Exercise and weight loss reduce blood pressure in men and women with mild hypertension: Effects on cardiovascular, metabolic, and hemodynamic functioning

• Type of Material: Article
• Authors: James A. Blumenthal, Duke University Medical Center; Andrew Sherwood, Duke University Medical Center; Elizabeth C. D. Gullette, Duke University Medical Center; Michael Babyak, Duke University Medical Center; Robert Waugh, Duke University Medical Center; Anastasia Georgiades, Duke University Medical Center; Linda Craighead, Emory University; Damon Tweedy, Duke University Medical Center; Mark Feinglos, Duke University Medical Center; Mark Appelbaum, University of California, San Diego; Junichiro Hayano, Nagoya City University; Alan Hinderliter, University of North Carolina
• Language: English
• Date: 2000-07-10
• Publisher: American Medical Association (AMA)
• Publication Version: Final Published Version
• Copyright Statement: 2000 American Medical Associations. All rights reserved
• Final Published Version (URL): http://dx.doi.org/10.1001/archinte.160.13.1947
• Title of Journal or Parent Work: Archives of Internal Medicine -New Series-
• ISSN: 0003-9926
• Volume: 160
• Issue: 13
• Start Page: 1947
• End Page: 1958
• Grant/Funding Information: This study was supported by grants HL 49572 and HL 59672 from the National Institutes of Health, Bethesda, Md; and grant M01-RR-30 from the General Clinical Research Center Program, National Center for Research Resources, National Institutes of Health.
• Keywords: Obesity; Middle Aged; Insulin; Life Style; Waiting Lists; Blood Pressure Monitoring, Ambulatory; Weight Loss; Male; Humans; Female; Hypertension; Exercise; Severity of Illness Index; Blood Glucose; Body Composition; Treatment Outcome; Adult; Patient Compliance
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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.