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Background: Lifestyle modifications have been recommended as the initial treatment strategy for lowering high blood pressure (BP). However, evidence for the efficacy of exercise and weight loss in the management of high BP remains controversial. Methods:One hundred thirty-three sedentary, overweight men and women with unmedicated high normal BP or stage 1 to 2 hypertension were randomly assigned to aerobic exercise only; a behavioral weight management program, including exercise; or a waiting list control group. Before and following treatment, systolic and diastolic BPs were measured in the clinic, during daily life, and during exercise and mental stress testing. Hemodynamic measures and metabolic functioning also were assessed.Results: Although participants in both active treatment groups exhibited significant reductions in BP relative to controls, those in the weight management group generally had larger reductions. Weight management was associated with a 7-mm Hg systolic and a 5-mm Hg diastolic clinic BP reduction, compared with a 4-mm Hg systolic and diastolic BP reduction associated with aerobic exercise; the BP for controls did not change. Participants in both treatment groups also displayed reduced peripheral resistance and increased cardiac output compared with controls, with the greatest reductions in peripheral resistance in those in the weight management group. Weight management participants also exhibited significantly lower fasting and postprandial glucose and insulin levels than participants in the other groups.Conclusions: Although exercise alone was effective in reducing BP, the addition of a behavioral weight loss program enhanced this effect. Aerobic exercise combined with weight loss is recommended for the management of elevated BP in sedentary, overweight individuals. Med. 2000;160:1947-1958 H YPERTENSION IS a major health problem in this country, affecting more than 43 million people in the United States. Arch Intern1 Hypertension is among the most common reasons for outpatient visits.2 Despite this, blood pressure (BP) control is often inadequate. 3Although BP can be lowered pharmacologically in hypertensive individuals, 4,5 antihypertensive medications are not effective for everyone, may be costly, and may induce adverse effects 6-9 that impair quality of life and reduce adherence. Moreover, abnormalities associated with hypertension, such as insulin resistance and lipemia, may persist or may even be exacerbated by some antihypertensive medications.10-13 As a result, nonpharmacological approaches to the treatment of hypertension have received growing attention.The 1997 report 5 of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that lifestyle modifications be the initial treatment strategy for lowering high BP. Despite these recommendations, however, empirical data supporting the efficacy of exercise and weight loss in the management of hypertension are relatively limited. Numerous observational studies [14][15][16] have de...

Mental stress during daily life, including reported feelings of tension, frustration, and sadness, can more than double the risk of myocardial ischemia in the subsequent hour. The clinical significance of mental stress-induced ischemia during daily life needs to be further evaluated.

These results suggest that EX + WL is an effective treatment for hyperinsulinemia and lowering of diastolic BP in patients with the syndrome X.

Abstract-The purpose of this study was to determine the effects of exercise and weight loss on cardiovascular responses during mental stress in mildly to moderately overweight patients with elevated blood pressure. Ninety-nine men and women with high normal or unmedicated stage 1 to stage 2 hypertension (systolic blood pressure 130 to 179 mm Hg, diastolic blood pressure 85 to 109 mm Hg) underwent a battery of mental stress tests, including simulated public speaking, anger recall interview, mirror trace, and cold pressor, before and after a 6-month treatment program. Subjects were randomly assigned to 1 of 3 treatments: (1) aerobic exercise, (2) weight management combining aerobic exercise with a behavioral weight loss program, or (3) waiting list control group. After 6 months, compared with control subjects, participants in both active treatment groups had lower levels of systolic blood pressure, diastolic blood pressure, total peripheral resistance, and heart rate at rest and during mental stress. Compared with subjects in the control group, subjects in the exercise and weight management groups also had greater resting stroke volume and cardiac output. Diastolic blood pressure was lower for the weight management group than for the exercise-only group during all mental stress tasks. These results demonstrate that exercise, particularly when combined with a weight loss program, can lower both resting and stress-induced blood pressure levels and produce a favorable hemodynamic pattern resembling that targeted for antihypertensive therapy. Key Words: hypertension, essential Ⅲ exercise Ⅲ obesity Ⅲ stress Ⅲ hemodynamics E pidemiological studies have shown that increased levels of physical activity reduce the incidence of all-cause mortality and cardiovascular-related deaths. 1 Although the mechanisms responsible for this benefit are not fully understood, exercise is known to have favorable effects on such traditional risk factors as elevated blood pressure (BP), 2 hyperinsulinemia, 3 and hyperlipidemia. 4 Recently, a number of biobehavioral risk factors that potentially may be modifiable with exercise have been identified. 5 For example, exercise has been shown to reduce depression, 6 anxiety, 7 and type A behavior. 8 An exaggerated cardiovascular response to mental stress is an additional risk factor, which has been shown to be associated with myocardial ischemia 9 and is predictive of the future development of hypertension 10,11 and coronary heart disease. 12 A series of cross-sectional studies have shown that individuals who are more active or physically fit have lower cardiovascular responses to stress. 13 Longitudinal studies are less consistent but generally demonstrate that heart rate (HR) and BP levels are attenuated after exercise training in healthy normotensive men and women. 14 However, to the best of our knowledge, the effects of exercise on BP stress responses in hypertensive individuals has not been studied. Moreover, because weight loss is associated with lower clinic BP 15 but has not been studied in...

In a cohort of overweight, sedentary men and women, exercise and weight loss reduced blood pressure and induced favorable changes in left ventricular structure.

Despite recent advances in the medical management of hypertension, chronically elevated blood pressure remains a major health problem in the United States, affecting almost 50 million Americans. It is widely recognized that lifestyle factors contribute to the development and maintenance of elevated blood pressure. This article critically reviews current approaches to the nonpharmacological treatment of high blood pressure and highlights outcome studies of exercise, weight loss and dietary modification, and stress management and relaxation therapies. Methodological issues in the assessment and treatment of hypertension are discussed, along with possible mechanisms by which lifestyle modification may reduce elevated blood pressure.

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