The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) hypertension guidelines state that doctors should promote nonpharmacological therapy to everyone with elevated blood pressure or diagnosed hypertension.1 Nonpharmacological therapy includes healthy diet,1-4 weight loss,1,5 sodium reduction,1,6-8 exercise,1,9-20 enhanced intake of dietary potassium,1,21-25 smoking cessation,1,26-28 and moderating alcohol consumption.1,29-34 Doctors should reassess blood pressure in three to six months for people just adopting healthy habits. People adopting healthy habits and started on antihypertensive medication should be assessed in one month.
Evidence shows that lowering blood pressure decreases the risk of adverse cardiovascular outcomes such as heart disease, stroke, and death.35-38 It may also slow the progression of kidney damage in people with chronic kidney disease.39 Further, meta-analyses as well as national and international guidelines suggest that lowering blood pressure decreases risk of these outcomes regardless of which hypertensive-lowering method is used. 35-38
Although the quality of the overall evidence is varied, the most recent meta-analyses confirm that moderate-intensity aerobic exercise can significantly lower BP within a few months of initiation. It is generally felt that at least 30 minutes per day of aerobic exercise on most days of the week is needed to achieve a BP-lowering effect.39,40 Because there is a risk of musculoskeletal injury and cardiovascular risk in some individuals, this level of aerobic exercise is recommended when there is no medical contraindication. A meta-analysis of aerobic exercise interventions found such training could reduce systolic BP by 3 – 4 mm Hg and diastolic BP by 2- 4 mm Hg.39 Even greater BP reductions were seen among people with hypertension at baseline.
Resistance (dynamic and isometric) training has been shown to lower BP.39,41-44 Ninety to 150 minutes per week of dynamic resistance activity or three sessions per week of isometric resistance work for a minimum of eight to ten weeks is estimated to be needed to see BP effects.1 Although meta-analyses of the effects of isometric resistance exercise are limited by small numbers, the effects of blood pressure have been shown to be large after sustained programs of 4 weeks or more. Drops in systolic BP range from 6 – 13 mm Hg and in diastolic BP from 4 – 6 mm Hg.41-44
References
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