Exercise and Weight Loss Reduce Blood Pressure in Men and Women With Mild Hypertension

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...

Changes in body weight and onset of hypertension in perimenopausal women

“…However, studies assessing the effect of weight loss on BP have frequently failed to take into account the effect of continued weight loss or negative energy balance on BP. [18][19][20] Actually there are quite a few studies that should have assessed the effects of weight maintenance after marked weight loss on BP. The Swedish Obesity Study showed that after marked surgically induced weight loss there was no improvement in the long-term frequency of hypertension, 21 which are in accordance with our study 22 in which dietinduced weight loss in abdominally obese subjects decreased ambulatory BP levels after weight loss, but during weight maintenance the BP returned to pretreatment levels.…”

Is weight loss the optimal target for obesity-related cardiovascular disease risk reduction?

“…In fact, a large meta-analysis (54), which reported an overall beneficial effect of chronic exercise on blood pressure, found that the average weight loss across the reviewed trials was largely inconsequential (-1.2 kg). Nevertheless, some studies report that individuals who become active and also lose a significant amount of weight (-7.9 kg), in comparison with those who lose minimal weight (-1.8 kg), show greater reductions in systolic and diastolic blood pressure (-7 mmHg and -5 mmHg versus -4 mmHg and -4 mmHg, respectively) (55).…”

“…The lipid improvements independent of significant weight reduction may also be mediated by improvements in body composition, such as reductions in visceral fat (60), but apparently are not due to improvements in CRF (51). Lastly, it appears that physical activity and weight loss may have independent effects on blood pressure, because reductions in blood pressure are significantly related to training-induced improvements in CRF (54), as well as the magnitude of weight loss (55).…”

Effects of exercise and weight loss on depressive symptoms among men and women with hypertension

“…This study represents a secondary analysis of a previously reported clinical trial examining the effects of exercise and weight loss in a sample of patients with high blood pressure [34]. Briefly, participants had unmedicated high normal BP or stage 1 to 2 hypertension and were sedentary, overweight or obese, and were at least 29 years old.…”