Exercise and Hypertension: Uncovering the Mechanisms of Vascular Control

Hypertension (HTN) has recently been determined to be the number one overall risk factor of disease. With direct and indirect costs amounting to $46.4 billion in 2011 and projections of six-fold increases by 2030, the importance of low-cost nonpharmacological interventions can be appreciated. Vascular structural changes, endothelial dysfunction, and sympathetic overstimulation are major contributing factors to the pathophysiology of HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of nonpharmacological interventions for BP control. Different ET modalities (aerobic, resistance, and concurrent training) have contributed differently to BP reduction and control, driving scientific discourse regarding the optimum ET prescription (modality, volume, and intensity) for such effects; ET results in a multitude of physiological effects, with vascular and autonomic adaptations providing major contributions to BP control. Despite widespread acceptance of the role and importance of ET for BP reduction, only 15% of US adults have been found to meet ET/physical activity recommendations. The purpose of this review is to explore BP lowering effects of aerobic and resistance ET and the underlying physiological mechanisms that result in such effects. Further research is required to enhance our understanding of the proper ET prescription for BP control across different age groups and racial ethnicities. Furthermore, research into methods of improving awareness and adherence to ET recommendations proves to be equally important. (C) 2016 Elsevier Inc. All rights reserved.