Skip to main content

The Impact of Exercise and Physical Fitness on Blood Pressure, Left Ventricular Hypertrophy, and Mortality Among Individuals with Prehypertension and Hypertension

  • Chapter

Part of the book series: Molecular and Translational Medicine ((MOLEMED))

Abstract

Chronic hypertension is a major and the most common risk factor for developing cardiovascular disease and mortality. Lifestyle modifications including increased physical activity as initial therapy to prevent, treat, and manage hypertension are recommended by the Eighth Joint National Committee for the management of high blood pressure in adults and the American College of Sports Medicine. The purposes of this chapter are to present the current consensus on: (1) the preventive aspects of exercise or physical fitness on the age-related progressive increase in BP and development of hypertension; (2) the interaction between exercise, blood pressure, and cardiac hypertrophy; and (3) the association between exercise capacity and mortality risk in individuals with prehypertension and hypertension.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

ACSM:

American College of Sports Medicine

BMI:

Body mass index

BP:

Blood pressure

CAD:

Coronary artery disease

CV:

Cardiovascular

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

JNC 7:

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

JNC 8:

The Eighth Joint National Committee on the Management of High Blood Pressure

LVH:

Left ventricular hypertrophy

LVM:

Left ventricular mass

METs:

Metabolic energy equivalents

SBP:

Systolic blood pressure

United States:

US

References

  1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  CAS  PubMed  Google Scholar 

  2. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–292.

    Article  PubMed  Google Scholar 

  3. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765–74.

    Article  CAS  PubMed  Google Scholar 

  4. World Health Organization. The World Health Report 2002: reducing risks, promoting healthy life. Geneva: WHO; 2002. p. 57–8.

    Google Scholar 

  5. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  6. Greenlund KJ, Croft JB, Mensah GA. Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999–2000. Arch Intern Med. 2004;164:2113–8.

    Article  PubMed  Google Scholar 

  7. Mainous III AG, Everett CJ, Liszka H, King DE, Egan BM. Prehypertension and mortality in a nationally representative cohort. Am J Cardiol. 2004;94:1496–500.

    Article  PubMed  Google Scholar 

  8. Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345:1291–7.

    Article  CAS  PubMed  Google Scholar 

  9. Wang Y, Wang QJ. The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med. 2004;164:2126–34.

    Article  PubMed  Google Scholar 

  10. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001;358:1682–6.

    Article  CAS  PubMed  Google Scholar 

  11. Grimm Jr RH, Grandits GA, Cutler JA, Stewart AL, McDonald RH, Svendsen K, et al. Relationships of quality-of-life measures to long-term lifestyle and drug treatment in the Treatment of Mild Hypertension Study. Arch Intern Med. 1997;157:638–48.

    Article  PubMed  Google Scholar 

  12. De Marco M, de Simone G, Roman MJ, Chinali M, Lee ET, Russell M, et al. Cardiovascular and metabolic predictors of progression of prehypertension into hypertension: the Strong Heart Study. Hypertension. 2009;54:974–80.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Liu J, Sui X, Lavie CJ, Zhou H, Mark Park YM, Cai B, et al. Effects of cardiorespiratory fitness on blood pressure trajectory with aging in a cohort of healthy men. J Am Coll Cardiol. 2014;64:1245–53.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gurven M, Blackwell AD, Rodriguez DE, Stieglitz J, Kaplan H. Does blood pressure inevitably rise with age?: longitudinal evidence among forager-horticulturalists. Hypertension. 2012;60:25–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000;35:569–82.

    Article  CAS  PubMed  Google Scholar 

  16. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550–8.

    Article  CAS  PubMed  Google Scholar 

  17. Levy D, Salomon M, D’Agostino RB, Belanger AJ, Kannel WB. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation. 1994;90:1786–93.

    Article  CAS  PubMed  Google Scholar 

  18. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I, et al. Prognostic value of left ventricular mass and geometry in systemic hypertension with left ventricular hypertrophy. Am J Cardiol. 1996;78:197–202.

    Article  CAS  PubMed  Google Scholar 

  19. Mathew J, Sleight P, Lonn E, Johnstone D, Pogue J, Yi Q, et al. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation. 2001;104:1615–21.

    Article  CAS  PubMed  Google Scholar 

  20. Muiesan ML, Salvetti M, Monteduro C, Bonzi B, Paini A, Viola S, et al. Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients. Hypertension. 2004;43:731–8.

    Article  CAS  PubMed  Google Scholar 

  21. Muiesan ML, Salvetti M, Rizzoni D, Castellano M, Donato F, Agabiti-Rosei E. Association of change in left ventricular mass with prognosis during long-term antihypertensive treatment. J Hypertens. 1995;13:1091–5.

    Article  CAS  PubMed  Google Scholar 

  22. Verdecchia P, Angeli F, Borgioni C, Gattobigio R, de Simone G, Devereux RB, et al. Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens. 2003;16:895–9.

    Article  PubMed  Google Scholar 

  23. Kokkinos P, Myers J. Exercise and physical activity: clinical outcomes and applications. Circulation. 2010;122:1637–48.

    Article  PubMed  Google Scholar 

  24. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46:667–75.

    Article  CAS  PubMed  Google Scholar 

  25. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.

    Article  PubMed  Google Scholar 

  26. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.

    Article  PubMed  Google Scholar 

  27. Huai P, Xun H, Reilly KH, Wang Y, Ma W, Xi B. Physical activity and risk of hypertension: a meta-analysis of prospective cohort studies. Hypertension. 2013;62:1021–6.

    Article  CAS  PubMed  Google Scholar 

  28. Gottdiener JS, Brown J, Zoltick J, Fletcher RD. Left ventricular hypertrophy in men with normal blood pressure: relation to exaggerated blood pressure response to exercise. Ann Intern Med. 1990;112:161–6.

    Article  CAS  PubMed  Google Scholar 

  29. Molina L, Elosua R, Marrugat J, Pons S. Relation of maximum blood pressure during exercise and regular physical activity in normotensive men with left ventricular mass and hypertrophy. MARATHOM Investigators. Medida de la Actividad fisica y su Relacion Ambiental con Todos los Lipidos en el HOMbre. Am J Cardiol. 1999;84:890–3.

    Article  CAS  PubMed  Google Scholar 

  30. Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thaulow E, Erikssen J. Exercise blood pressure predicts cardiovascular mortality in middle-aged men. Hypertension. 1994;24:56–62.

    Article  CAS  PubMed  Google Scholar 

  31. Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thaulow E, Erikssen J. Exercise blood pressure predicts mortality from myocardial infarction. Hypertension. 1996;27:324–9.

    Article  CAS  PubMed  Google Scholar 

  32. Parker ED, Schmitz KH, Jacobs Jr DR, Dengel DR, Schreiner PJ. Physical activity in young adults and incident hypertension over 15 years of follow-up: the CARDIA study. Am J Public Health. 2007;97:703–9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Faselis C, Doumas M, Kokkinos JP, Panagiotakos D, Kheirbek R, Sheriff HM, et al. Exercise capacity and progression from prehypertension to hypertension. Hypertension. 2012;60(2):333–8.

    Article  CAS  PubMed  Google Scholar 

  34. Blair SN, Goodyear NN, Gibbons LW, Cooper KH. Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA. 1984;252:487–90.

    Article  CAS  PubMed  Google Scholar 

  35. Chase NL, Sui X, Lee DC, Blair SN. The association of cardiorespiratory fitness and physical activity with incidence of hypertension in men. Am J Hypertens. 2009;22:417–24.

    Article  PubMed  Google Scholar 

  36. Kokkinos P. Cardiorespiratory fitness, exercise, and blood pressure. Hypertension. 2014;64:1160–4.

    Article  CAS  PubMed  Google Scholar 

  37. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.

    Article  CAS  PubMed  Google Scholar 

  38. Kokkinos PF, Narayan P, Colleran JA, Pittaras A, Notargiacomo A, Reda D, et al. Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. N Engl J Med. 1995;333:1462–7.

    Article  CAS  PubMed  Google Scholar 

  39. Hinderliter A, Sherwood A, Gullette EC, Babyak M, Waugh R, Georgiades A, et al. Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension. Arch Intern Med. 2002;162:1333–9.

    Article  PubMed  Google Scholar 

  40. Turner MJ, Spina RJ, Kohrt WM, Ehsani AA. Effect of endurance exercise training on left ventricular size and remodeling in older adults with hypertension. J Gerontol A Biol Sci Med Sci. 2000;55:M245–51.

    Article  CAS  PubMed  Google Scholar 

  41. Rinder MR, Spina RJ, Peterson LR, Koenig CJ, Florence CR, Ehsani AA. Comparison of effects of exercise and diuretic on left ventricular geometry, mass, and insulin resistance in older hypertensive adults. Am J Physiol Regul Integr Comp Physiol. 2004;287:R360–8.

    Article  CAS  PubMed  Google Scholar 

  42. Palatini P, Visentin P, Dorigatti F, Guarnieri C, Santonastaso M, Cozzio S, et al. Regular physical activity prevents development of left ventricular hypertrophy in hypertension. Eur Heart J. 2009;30:225–32.

    Article  PubMed  Google Scholar 

  43. Baglivo HP, Fabregues G, Burrieza H, Esper RC, Talarico M, Esper RJ. Effect of moderate physical training on left ventricular mass in mild hypertensive persons. Hypertension. 1990;15(2 Suppl):I153–6.

    Article  CAS  PubMed  Google Scholar 

  44. Reid CM, Dart AM, Dewar EM, Jennings GL. Interactions between the effects of exercise and weight loss on risk factors, cardiovascular haemodynamics and left ventricular structure in overweight subjects. J Hypertens. 1994;12:291–301.

    CAS  PubMed  Google Scholar 

  45. Stewart KJ, Ouyang P, Bacher AC, Lima S, Shapiro EP. Exercise effects on cardiac size and left ventricular diastolic function: relationships to changes in fitness, fatness, blood pressure and insulin resistance. Heart. 2006;92:893–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Papademetriou V, Notargiacomo A, Sethi E, Costello R, Fletcher R, Freis ED. Exercise blood pressure response and left ventricular hypertrophy. Am J Hypertens. 1989;2:114–6.

    CAS  PubMed  Google Scholar 

  47. Wilson MF, Sung BH, Pincomb GA, Lovallo WR. Exaggerated pressure response to exercise in men at risk for systemic hypertension. Am J Cardiol. 1990;66:731–6.

    Article  CAS  PubMed  Google Scholar 

  48. Singh JP, Larson MG, Manolio TA, O'Donnell CJ, Lauer M, Evans JC, et al. Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study. Circulation. 1999;99:1831–6.

    Article  CAS  PubMed  Google Scholar 

  49. Fagard RH, Pardaens K, Staessen JA, Thijs L. Prognostic value of invasive hemodynamic measurements at rest and during exercise in hypertensive men. Hypertension. 1996;28:31–6.

    Article  CAS  PubMed  Google Scholar 

  50. Manolio TA, Burke GL, Savage PJ, Sidney S, Gardin JM, Oberman A. Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults: the CARDIA study. Am J Hypertens. 1994;7:234–41.

    Article  CAS  PubMed  Google Scholar 

  51. Lauer MS, Pashkow FJ, Harvey SA, Marwick TH, Thomas JD. Angiographic and prognostic implications of an exaggerated exercise systolic blood pressure response and rest systolic blood pressure in adults undergoing evaluation for suspected coronary artery disease. J Am Coll Cardiol. 1995;26:1630–6.

    Article  CAS  PubMed  Google Scholar 

  52. Tanaka H, Bassett Jr DR, Turner MJ. Exaggerated blood pressure response to maximal exercise in endurance-trained individuals. Am J Hypertens. 1996;9:1099–103.

    Article  CAS  PubMed  Google Scholar 

  53. Kokkinos P, Pittaras A, Narayan P, Faselis C, Singh S, Manolis A. Exercise capacity and blood pressure associations with left ventricular mass in prehypertensive individuals. Hypertension. 2007;49:55–61.

    Article  CAS  PubMed  Google Scholar 

  54. Lim PO, Donnan PT, MacDonald TM. Blood pressure determinants of left ventricular wall thickness and mass index in hypertension: comparing office, ambulatory and exercise blood pressures. J Hum Hypertens. 2001;15:627–33.

    Article  CAS  PubMed  Google Scholar 

  55. Kokkinos P, Pittaras A, Manolis A, Panagiotakos D, Narayan P, Manjoros D, et al. Exercise capacity and 24-h blood pressure in prehypertensive men and women. Am J Hypertens. 2006;19:251–8.

    Article  PubMed  Google Scholar 

  56. Kokkinos PF, Narayan P, Fletcher RD, Tsagadopoulos D, Papademetriou V. Effects of aerobic training on exaggerated blood pressure response to exercise in African-Americans with severe systemic hypertension treated with indapamide +/− verapamil +/− enalapril. Am J Cardiol. 1997;79:1424–6.

    Article  CAS  PubMed  Google Scholar 

  57. Blair SN, Kohl III HW, Barlow CE, Gibbons LW. Physical fitness and all-cause mortality in hypertensive men. Ann Med. 1991;23(3):307–12.

    Article  CAS  PubMed  Google Scholar 

  58. Kokkinos P, Manolis A, Pittaras A, Doumas M, Giannelou A, Panagiotakos DB, et al. Exercise capacity and mortality in hypertensive men with and without additional risk factors. Hypertension. 2009;53(3):494–9.

    Article  CAS  PubMed  Google Scholar 

  59. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801.

    Article  PubMed  Google Scholar 

  60. Faselis C, Doumas M, Panagiotakos D, Kheirbek R, Korshak L, Manolis A, et al. Body mass index, exercise capacity, and mortality risk in male veterans with hypertension. Am J Hypertens. 2012;25:444–50.

    Article  PubMed  Google Scholar 

  61. Kokkinos P, Faselis C, Myers J, Pittaras A, Sui X, Zhang J, et al. Cardiorespiratory fitness and the paradoxical BMI-mortality risk association in male veterans. Mayo Clin Proc. 2014;89:754–62.

    Article  PubMed  Google Scholar 

  62. Kokkinos P, Myers J, Doumas M, Faselis C, Manolis A, Pittaras A, et al. Exercise capacity and all-cause mortality in prehypertensive men. Am J Hypertens. 2009;22:735–41.

    Article  PubMed  Google Scholar 

  63. Kokkinos P, Doumas M, Myers J, Faselis C, Manolis A, Pittaras A, et al. A graded association of exercise capacity and all-cause mortality in males with high-normal blood pressure. Blood Press. 2006;18:261–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter Kokkinos Ph.D., F.A.C.S.M., F.A.H.A. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Kokkinos, P. (2015). The Impact of Exercise and Physical Fitness on Blood Pressure, Left Ventricular Hypertrophy, and Mortality Among Individuals with Prehypertension and Hypertension. In: Pescatello, L. (eds) Effects of Exercise on Hypertension. Molecular and Translational Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-17076-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17076-3_4

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-17075-6

  • Online ISBN: 978-3-319-17076-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics