No abstract

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.