Physical exercise in primary hypertension

Abstract

An integral part of therapy in arterial hypertension, an important
cardiovascular risk factor, is nonpharmacological
treatment which includes appropriate physical activity.
Response of the cardiovascular system to physical effort
depends on its type (static, dynamic), time of endurance,
intensity and amount of involved muscle tissue. In patients
with arterial hypertension blood pressure rise is
higher than in normotensive subjects. With the progression
of the disease there is a rise in values of peripheral
vascular resistance, while left ventricle ejection fraction and
heart rate gradually decrease. Regular physical effort reduces
SBP per 4–8 mm Hg and DBP per 2–6 mm Hg.
Through reaching new balance between elements of the
autonomic nervous system heart rate in physical effort and
while resting is being reduced. In physical effort ejection
fraction is rising and left ventricle load is decreased. Increase
in coronary flow and regression of left ventricle
hypertrophy is observed. This effect is comparable with
achieved with antihypertensive treatment.
Following changes mentioned above, physical effort economizes
work of the cardiovascular system and allows for more
effective oxygen usage with significantly lower load. Regular
physical activity has positive influence also on many other
factors of cardiovascular risk such as coagulation system parameters,
serum lipids profile or insulin resistance.
Patients with arterial hypertension should be advised to
perform regular physical effort of moderate intensity for
around 30–45 minutes per day. Endurance exercises (walking, jogging, swimming) are preferred, while resistance exercises
should be only an addition. Intensity of advised
aerobic training should depend on necessary baseline and
repeated thereafter assessment of the state of cardiovascular
system and control of the values of blood pressure.
If hypertension is not properly controlled the physical effort
should be limited until sufficient hypotensive pharmacotherapy
is used. Strenuous isometric exercises (i.e. weight
lifting) are not recommended. The hypotensive effect
achieved with regular physical effort may require appropriate
modification of pharmacotherapy.