AF Association News & Events

New ESC consensus document tailors exercise advice to blood pressure status

A European Society of Cardiology (ESC) consensus document, published in the European Journal of Preventive Cardiology, recommends specific activities according to an individual’s current blood pressure level. A press release reports that for the first time, in the document, an analysis of the highest quality evidence has been performed to produce detailed guidance on how to lower blood pressure in people with hypertension, high-normal blood pressure, and normal blood pressure.

For each of the three groups, the press release explains, the paper outlines the first exercise priority for lowering blood pressure, followed by alternatives that still achieve reduction but to a lesser extent. For people with hypertension (blood pressure of at least 140/90 mmHg), aerobic exercise is the most effective method. This includes activities such as walking, running, cycling, or swimming.

However, in those with high-normal blood pressure (130–139/85–89 mmHg), dynamic resistance training is the priority. This refers to strength training typically involving at least six large muscle groups where muscle contraction results in movement — for example, lifting weights, squats, and push-ups.

People with normal blood pressure (less than 130/84 mmHg), the consensus document advises, benefit most from isometric resistance training. This involves static contraction of the muscles, such as the handgrip exercise.

Lead author of the consensus document Professor Henner Hanssen (University of Basel, Basel, Switzerland) comments: “The goal of the recommendations for all three groups is primarily to lower blood pressure. Ultimately, through blood pressure reduction, we can reduce the risk of heart attack, stroke and death from cardiovascular disease — thereby spending more years of life in good health.” He adds that for people with hypertension, aerobic exercise can lead to a similar — “even slightly more” — blood pressure reduction than taking a single antihypertensive medication.

One in four heart attacks are caused by high blood pressure, which is also linked to atrial fibrillation (AF). If you have AF, without anti-coagulation therapy, you may be five times more likely to have an ischaemic stroke than someone without AF. For more information about AF, see our What is Atrial Fibrillation page.

It is estimated that by 2025, around 60% of the world’s population will have hypertension. While it is widely accepted that exercise lowers blood pressure, until now, recommendations have focused on the amount of exercise per week, without considering an individual’s starting blood pressure level.

Professor Hanssen states: “Obese individuals are very likely to develop high blood pressure if obesity persists over the years. Healthy individuals with a hypertensive parent are also at risk of developing high blood pressure, as are women who had high blood pressure during pregnancy (gestational hypertension). People in these groups can postpone or even prevent hypertension by exercising.”

“For most exercises, the blood pressure lowering effect lasts for about 24 hours, similar to medication, so it is best to be active every day if possible,” he adds.


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