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Exercise and Weight Loss Reduce Blood Pressure in Men and Women With Mild Hypertension
Effects on Cardiovascular, Metabolic, and Hemodynamic Functioning
James A. Blumenthal, PhD;
Andrew Sherwood, PhD;
Elizabeth C. D. Gullette, PhD;
Michael Babyak, PhD;
Robert Waugh, MD;
Anastasia Georgiades, PhD;
Linda W. Craighead, PhD;
Damon Tweedy;
Mark Feinglos, MD;
Mark Appelbaum, PhD;
Junichiro Hayano, MD;
Alan Hinderliter, MD
Arch Intern Med. 2000;160:1947-1958.
Background Lifestyle modifications have been recommended as the initial treatment strategy for lowering high blood pressure (BP). However, evidence for the efficacy of exercise and weight loss in the management of high BP remains controversial.
Methods One hundred thirty-three sedentary, overweight men and women with unmedicated high normal BP or stage 1 to 2 hypertension were randomly assigned to aerobic exercise only; a behavioral weight management program, including exercise; or a waiting list control group. Before and following treatment, systolic and diastolic BPs were measured in the clinic, during daily life, and during exercise and mental stress testing. Hemodynamic measures and metabolic functioning also were assessed.
Results Although participants in both active treatment groups exhibited significant reductions in BP relative to controls, those in the weight management group generally had larger reductions. Weight management was associated with a 7–mm Hg systolic and a 5–mm Hg diastolic clinic BP reduction, compared with a 4–mm Hg systolic and diastolic BP reduction associated with aerobic exercise; the BP for controls did not change. Participants in both treatment groups also displayed reduced peripheral resistance and increased cardiac output compared with controls, with the greatest reductions in peripheral resistance in those in the weight management group. Weight management participants also exhibited significantly lower fasting and postprandial glucose and insulin levels than participants in the other groups.
Conclusions Although exercise alone was effective in reducing BP, the addition of a behavioral weight loss program enhanced this effect. Aerobic exercise combined with weight loss is recommended for the management of elevated BP in sedentary, overweight individuals.
From the Departments of Psychiatry and Behavioral Sciences (Drs Blumenthal, Sherwood, Gullette, Babyak, and Georgiades) and Medicine (Drs Waugh and Feinglos and Mr Tweedy), Duke University Medical Center, Durham, NC; the Department of Psychology, University of Colorado, Boulder (Dr Craighead); the Department of Psychology, University of California, San Diego (Dr Appelbaum); the Department of Internal Medicine, Nagoya City University, Nagoya, Japan (Dr Hayano); and the Department of Medicine, University of North Carolina, Chapel Hill (Dr Hinderliter).
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