¿Puede el ejercicio bajar mi presión arterial?

The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) hypertension guidelines state that doctors should promote nonpharmacological therapy to everyone with elevated blood pressure or diagnosed hypertension.¹ Nonpharmacological therapy includes healthy diet,^1-4 weight loss,^1,5 sodium reduction,^1,6-8 exercise,^1,9-20 enhanced intake of dietary potassium,^1,21-25 smoking cessation,^1,26-28 and moderating alcohol consumption.^1,29-34  Doctors should reassess blood pressure in three to six months for people just adopting healthy habits. People adopting healthy habits and started on antihypertensive medication should be assessed in one month.

Evidence shows that lowering blood pressure decreases the risk of adverse cardiovascular outcomes such as heart disease, stroke, and death.^35-38 It may also slow the progression of kidney damage in people with chronic kidney disease.³⁹ Further, meta-analyses as well as national and international guidelines suggest that lowering blood pressure decreases risk of these outcomes regardless of which hypertensive-lowering method is used. ^35-38

Although the quality of the overall evidence is varied, the most recent meta-analyses confirm that moderate-intensity aerobic exercise can significantly lower BP within a few months of initiation. It is generally felt that at least 30 minutes per day of aerobic exercise on most days of the week is needed to achieve a BP-lowering effect.^39,40 Because there is a risk of musculoskeletal injury and cardiovascular risk in some individuals, this level of aerobic exercise is recommended when there is no medical contraindication. A meta-analysis of aerobic exercise interventions found such training could reduce systolic BP by 3 – 4 mm Hg and diastolic BP by 2- 4 mm Hg.³⁹ Even greater BP reductions were seen among people with hypertension at baseline.

Resistance (dynamic and isometric) training has been shown to lower BP.^39,41-44 Ninety to 150 minutes per week of dynamic resistance activity or three sessions per week of isometric resistance work for a minimum of eight to ten weeks is estimated to be needed to see BP effects.¹ Although meta-analyses of the effects of isometric resistance exercise are limited by small numbers, the effects of blood pressure have been shown to be large after sustained programs of 4 weeks or more. Drops in systolic BP range from 6 – 13 mm Hg and in diastolic BP from 4 – 6 mm Hg.^41-44

References

1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. Nov 13 2017;doi:10.1161/hyp.0000000000000066
2. Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. Apr 23-30 2003;289(16):2083-93. doi:10.1001/jama.289.16.2083
3. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. The New England Journal of Medicine. Apr 17 1997;336(16):1117-24. doi:10.1056/nejm199704173361601
4. Gay HC, Rao SG, Vaccarino V, Ali MK. Effects of different dietary interventions on blood pressure: systematic review and meta-analysis of randomized controlled trials. Hypertension. Apr 2016;67(4):733-9. doi:10.1161/hypertensionaha.115.06853
5. Expert panel report: guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring, Md). Jul 2014;22 Suppl 2:S41-410. doi:10.1002/oby.20660
6. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. Apr 3 2013;346:f1326. doi:10.1136/bmj.f1326
7. He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. Apr 3 2013;346:f1325. doi:10.1136/bmj.f1325
8. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. The New England Journal of Medicine. Jan 4 2001;344(1):3-10. doi:10.1056/nejm200101043440101
9. Whitworth JA. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. Journal of Hypertension. Nov 2003;21(11):1983-92. doi:10.1097/01.hjh.0000084751.37215.d2
10. Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. Dec 2013;15(6):659-68. doi:10.1007/s11906-013-0386-8
11. Fagard RH. Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental Pharmacology & Physiology. Sep 2006;33(9):853-6. doi:10.1111/j.1440-1681.2006.04453.x
12. Arakawa K. Antihypertensive mechanism of exercise. Journal of Hypertension. Mar 1993;11(3):223-9.
13. Hagberg JM, Montain SJ, Martin WH, 3rd, Ehsani AA. Effect of exercise training in 60- to 69-year-old persons with essential hypertension. The American Journal of Cardiology. Aug 1 1989;64(5):348-53.
14. Kiyonaga A, Arakawa K, Tanaka H, Shindo M. Blood pressure and hormonal responses to aerobic exercise. Hypertension. Jan-Feb 1985;7(1):125-31.
15. Chopra S, Baby C, Jacob JJ. Neuro-endocrine regulation of blood pressure. Indian J Endocrinol Metab. Oct 2011;15 Suppl 4:S281-8. doi:10.4103/2230-8210.86860
16. Foy CG, Foley KL, D'Agostino RB, Jr., Goff DC, Jr., Mayer-Davis E, Wagenknecht LE. Physical activity, insulin sensitivity, and hypertension among US adults: findings from the Insulin Resistance Atherosclerosis Study. Am J Epidemiol. May 15 2006;163(10):921-8. doi:10.1093/aje/kwj113
17. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. Journal of the American Heart Association. Feb 1 2013;2(1):e004473. doi:10.1161/jaha.112.004473
18. 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. Apr 2 2002;136(7):493-503. doi:10.7326/0003-4819-136-7-200204020-00006
19. Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clinic Proceedings. Mar 2014;89(3):327-34. doi:10.1016/j.mayocp.2013.10.030
20. Inder JD, Carlson DJ, Dieberg G, McFarlane JR, Hess NC, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertension research : official journal of the Japanese Society of Hypertension. Feb 2016;39(2):88-94. doi:10.1038/hr.2015.111
21. Whelton PK, He J, Cutler JA, et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA. May 28 1997;277(20):1624-32.
22. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. Jan 3 2012;125(1):e2-e220. doi:10.1161/CIR.0b013e31823ac046
23. Weaver CM. Potassium and health. Adv Nutr. May 1 2013;4(3):368s-77s. doi:10.3945/an.112.003533
24. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. Apr 3 2013;346:f1378. doi:10.1136/bmj.f1378
25. Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, 2005 (U.S. Department of Agriculture, Agricultural Research Service) (2004).
26. Groppelli A, Giorgi DM, Omboni S, Parati G, Mancia G. Persistent blood pressure increase induced by heavy smoking. Journal of Hypertension. May 1992;10(5):495-9.
27. Halperin RO, Gaziano JM, Sesso HD. Smoking and the risk of incident hypertension in middle-aged and older men. American Journal of Hypertension. Feb 2008;21(2):148-52. doi:10.1038/ajh.2007.36
28. Bowman TS, Gaziano JM, Buring JE, Sesso HD. A prospective study of cigarette smoking and risk of incident hypertension in women. Journal of the American College of Cardiology. Nov 20 2007;50(21):2085-92. doi:10.1016/j.jacc.2007.08.017
29. National Institute on Alcohol Abuse and Alcoholism (NIAAA). What is a standard drink? National Institute on Alcohol Abuse and Alcoholism (NIAAA). Accessed Mar 17, 2018, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink
30. Moyer VA. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Aug 6 2013;159(3):210-8. doi:10.7326/0003-4819-159-3-201308060-00652
31. Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. The Lancet Public Health. Feb 2017;2(2):e108-e120. doi:10.1016/s2468-2667(17)30003-8
32. Stewart SH, Latham PK, Miller PM, Randall P, Anton RF. Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study. Addiction. Oct 2008;103(10):1622-8. doi:10.1111/j.1360-0443.2008.02317.x
33. Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. Nov 2001;38(5):1112-7.
34. Lang T, Nicaud V, Darne B, Rueff B. Improving hypertension control among excessive alcohol drinkers: a randomised controlled trial in France. The WALPA Group. Journal of Epidemiology and Community Health. Dec 1995;49(6):610-6.
35. Ahluwalia M, Bangalore S. Management of hypertension in 2017: targets and therapies. Curr Opin Cardiol. Jul 2017;32(4):413-421. doi:10.1097/hco.0000000000000408
36. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427
37. Pignone M, Viera AJ. Blood pressure treatment targets in adults aged 60 years or older. Ann Intern Med. 2017;166(6):445-445. doi:10.7326/M17-0034
38. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166(6):430-430. doi:10.7326/M16-1785

39. Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehabil 2007; 14 (1): 12-17.
40. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43 (7): 1334-1359.
41. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc 2013; 2 (1): e004473.
42. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension 2011; 58 (5): 950-958.
43. Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc 2014; 89 (3): 327-334.
44. Kelley GA, Kelley KS. Isometric handgrip exercise and resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens 2010; 28 (3): 411-418.