood pressure in patients whose hypertension responds poorly to medications, a new study suggests.

A randomized controlled clinical trial showed that patients with resistant hypertension assigned to a moderate-intensity aerobic exercise training program had lower blood pressure (BP) compared with patients who received usual care.

Dr Fernando Ribeiro

"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," Fernando Ribeiro, PhD, University of Aveiro in Portugal, told | Medscape Cardiology. "Aerobic exercise was safe and associated with a significant and clinically relevant reduction in 24-hour, daytime ambulatory, and office blood pressure."

The findings were published online August 4 in JAMA Cardiology.

The researchers enrolled 53 patients aged 40 to 75 years with a diagnosis of resistant hypertension in this prospective, single-blinded trial.

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."

From March 2017 to December 2019 at two sites in Portugal, 26 patients were randomly assigned to a 12-week aerobic exercise training program involving three 40-minute supervised sessions per week in addition to usual care. Another 27 patients in the control group were allocated to receive usual care only.

24-hour ambulatory systolic blood pressure was reduced by 7.1 mm Hg (95% CI, −12.8 to −1.4; P = .02) in patients in the exercise group compared with the control group. In the exercise group, there were additional reductions of:

  • –5.1 mm Hg of 24-hour ambulatory diastolic blood pressure (95% CI, −7.9 to −2.3; P = .001)

  • –8.4 mm Hg of daytime systolic blood pressure (95% CI, −14.3 to –2.5, P = .006)

  • –5.7 mm Hg of daytime diastolic blood pressure (95% CI, −9.0 to −2.4; P = .001)

  • –10.0 mm Hg of office systolic blood pressure (95% CI, −17.6 to −2.5; P = .01)

Additionally, a significant improvement in cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 - 6.6; P < .001) was observed in the exercise group compared with the control group.

Although prior research has suggested that exercise may lower blood pressure, this study is particularly useful because it "outlines very specifically what types of exercise you can recommend," said Daniel Lackland, DrPH, Medical University of South Carolina, Charleston.

Although important, exercise is "one part of the overall management of high blood pressure. If people are being prescribed medication, they should continue taking it and work on lifestyle changes like reducing salt intake and drinking in moderation," added Lackland, who was not involved in the research.

Also commenting on the findings, Wanpen Vongpatanasin, MD, UT Southwestern Medical Center, Dallas, Texas, pointed out that there are many potential benefits from exercise training. "It might improve endothelial function, decrease vascular stiffness and nervous system reactivity to stress, and improve quality of life for patients," she said.

The study has several limitations, including 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."

It would also have been helpful if investigators monitored patient adherence to prescribed medications through urine or blood samples rather than a questionnaire, said Vongpatanasin, who was not associated with the research.

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.

Ribeiro, Lackland, and Vongpatanasin have disclosed no relevant financial relationships. This study was funded by the European Union through the European Regional Development Fund Operational Competitiveness Factors Program (COMPETE) and by the Portuguese government through the Foundation for Science and Technology. The funders had no role in the study.

JAMA Cardiol. Published online August 4, 2021. Abstract

Anna Goshua is a reporting intern with Medscape. She is a dual medical and journalism student who has previously written for STAT, Scientific American, Slate, and other outlets. She can be reached at  or  @AnnaGoshua .  

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