Hypertension – The Epidemic of High Blood Pressure

Hypertension is one of the most prevalent chronic diseases in North America.  Five million Canadian adults have high blood pressure, representing 19 percent of the adult population, and a further 20 percent of Canadian adults have pre-hypertension.  Of Canadians with high blood pressure, 83 percent are aware of their condition and 17 percent are unaware.  Hypertension becomes more common as people age, evidenced by the sobering statistic that 53 percent of Canadians aged 60 to 79 suffer from the condition.  Women in particular should be alarmed, as hypertensive females have a 3 to 5 times greater risk of developing heart disease than women with normal blood pressure.  (Statistics from the Heart and Stroke Foundation)  Hypertensive individuals of both genders are 3-4 times more likely to develop coronary artery disease, and up to 7 times more likely to have a stroke.

Exercise is now recognized as an important part of therapy for controlling hypertension.  While we know that aerobic exercise reduces both systolic and diastolic blood pressure by an average of 10 mmHg, how this happens is not completely understood.  It appears that exercise reduces cardiac output, and reduces the total peripheral resistance of blood vessels.  Less resistance inside blood vessels means that the diameter of these vessels increases – meaning that the heart does not need to work as hard to pump blood to the body.

Exercise Specialist Recommendations:

  • Focus on weight management.  Many people with hypertension are overweight or obese.  For this reason, non-drug therapy should be used as a first line treatment.  This includes regular exercise, as well as salt restriction and other dietary modifications.
  • Do not hold your breath when exercising!  This is called the Valsalva Maneuver, and will increase blood pressure.  Try to focus on regular, smooth breathing.
  • Weight train!  Resistance training should supplement endurance training.  However, do not lift heavy weights – keep the resistance low, and the repetitions high.
  • Use the Rate of Perceived Exertion to monitor exercise intensity.  This is estimating how hard you are working on a scale of 1 to 10 – 10 being an intensity you could not be able to sustain for longer then about 60 seconds.   Anti-hypertensive medications, primarily beta-blockers, chemically lower heart rate, so using heart rate prediction formulas will not be accurate.  People with hypertension should exercise at a 4-6 out of 10 in terms of intensity.
  • Monitor blood pressure before and after exercise for the first few weeks.  Systolic blood pressure (the upper number) should go up with aerobic exercise, but diastolic blood pressure (the lower number) should stay the same or go down slightly.  An increase in diastolic blood pressure during exercise is a huge red flag and if this happens, consult your doctor as soon as possible.
  • Extend your warm-up and cool-down.  Each should be about 10 minutes for hypertensive individuals.
  • Exercise at least four times per week.  Gradually increase your workout sessions to 30-60 minutes.  Exercise has a dose-response ratio when it comes to hypertension – the ideal is to burn between 1800 and 2200 calories per week.  In order to do this, most people will need to exercise almost every day.  A lower caloric expenditure will still be beneficial – but not to the same degree.
  • Schedule your workouts or they will not happen!!!

If you suffer from hypertension, talk to your doctor about how exercise can and should be part of your treatment plan.  As your blood pressure drops, assess with your doctor whether medication doses can be adjusted accordingly.  Although hypertension is a serious health condition, an affirmative view can be taken if the diagnosis is a catalyst for positive lifestyle changes!