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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Focus on Fitness Focus on Fitness

Lower Your Blood Pressure With Exercise

May 04, 2014

By Howard LeWine M.D.

Brigham and Women's Hospital

Regular exercise is a great way to prevent high blood pressure or hypertension. But did you know it's also one of the best means of lowering high blood pressure? It may even help you avoid having to take medication to bring your numbers into the normal ranges.

How Exercise Helps

Your blood pressure is determined by the force your heart produces in your arteries when it pumps blood through your body and by the tension of the artery walls. High blood pressure occurs when the blood pushes against artery walls with too much pressure.

Persistently high blood pressure puts a strain on the arteries, which can cause them to harden, become clogged or to weaken. This in turn increases the risk of heart disease and stroke.

Here's how exercise can help. The cells lining our artery walls contain chemicals that determine the degree of tension of the arteries. Exercise training keeps these cells — called vascular endothelial cells — healthy. Healthy endothelial cells release more chemical "relaxers" and inhibit the production of chemical "tighteners." With less resistance in the arteries, your heart can pump more efficiently and blood flows more easily.

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What's The Best Exercise?

There is no "best" way to exercise to help lower blood pressure. The old "no-pain-no-gain" regimen of high-intensity activity aimed at pushing the heart and lungs to their limits is long gone. Start with a goal of 30 minutes or more of moderate-intensity activity done on most — but preferably all — days of the week.

Brisk walking and leaf-raking joined jogging and swimming as acceptable activities. With this no-sweat version, you don't even have to be active for 30 minutes straight. Segments of 10 to 15 minutes are fine. The emphasis on moderate activity was aimed, in part, at getting people who wouldn’t exercise to increase their daily physical activity.

Today, 30 minutes of moderate intensity exercise remains a good start. But the new goal, set by the Institute of Medicine is to perform 60 minutes of more vigorous exercise to raise your heart rate to a moderate intensity level.

In general, you should vary your daily workout with a combination of cardiovascular (aerobics) and resistance training. Also you want to stretch after each exercise session. To lower blood pressure, spend more time on aerobics. Some resistance training is fine but don't strain. Do more repetitions at lighter weights to prevent your blood pressure from temporarily spiking up.

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Exercise Precautions

Since high blood pressure is a risk factor for heart disease and stroke, you should ask your doctor for advice about an exercise routine that is right for you. In general, if you don't have other risk factors for heart disease and you don't take blood pressure medication, no special precautions are necessary.

To insure that you stick with it, start slowly and gradually work up to longer and more intense exercise sessions. If you do experience chest pain, shortness of breath, dizziness or cold sweats, don't push through it. Contact your doctor; he or she may want to order a stress test before giving you the go-ahead to restart your program.

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Exercise and Blood Pressure Medications

If you are taking one or more medications for high blood pressure, you can still exercise but you need to check with your doctor first. Depending upon the class of medication, you may need to take some extra precautions:

    • Thiazide diuretics, such as hydrochlorothiazide and chlorthalidone can alter the levels of certain chemicals in your blood, especially potassium. Most diuretics cause the kidneys to eliminate potassium, which lowers the amount in the blood. Your doctor may want to check your potassium level if you plan to start a vigorous exercise program. Bananas, tomatoes and citrus fruits are good sources of potassium.

    • Thiazide diuretics also lower blood volume slightly so you may be more prone dehydration with exercise. If you plan to do vigorous or prolonged exercise routines, talk with your doctor about lowering the dose of the thiazide diuretic and adding a blood pressure medicine with a different action. Some people, especially older women, are at risk of developing a very low blood sodium concentration. This situation will be made worse if you just re-hydrate with plain water rather than a sports drink.

    • Beta blockers, such as atenolol, metoprolol and labetalol, and the calcium channel blockers verapamil and diltiazem slow the heart rate. When doing aerobic activity, don't be concerned if your heart rate (pulse) does not reach the recommended target heart range for moderate intensity exercise.You are still getting the benefits of exercise. Not reaching a target heart rate is not a reason to change the dose of beta blocker unless you are a competitive athlete.

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Burn Those Calories

Any increase in the amount of physical activity you do is a step in the right direction. Burning more calories with shorts walks and climbing the stairs can help maintain a healthy body weight. And losing weight, even if you only increase your exercise a little, will help lower blood pressure.

If you're already somewhat active, try adding more exercise to your routine. Adding activities that burn an extra 100 calories per day can make a difference. Increase that to 300 calories per day and the weight-loss benefits really start to kick in.

Here are some examples of activities that will burn 200-300 calories per hour:

  • Walking briskly (at a 4-mile per hour pace)
  • Heavy cleaning, such as washing windows or the car
  • Playing tennis

Howard LeWine, M.D. is chief editor of Internet publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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