The impact of physical activity on mortality in patients with high blood pressure: a systematic review

Background: Physical activity has been shown to be beneficial for the prevention and management of hypertension. In the general population, physical activity has been shown to decrease mortality. Purpose: The purpose of this systematic review was to identify and synthesize the literature examining the impact of physical activity on mortality in patients with high blood pressure (BP). Methods: An extensive search was conducted by two independent authors using Medline, Embase and Cochrane Library electronic databases (between 1985 and January 2012) and manual search from the reference list of relevant articles. Inclusion criteria were as follows: longitudinal design with minimum 1-year follow-up; hypertensive status of the cohort was indicated; and BP, physical activity, and mortality were measured. Results: Six articles evaluating a combined total of 48 448 men and 47 625 women satisfied the inclusion criteria. Cardiovascular and/or all-cause mortality were shown to be inversely related to physical activity in all studies. For example, patients with high BP who participated in any level of physical activity had a reduced risk (by 16–67%) of cardiovascular mortality, whereas a greater than two-fold increase in risk of mortality was noted in nonactive individuals. However, activity classification and parameters, such as frequency, duration, intensity, and volume, as well as BP status, were not consistent across studies. Conclusions: Regular physical activity is beneficial for reducing mortality in patients with high BP. More research is needed to establish the impact of specific kinds of physical activity and whether any differences exist between sexes.

[1]  Lawrence A Leiter,et al.  The 2012 Canadian hypertension education program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. , 2012, The Canadian journal of cardiology.

[2]  R. Fagard,et al.  Impact of Resistance Training on Blood Pressure and Other Cardiovascular Risk Factors: A Meta-Analysis of Randomized, Controlled Trials , 2011, Hypertension.

[3]  Simon L Bacon,et al.  The 2011 Canadian Hypertension Education Program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. , 2011, The Canadian journal of cardiology.

[4]  H. Burr,et al.  Physical work demands, hypertension status, and risk of ischemic heart disease and all-cause mortality in the Copenhagen Male Study. , 2010, Scandinavian journal of work, environment & health.

[5]  H. Burr,et al.  Fitness, work, and leisure-time physical activity and ischaemic heart disease and all-cause mortality among men with pre-existing cardiovascular disease. , 2010, Scandinavian journal of work, environment & health.

[6]  V. Salomaa,et al.  Leisure-time physical activity, cardiovascular risk factors and mortality during a 34-year follow-up in men , 2010, European Journal of Epidemiology.

[7]  D. Warburton,et al.  A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults , 2010, The international journal of behavioral nutrition and physical activity.

[8]  C. Vlachopoulos,et al.  Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness , 2011 .

[9]  H. Burr,et al.  Physical demands at work, physical fitness, and 30-year ischaemic heart disease and all-cause mortality in the Copenhagen Male Study. , 2010, Scandinavian journal of work, environment & health.

[10]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[11]  M. Nieminen,et al.  Exercise and cardiovascular outcomes in hypertensive patients in relation to structure and function of left ventricular hypertrophy: the LIFE study , 2009, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[12]  Susan L Murphy,et al.  Review of physical activity measurement using accelerometers in older adults: considerations for research design and conduct. , 2009, Preventive medicine.

[13]  M. Tremblay,et al.  A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review , 2008, The international journal of behavioral nutrition and physical activity.

[14]  B. Fernhall,et al.  Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives , 2008, Journal of Human Hypertension.

[15]  J. Tardif,et al.  Usefulness of self-reported leisure-time physical activity to predict long-term survival in patients with coronary heart disease. , 2008, The American journal of cardiology.

[16]  Klaas R. Westerterp,et al.  Physical activity as determinant of daily energy expenditure , 2008, Physiology & Behavior.

[17]  J. Tuomilehto,et al.  Occupational, commuting, and leisure-time physical activity in relation to cardiovascular mortality among finnish subjects with hypertension. , 2007, American journal of hypertension.

[18]  J. Granger,et al.  Inflammatory cytokines in the pathophysiology of hypertension during preeclampsia , 2007, Current hypertension reports.

[19]  S. Julius,et al.  The effect of baseline physical activity on cardiovascular outcomes and new‐onset diabetes in patients treated for hypertension and left ventricular hypertrophy: the LIFE study , 2007, Journal of internal medicine.

[20]  K. Westerterp,et al.  Physical Activity Assessment With Accelerometers: An Evaluation Against Doubly Labeled Water , 2007, Obesity.

[21]  Piotr Ponikowski,et al.  2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, European heart journal.

[22]  I. Janszky,et al.  Physical activity and exercise performance predict long‐term prognosis in middle‐aged women surviving acute coronary syndrome , 2007, Journal of internal medicine.

[23]  R. Schmieder,et al.  Guidelines for management of arterial hypertension , 2007 .

[24]  L. Vatten,et al.  Combined effect of blood pressure and physical activity on cardiovascular mortality , 2006, Journal of hypertension.

[25]  A. Wolk,et al.  Low physical activity and mortality in women: Baseline lifestyle and health as alternative explanations , 2006, Scandinavian journal of public health.

[26]  R. Fagard.  EXERCISE IS GOOD FOR YOUR BLOOD PRESSURE: EFFECTS OF ENDURANCE TRAINING AND RESISTANCE TRAINING , 2006, Clinical and experimental pharmacology & physiology.

[27]  J. Granger.  An emerging role for inflammatory cytokines in hypertension. , 2006, American journal of physiology. Heart and circulatory physiology.

[28]  Véronique A. Cornelissen,et al.  Effects of Endurance Training on Blood Pressure, Blood Pressure–Regulating Mechanisms, and Cardiovascular Risk Factors , 2005, Hypertension.

[29]  J. Wylie-Rosett,et al.  Exercise and cardiovascular outcomes by hypertensive status: NHANES I epidemiological follow-up study, 1971-1992. , 2005, American journal of hypertension.

[30]  S. Oparil,et al.  Gender and Blood Pressure , 2005, Journal of clinical hypertension.

[31]  K. Reynolds,et al.  Global burden of hypertension: analysis of worldwide data , 2005, The Lancet.

[32]  P. Thompson,et al.  The effect of physical activity on endothelial function in man. , 2004, Acta physiologica Scandinavica.

[33]  J. Tuomilehto,et al.  Relationship of Physical Activity and Body Mass Index to the Risk of Hypertension: A Prospective Study in Finland , 2004, Hypertension.

[34]  Daniel W. Jones,et al.  Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. , 2003, Hypertension.

[35]  Ihab Hajjar,et al.  Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. , 2003, JAMA.

[36]  G. Schuler,et al.  Regular Physical Activity Improves Endothelial Function in Patients With Coronary Artery Disease by Increasing Phosphorylation of Endothelial Nitric Oxide Synthase , 2003, Circulation.

[37]  G. Sesti,et al.  Weight loss in combination with physical activity improves endothelial dysfunction in human obesity. , 2003, Diabetes care.

[38]  T. Valle,et al.  Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women , 2003, Diabetologia.

[39]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[40]  Majid Ezzati,et al.  For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group , 2022 .

[41]  E. Ford.  Does Exercise Reduce Inflammation? Physical Activity and C-Reactive Protein Among U.S. Adults , 2002, Epidemiology.

[42]  G. Davey Smith,et al.  Physical activity and cause‐specific mortality in men with Type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[43]  Jiang He,et al.  Effect of Aerobic Exercise on Blood Pressure , 2002, Annals of Internal Medicine.

[44]  M. Nieminen,et al.  For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group , 2022 .

[45]  Jan A Staessen,et al.  Cardiovascular protection and blood pressure reduction: a meta-analysis , 2001, The Lancet.

[46]  R. Fagard.  Exercise characteristics and the blood pressure response to dynamic physical training. , 2001, Medicine and science in sports and exercise.

[47]  P. Skerrett,et al.  Physical activity and all-cause mortality: what is the dose-response relation? , 2001, Medicine and science in sports and exercise.

[48]  P. O’Connor,et al.  Physical inactivity and short-term all-cause mortality in adults with chronic disease. , 2001, Archives of internal medicine.

[49]  J F Reckelhoff,et al.  Gender Differences in the Regulation of Blood Pressure , 2001, Hypertension.

[50]  B. Kullberg,et al.  Pro‐inflammatory cytokines in patients with essential hypertension , 2001, European journal of clinical investigation.

[51]  M. Schroll,et al.  All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. , 2000, Archives of internal medicine.

[52]  R. Rikli,et al.  Reliability, Validity, and Methodological Issues in Assessing Physical Activity in Older Adults , 2000, Research quarterly for exercise and sport.

[53]  R A Washburn,et al.  Assessment of Physical Activity in Older Adults , 2000, Research quarterly for exercise and sport.

[54]  G. Kelley,et al.  Progressive resistance exercise and resting blood pressure : A meta-analysis of randomized controlled trials. , 2000, Hypertension.

[55]  W Winkelstein,et al.  Work and leisure time physical activity and mortality in men and women from a general population sample. , 1999, Annals of epidemiology.

[56]  B. Hedblad,et al.  Hypertensive men who exercise regularly have lower rate of cardiovascular mortality. , 1999, Journal of hypertension.

[57]  M. Nieminen,et al.  Characteristics of 9194 patients with left ventricular hypertrophy: the LIFE study. Losartan Intervention For Endpoint Reduction in Hypertension. , 1998, Hypertension.

[58]  N. Black,et al.  The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. , 1998, Journal of epidemiology and community health.

[59]  H. Hense,et al.  Quality assessment of data on blood pressure in the WHO MONICA Project , 1998 .

[60]  Hirofumi Tanaka,et al.  Absence of age-related increase in central arterial stiffness in physically active women. , 1998, Arteriosclerosis, thrombosis, and vascular biology.

[61]  James D Cameron,et al.  Arterial compliance increases after moderate-intensity cycling. , 1997, American journal of physiology. Heart and circulatory physiology.

[62]  E. Lambert,et al.  Physical activity, change in blood pressure and predictors of mortality in older South Africans--a 2-year follow-up study. , 1997, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[63]  I. Vuori,et al.  Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. , 1997, International journal of epidemiology.

[64]  M. Nieminen,et al.  The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study: rationale, design, and methods. The LIFE Study Group. , 1997, American journal of hypertension.

[65]  Paffenbarger Rs,et al.  Intensity of physical activity related to incidence of hypertension and all-cause mortality: an epidemiological view. , 1997 .

[66]  Paffenbarger,et al.  Intensity of physical activity related to incidence of hypertension and all-cause mortality: an epidemiological view. , 1997, Blood pressure monitoring.

[67]  J. Macintyre,et al.  Physical Fitness and All-Cause Mortality , 1995 .

[68]  R. Glynn,et al.  Evidence for a positive linear relation between blood pressure and mortality in elderly people , 1995, The Lancet.

[69]  S. Flocke,et al.  Self-reported physical activity predicts long-term coronary heart disease and all-cause mortalities. Twenty-one-year follow-up of the Israeli Ischemic Heart Disease Study. , 1995, Archives of family medicine.

[70]  T. Wascher,et al.  Endothelial dysfunction in hypertension , 1994, The Lancet.

[71]  K. Arakawa.  Antihypertensive mechanism of exercise. , 1993, Journal of hypertension.

[72]  R. Paffenbarger,et al.  Physical activity and hypertension: an epidemiological view. , 1991, Annals of medicine.

[73]  H. Kohl,et al.  Physical fitness and all-cause mortality in hypertensive men. , 1991, Annals of medicine.

[74]  R S Paffenbarger,et al.  Physical fitness and all-cause mortality. A prospective study of healthy men and women. , 1989, JAMA.

[75]  G. De Backer,et al.  The Belgian Heart Disease Prevention Project: 10-year mortality follow-up. , 1988, European heart journal.

[76]  R. Rauramaa,et al.  Leisure time and occupational physical activity: risk of death from ischemic heart disease. , 1988, American journal of epidemiology.

[77]  R. Paffenbarger,et al.  Physical activity, other life-style patterns, cardiovascular disease and longevity. , 2009, Acta medica Scandinavica. Supplementum.

[78]  R. Rauramaa,et al.  Inhibition of platelet aggregability by moderate-intensity physical exercise: a randomized clinical trial in overweight men. , 1986, Circulation.

[79]  G. Heath,et al.  Effects of exercise and lack of exercise on glucose tolerance and insulin sensitivity. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.