Impact of exercise modalities on blood pressure control in hypertensive patients
A narrative review
Keywords:
hypertension, blood pressure regulation, aerobic exercise, resistance training, mind-body exercises, deep breathing exercisesAbstract
Hypertension poses a significant health burden, necessitating effective interventions to manage blood pressure and mitigate associated cardiovascular risks. Exercise has emerged as a cornerstone non-pharmacological strategy in the management of hypertension. This comprehensive review synthesizes current evidence regarding the impact of various exercise modalities on blood pressure regulation in hypertensive individuals. The review commences by elucidating the physiological mechanisms underpinning exercise-induced blood pressure alterations, highlighting factors influencing blood pressure responses during different exercises. It delineates the differential impacts of aerobic and resistance training, examining their effectiveness in blood pressure reduction among diverse populations, considering age, fitness levels, and comorbidities. Moreover, the review explores the emerging prominence of high-intensity interval training (HIIT), showcasing its unique effects on blood pressure regulation and cardiorespiratory fitness improvement compared to traditional continuous aerobic exercises. Additionally, alternative mind-body exercises, including tai chi, qigong, and mindfulness-based interventions, are investigated for their potential to influence blood pressure levels among hypertensive populations. Furthermore, the review identifies novel exercise approaches such as deep breathing exercises and multi-modal isometric exercise training (MIET) as promising strategies for blood pressure control in hypertensive individuals, emphasizing their potential benefits and implications for tailored exercise prescriptions.
Downloads
References
Agarwal, S., Jain, M., Arora, S., & Sheikher, C. (2022). EFFECTS OF RESISTANCE EXERCISE ON BLOOD PRESSURE IN HYPERTENSIVE PATIENTS OF CENTRAL INDIA: A PROSPECTIVE STUDY. Asian Journal of Pharmaceutical and Clinical Research, 141–142. https://doi.org/10.22159/ajpcr.2022.v15i12.46500
Am, A. I., Ishak, R. B., Putri, A. P., Wahyudi, T., & Rahmasari, I. (2023). Effectiveness of Progressive Muscle Relaxation as Complementary Therapy in Managing Blood Pressure Among Adult with Hypertension. Proceedings of the International Conference on Nursing and Health Sciences, 4(1), 137–142. https://doi.org/10.37287/picnhs.v4i1.1729
Baddeley-White, D. S., Wood, C. N., McGowan, C. L. M., Howden, R., Gaillard, E. C., Gordon, B. D. H., Goss-Sampson, M. A., & Swaine, I. L. (2021). Blood pressure-lowering efficacy of a 6-week multi-modal isometric exercise intervention. Blood Pressure Monitoring, 26(1), 30–38. https://doi.org/10.1097/MBP.0000000000000492
Baffour-Awuah, B., Pearson, M. J., Dieberg, G., & Smart, N. A. (2023). Isometric Resistance Training to Manage Hypertension: Systematic Review and Meta-analysis. Current Hypertension Reports, 25(4), 35–49. https://doi.org/10.1007/s11906-023-01232-w
Baghaiee, B., Dolatabadi Farahani, N., S Pescatello, L., Davaran Hagh, E., & Ebrahimi, K. (2022). The effect of resistance training on blood pressure, apelin, ANP, PON1, adiponectin, H2O2, and ET-1 in hypertensive men. Journal of Shahrekord University of Medical Sciences, 25(1), 30–38. https://doi.org/10.34172/jsums.2023.726
Bhowmik, R., Shaharyar, Md. A., Anand, K., Mazumdar, H., Mandal, A., Mandal, P., Chakraborty, S., Panday, P., & Karmakar, S. (2023). Mechanism of action of drugs used in hypertension. In How Synthetic Drugs Work (pp. 349–367). Elsevier. https://doi.org/10.1016/B978-0-323-99855-0.00015-4
Botzer, A., Finkelstein, Y., & Unger, R. (2021). Blood Pressure Regulation Evolved from Basic Homeostatic Components. Biomedicines, 9(5), 469. https://doi.org/10.3390/biomedicines9050469
Brasileiro-Santos, M. D. S., & Santos, A. D. C. (2017). Neural mechanismsand post-exercise hypotension: The importance of experimental studies. Motriz: Revista de Educação Física, 23(spe). https://doi.org/10.1590/s1980-6574201700si0006
Coelho-Júnior, H. J., Silva Aguiar, S., Calvani, R., Picca, A., De Azevedo Carvalho, D., Rodrigues, B., Zwarg-Sá, J. D. C., Bacurau, R. F., Cesari, M., Marzetti, E., & Uchida, M. C. (2022). Acute and chronic effects of traditional and high-speed resistance training on blood pressure in older adults: A crossover study and systematic review and meta-analysis. Experimental Gerontology, 163, 111775. https://doi.org/10.1016/j.exger.2022.111775
De Barcelos, G. T., Heberle, I., Coneglian, J. C., Vieira, B. A., Delevatti, R. S., & Gerage, A. M. (2022). Effects of Aerobic Training Progression on Blood Pressure in Individuals With Hypertension: A Systematic Review With Meta-Analysis and Meta-Regression. Frontiers in Sports and Active Living, 4, 719063. https://doi.org/10.3389/fspor.2022.719063
De Ciuceis, C., Rizzoni, D., & Palatini, P. (2023). Microcirculation and Physical Exercise In Hypertension. Hypertension, 80(4), 730–739. https://doi.org/10.1161/HYPERTENSIONAHA.122.19465
De Moraes, J. A., De Barcelos, G. T., Coneglian, J. C., Do Espírito Santo, B. C. D. R., Delevatti, R. S., & Gerage, A. M. (2022). Combined Training with Aerobic Exercise Performed Outdoors Can Promote Better Blood Pressure and Affective Responses in Individuals with Cardiovascular Risk Factors. International Journal of Environmental Research and Public Health, 19(23), 16009. https://doi.org/10.3390/ijerph192316009
De Souza Mesquita, F. O., Gambassi, B. B., De Oliveira Silva, M., Moreira, S. R., Neves, V. R., Gomes-Neto, M., & Schwingel, P. A. (2023). Effect of High-Intensity Interval Training on Exercise Capacity, Blood Pressure, and Autonomic Responses in Patients With Hypertension: A Systematic Review and Meta-analysis. Sports Health: A Multidisciplinary Approach, 15(4), 571–578. https://doi.org/10.1177/19417381221139343
Edwards, J. J., Taylor, K. A., Cottam, C., Jalaludeen, N., Coleman, D. A., Wiles, J. D., Sharma, R., & O’Driscoll, J. M. (2021). Ambulatory blood pressure adaptations to high-intensity interval training: A randomized controlled study. Journal of Hypertension, 39(2), 341–348. https://doi.org/10.1097/HJH.0000000000002630
Esmailiyan, M., Amerizadeh, A., Vahdat, S., Ghodsi, M., Doewes, R. I., & Sundram, Y. (2023). Effect of Different Types of Aerobic Exercise on Individuals With and Without Hypertension: An Updated Systematic Review. Current Problems in Cardiology, 48(3), 101034. https://doi.org/10.1016/j.cpcardiol.2021.101034
Fagard, R. H., & Cornelissen, V. A. (2007). Effect of exercise on blood pressure control in hypertensive patients. European Journal of Cardiovascular Prevention & Rehabilitation, 14(1), 12–17. https://doi.org/10.1097/HJR.0b013e3280128bbb
Fecchio, R. Y., De Sousa, J. C. S., Oliveira-Silva, L., Da Silva Junior, N. D., Pio-Abreu, A., Da Silva, G. V., Drager, L. F., Low, D. A., & Forjaz, C. L. M. (2023). Effects of dynamic, isometric and combined resistance training on blood pressure and its mechanisms in hypertensive men. Hypertension Research, 46(4), 1031–1043. https://doi.org/10.1038/s41440-023-01202-4
Fisher, J. P., & Secher, N. H. (2019). Regulation of Heart Rate and Blood Pressure During Exercise in Humans. In Muscle and Exercise Physiology (pp. 541–560). Elsevier. https://doi.org/10.1016/B978-0-12-814593-7.00024-4
Fu, Y., Feng, Q., Wei, Y., Fan, L., Pan, Y., Ji, J., & Lin, C. (2022). Meta-Analysis of the Effect of Aerobic Training on Blood Pressure in Hypertensive Patients. Computational and Mathematical Methods in Medicine, 2022, 1–8. https://doi.org/10.1155/2022/9281661
Ge, B., Chen, H., & Liao, X. (2022). The Effect of Mind-Body Exercise on Blood Pressure in Middle-Aged and Elderly Patients with Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine, 2022, 1–18. https://doi.org/10.1155/2022/7984658
Gerage, A. M., Alberton, C. L., Cucato, G. G., Delevatti, R. S., & Ritti-Dias, R. M. (2023). Editorial: Exercise intervention for prevention and management of hypertension. Frontiers in Physiology, 14, 1244715. https://doi.org/10.3389/fphys.2023.1244715
Hart, E. C., & Charkoudian, N. (2017). The Complex Challenge of Blood Pressure Regulation. In Principles of Gender-Specific Medicine (pp. 611–620). Elsevier. https://doi.org/10.1016/B978-0-12-803506-1.00032-2
Henkin, J. S., Pinto, R. S., Machado, C. L. F., & Wilhelm, E. N. (2023). Chronic effect of resistance training on blood pressure in older adults with prehypertension and hypertension: A systematic review and meta-analysis. Experimental Gerontology, 177, 112193. https://doi.org/10.1016/j.exger.2023.112193
Herlina, D. (2023). The Effect of Hypertension Exercise on Blood Pressure Control in the Elderly with Hypertension in the Working Area of Kumun Health Center. MAHESA : Malahayati Health Student Journal, 3(6), 1726–1735. https://doi.org/10.33024/mahesa.v3i6.10437
High Blood Pressure (BP). (2023). In H. J. N. Bethell & D. Brodie, Exercise (pp. 56–60). CABI. https://doi.org/10.1079/9781800621855.0011
Igarashi, Y. (2022). Effects of Differences in Exercise Programs With Regular Resistance Training on Resting Blood Pressure in Hypertensive Adults: A Systematic Review and Meta-Analysis. Journal of Strength and Conditioning Research, Publish Ahead of Print. https://doi.org/10.1519/JSC.0000000000004236
John, A. T., Chowdhury, M., Islam, Md. R., Mir, I. A., Hasan, M. Z., Chong, C. Y., Humayra, S., & Higashi, Y. (2022). Effectiveness of High-Intensity Interval Training and Continuous Moderate-Intensity Training on Blood Pressure in Physically Inactive Pre-Hypertensive Young Adults. Journal of Cardiovascular Development and Disease, 9(8), 246. https://doi.org/10.3390/jcdd9080246
Kokubo, Y., Iwashima, Y., & Kamide, K. (2015). Hypertension: Introduction, Types, Causes, and Complications. In G. Jagadeesh, P. Balakumar, & K. Maung-U (Eds.), Pathophysiology and Pharmacotherapy of Cardiovascular Disease (pp. 635–653). Springer International Publishing. https://doi.org/10.1007/978-3-319-15961-4_30
Lee, E. J., Anselmo, M., & Keller‐Ross, M. L. (2023). Blood pressure regulation during exercise: Is age central to the problem? The Journal of Physiology, 601(14), 2755–2756. https://doi.org/10.1113/JP284901
Lee, S. H., & Chae, Y. R. (2020). Characteristics of Aerobic Exercise as Determinants of Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-Analysis. Journal of Korean Academy of Nursing, 50(6), 740. https://doi.org/10.4040/jkan.20169
Li, L., Liu, X., Shen, F., Xu, N., Li, Y., Xu, K., Li, J., & Liu, Y. (2022). Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in patients with hypertension: A meta-analysis. Medicine, 101(50), e32246. https://doi.org/10.1097/MD.0000000000032246
Loucks, E. B., Schuman‐Olivier, Z., Saadeh, F. B., Scarpaci, M. M., Nardi, W. R., Proulx, J. A., Gutman, R., King, J., Britton, W. B., & Kronish, I. M. (2023). Effect of Adapted Mindfulness Training in Participants With Elevated Office Blood Pressure: The MB‐BP Study: A Randomized Clinical Trial. Journal of the American Heart Association, 12(11), e028712. https://doi.org/10.1161/JAHA.122.028712
Lu, Z., Song, Y., Chen, H., Li, S., Teo, E.-C., & Gu, Y. (2022). A Mixed Comparisons of Aerobic Training With Different Volumes and Intensities of Physical Exercise in Patients With Hypertension: A Systematic Review and Network Meta-Analysis. Frontiers in Cardiovascular Medicine, 8, 770975. https://doi.org/10.3389/fcvm.2021.770975
Maya, Á. T. D., Assunção, M. J., Brito, C. J., Vieira, E., Rosa, T. S., Pereira, F. B., De Toledo Nóbrega, O., De França, N. M., & Ferreira, A. P. (2018). High-intensity interval aerobic exercise induced a longer hypotensive effect when compared to continuous moderate. Sport Sciences for Health, 14(2), 379–385. https://doi.org/10.1007/s11332-018-0444-3
Munir, N. W., Asfar, A., Sakir, R., & Asnaniar, W. O. S. (2021). Chronic Disease Management Program Exercise On Blood Pressure In Hypertensive Patients. Jurnal Aisyah : Jurnal Ilmu Kesehatan, 6. https://doi.org/10.30604/jika.v6iS1.764
Parati, G., & Ochoa, J. E. (2018). Blood pressure measurement in hypertension: Definition and classification of blood pressure levels. In B. Williams (Ed.), ESC CardioMed (pp. 2389–2401). Oxford University Press. https://doi.org/10.1093/med/9780198784906.003.0564_update_001
Raven, P. B., Potts, J. T., & Swi, X. (1997). Baroreflex Regulation of Blood Pressure during Dynamic Exercise: Exercise and Sport Sciences Reviews, 25, 365???390. https://doi.org/10.1249/00003677-199700250-00015
Ribeiro, A. S., Nunes, J. P., Coronado, K. E., Andrade-Lima, A., Dos Santos, L., Aguiar, A. F., Schoenfeld, B. J., & Cyrino, E. S. (2021). Effect of Resistance Training Intensity on Blood Pressure in Older Women. Journal of Aging and Physical Activity, 29(2), 225–232. https://doi.org/10.1123/japa.2020-0049
Salmon, T., Hatherley, J., & Sankaranarayanan, R. (2022). Hypertension: A cardiovascular risk factor. In S. Nadar & G. Lip (Eds.), Hypertension (Oxford Cardiology Library) 3E (3rd ed., pp. 41–48). Oxford University PressOxford. https://doi.org/10.1093/med/9780198870678.003.0005
Sardeli, A. V., Griffith, G. J., Dos Santos, M. V. M. A., Ito, M. S. R., Nadruz, W., & Chacon-Mikahil, M. P. T. (2020). Do baseline blood pressure and type of exercise influence level of reduction induced by training in hypertensive older adults? A meta-analysis of controlled trials. Experimental Gerontology, 140, 111052. https://doi.org/10.1016/j.exger.2020.111052
Schneider, V. M., Domingues, L. B., Umpierre, D., Tanaka, H., & Ferrari, R. (2023). Exercise characteristics and blood pressure reduction after combined aerobic and resistance training: A systematic review with meta-analysis and meta-regression. Journal of Hypertension, 41(7), 1068–1076. https://doi.org/10.1097/HJH.0000000000003455
Segar, J. L. (2013). Neurohumoral and Autonomic Regulation of Blood Pressure. In J. T. Flynn, J. R. Ingelfinger, & R. J. Portman (Eds.), Pediatric Hypertension (pp. 3–23). Humana Press. https://doi.org/10.1007/978-1-62703-490-6_1
Shariful Islam, M., Fardousi, A., Sizear, M. I., Rabbani, Md. G., Islam, R., & Saif-Ur-Rahman, K. M. (2023). Effect of leisure-time physical activity on blood pressure in people with hypertension: A systematic review and meta-analysis. Scientific Reports, 13(1), 10639. https://doi.org/10.1038/s41598-023-37149-2
Simamane, M., Constantinou, D., Gradidge, P. J.-L., & Watson, E. (2023). Physical Activity Interventions for The Management of Hypertension: A Scoping Review [Preprint]. In Review. https://doi.org/10.21203/rs.3.rs-2835337/v1
Smolensky, M. H., Hermida, R. C., & Portaluppi, F. (2017). Circadian mechanisms of 24-hour blood pressure regulation and patterning. Sleep Medicine Reviews, 33, 4–16. https://doi.org/10.1016/j.smrv.2016.02.003
Songcharern, N., Ruangthai, R., Tumnark, P., & Phoemsapthawee, J. (2022). Improved arterial stiffness after combined aerobic and resistance training: Correlation with heart rate variability change in prehypertensive offspring of hypertensive parents. Journal of Exercise Rehabilitation, 18(6), 395–405. https://doi.org/10.12965/jer.2244416.208
Stefani, L., Mascherini, G., Tosi, B., & Galanti, G. (2019). Hypertension Today: Role of Sports and Exercise Medicine. Journal Of Hypertension And Cardiology, 2(4), 20–27. https://doi.org/10.14302/issn.2329-9487.jhc-19-2714
Sutomo, S., Purwanto, N. H., & Siswantoro, E. (2023). APPLICATION OF MIND BODY THERAPY IN HYPERTENSION PATIENTS: LITERATURE REVIEW. Proceeding of International Conference of Kerta Cendekia, 2(1), 164–173. https://doi.org/10.36720/ickc.v2i1.518
Tamayo Acosta, J., Sosa Gomez, A. E., Samuel, S., Pelenyi, S., Acosta, R. E., & Acosta, M. (2022). Effects of Aerobic Exercise Versus High-Intensity Interval Training on V̇O2max and Blood Pressure. Cureus. https://doi.org/10.7759/cureus.30322
Trihartuty, T., Lestari, P., & Ulfiana, E. (2022). Aerobics Low Impact terhadap Tekanan Darah pada Penderita Hipertensi. Journal of Telenursing (JOTING), 4(2), 477–487. https://doi.org/10.31539/joting.v4i2.2668
Vieira-Souza, L. M., Aidar, F. J., Mota, M. G., Reis, G. C., Lima Júnior, C. M. A., Silva, F. J. A. D., Jesus, J. B. D., Azevedo, D. E. R. D., Marçal, A. C., & Santos, J. L. D. (2023). HIGH-INTENSITY INTERVAL TRAINING POSES NO RISK TO HYPERTENSIVE WOMEN. Revista Brasileira de Medicina Do Esporte, 29, e2021_0321. https://doi.org/10.1590/1517-8692202329012021_0321
Wehrmann, A., Tian, E. J., Tyack, E. (Liz), & Kumar, S. (2023). The evidence of effectiveness of isometric resistance training on the management of hypertension in adults: An umbrella review. Blood Pressure Monitoring, 28(4), 171–184. https://doi.org/10.1097/MBP.0000000000000655
Xi, H., He, Y., Niu, Y., Sui, X., Zhang, J., Zhu, R., Xu, H., Zhang, S., Li, Y., Yuan, Y., & Guo, L. (2021). Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials. Experimental Gerontology, 155, 111560. https://doi.org/10.1016/j.exger.2021.111560
Published
How to Cite
Issue
Section
Copyright (c) 2024 International journal of health sciences

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.








