Treatment Options

Once hypertension has been diagnosed, a management plan is initiated to reduce blood pressure (BP) as well as overall cardiovascular risk[1] . The goal for hypertensive patients with diabetes or chronic kidney disease is to reduce BP to less than 130/80mm Hg and other hypertension patients to below 140/90mm Hg, with the primary focus on reducing the systolic BP goal [2] . This can be initially attempted by lifestyle modifications (diet alteration and exercise prescription) or otherwise an addition of pharmacological treatment.
Exercise prescription (aerobic or resistance training) has been found to significantly reduce blood pressure. Haapanen and colleagues discovered that the risk of hypertension was highest for the least active men and women. They also found that the risk of hypertension was 60-70% higher for sedentary men than for the most active men and that there was a strong negative association between the risk of hypertension with the total amount of time and intensity of physical activity for men[3] . In addition, research has indicated that 10 weeks of aerobic exercise can reduce systolic BP by 13mm Hg and diastolic BP by 6mm Hg [4] . By lowering systolic BP by just 2 mm Hg, it reduces the risk of death from stroke by 6% and heart disease by 2%[5] . Lifestyle modification is also highly effective and the least invasive method to reduce blood pressure and thus the impact of hypertension.
In addition to exercise prescription, diet modification such as the DASH (dietary Approaches to Stop Hypertension) diet program that involves an emphasis on fruit, vegetables and low fat dairy products and reducing consumption of fats, red meat, sweets and sugar containing beverages, has been found to reduce BP, as well as other cardiovascular risk factors[6] . However, research by Appel and colleagues [7] discovered that exercise prescription of at least 180min/week of moderate-intensity physical activity was just as beneficial as the addition of the DASH diet to the same exercise prescription.
Exercise_30_minutes_a_day_reduce_BP.jpg choose_one_poster.jpg

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Pharmacological Treatment
Pharmacological treatment can be beneficial, however should be guided by the degree of elevated BP, organ damage, the presence of cardiovascular disease or other risk factors. This is because certain high risk conditions can increase the risk of compelling indications, including heart failure, postmyocardial infarction, CHD, diabetes, chronic kidney disease, and recurrent stroke prevention. For example, beta-blockers are widely recommened to patients with blood pressure above a systolic BP of 130mm Hg or diastolic BP of 90mm Hg[8] , although previous research indicated that after a 10 week exercise program, fitness did not increase when taking non-selective beta-blockers (propanolol). While research did indicate that fitness increased with beta-1-selective beta blockers (metaprolol), fitness improvements were not as high as the control group, who were not undergoing beta-blocker therapy [9] . Thus, beta-blockers should be avoided by patients who can reduce their BP with moderate-intensity exercise.


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Breathing Exercise Training
Not all exercise training for the treatment or prevention of hypertension needs to be either aerobic or anaerobic. A study by Mourya and colleagues investigated the efficacy and safety of both Slow-Breathing (SB) and Fast-Breathing (FB) exercises with essential hypertensive patients[10] . The graphed results below support that both SB and FB exercises improve both Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) control. (which group is which?)


Further, Meles and colleagues self-measured home BP responses of hypertensive individuals to daily device guided breathing exercises (DGBE). The study required patients to do the DGBE daily for 8 weeks[11] . Results supported the finding of Mourya and colleagues, with significant decreases in both systolic and diastolic BP .


  1. ^

    National Heart Foundation of Australia (NHFA) (National Blood Pressure and Vascular Diseases Advisory Committee) (2008). Guide to Management of Hypertension
  2. ^ Contractor, A. & Gordon, N. Cited from: Ehrman, J. K., Gordon, P. M., Visich, P. S., & Keteyian, S. J. (2009). Clinical Exercise Physiology. Human Kinetics.
  3. ^

    Haapanen, N, Miilunpalo, S., Vuori, I., Oja, P., Pasanen, M. (1997). Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. International Journal of Epidemiology; 26(4): 739-747. doi: 10.1093/ije/26.4.739
  4. ^ Tsai,J., Yang, H., Wang, W., Hsieh, M., Chen, P., Kao, C., Kao, P., Wang, C., Chan, P. (2004). The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension. Clinical and Experimental Hypertension; 26(3): 255-265.
  5. ^ McArdle, W., Katch, F., Katch, V. (2010). Exercise Physiology (7th Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
  6. ^

    Joint National Committee (JNC V). The fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (1993). Arch Intern Med; 153 (2): 149-152.
  7. ^ Appel, L., Champagne, C., Harsha, D., Cooper, L. (2003). Effects of comprehensive lifestyle modification on blood pressure control. Journal of the American Medical Association; 290(16): 2083-2093.
  8. ^

    McArdle, W., Katch, F., Katch, V. (2010). Exercise Physiology (7th Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
  9. ^ Ades, P., Gunther, P., Meacham, C., Handy, M. (1988). Hypertension, exercise, and beta-adrenergic blockade. Annals of Internal Medicine; 109:629-634.
  10. ^

    Mourya, M., Mahajan, A.S., Narinder, P.S., & Jain, A.K. (2009). Effect of Slow- and Fast-Breathing Exercises on Autonomic Functions in Patients with Essential Hypertension. The Journal of Alternative and Complementary Medicine, 15(7): 711–717.
  11. ^

    Meles, E., Giannattasio, C., Failla, M., Gentile, G., Capra, A., & Mancia, G. (2004). Nonpharmacologic Treatment of Hypertension by Respiratory Exercise in the Home Setting. Amercian Journal of Hypertension, 17(4): 370-374.