In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

Exercise as an essential part of long-term preventive strategy for hypertension

Comment by Maria Antonopoulou, Primary Care and Risk Factor Management Section

Preventive Cardiology

Physical activity as a lifestyle measure improves overall health and fitness and reduces the risk of cardiovascular diseases and hypertension in particular. Exercise helps to lower blood pressure (BP) in people with hypertension and high-normal blood pressure or maintain normal blood pressure1. This large  Swedish study retrospective aimed to analyse further the long-term effect of cardiorespiratory fitness (CRF) to the incidence of hypertension in normotensive adults, along with changes in other lifestyle-related variables. For this purpose, the national health profile assessment database was used and data gathered for 91,728 participants (48% women, mean age 40.7 years) who underwent two examinations, twice with an average of 4.3 years. BP measurements, CRF assessments estimated as maximal oxygen consumption (VO2max), as well as demographics and common lifestyle measures were all included in the analysis.

Among the main results it was found that a large increase (+≥3% annual change) in CRF between two examinations was associated with a 11% lower risk of incident hypertension, compared with maintainers, whether a small (–1.0 to -2.9%) and large (≥–3%) annual decrease in CRF was associated with a 21% and 25% higher risk, respectively and independently of simultaneous changes in other lifestyle-related behaviours (smoking, BMI, diet, stress and exercise habits) according to multi-adjustment analysis. It was interesting that participants who changed to or maintained risk behaviour/level of smoking and stress, but maintained or increased their CRF between the two examinations had a lower risk of hypertension compared with those who decrease their CRF. One truly impressive finding was that obesity did not add significantly to the progress of hypertension: Instead, the risk of hypertension was diminished in those who maintained or become obese during follow-up, if they had increased their CRF, in other words being obese but fit. Similarly, stress as expected was found to increase the risk of hypertension, but again this association only applied to the individuals who decreased their CRF at follow-up.

Even though the study limitations- such as the missing data from the family/personal history, questions about other diagnoses e.g. stress which was self- reported and the questions about the establishment/criteria of the hypertension diagnoses- the findings strongly suggest that any long-term strategy for maintaining a normal BP using lifestyle behaviours should prioritise increased CRF as much as stopping smoking or losing weight. Preserving or increasing CRF in adulthood is essential to decrease the risk of incident hypertension and this should be incorporated in both public health policies as a primary prevention measure and in personalised lifestyle advice.


Maria Antonopoulou commented on this article:

Tobias Holmlund, Bjorn Ekblom, Mats Borjesson, Gunnar Andersson, Peter Wallin and Elin Ekblom-Bak Association between change in cardiorespiratory fitness and incident hypertension in Swedish adults
European Journal of Preventive Cardiology, Volume 28, Issue 13, November 2021, Pages 1515–1522,

other references:

1. Hanssen H, Boardman H, Deiseroth A, et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. European Journal of Preventive Cardiology 2021. doi:10.1093/eurjpc/zwaa141.

Notes to editor

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.