Abstract
Background: Thirteen percent of deaths worldwide are attributed to blood pressure above the normal range, or hypertension. Activation of the sympathetic nervous system plays a predominant role in blood pressure elevation. A phenotype of hypertension, referred to as resistant hypertension, occurs when the goal blood pressure is not achieved when using three or more medications, including a diuretic. A sleep disorder, obstructive sleep apnea, is also associated with increased sympathetic activity and as well, is strongly associated with resistant hypertension. However whilst the use of a continuous positive airway pressure device during sleep is effective in eliminating the breath pauses in people with obstructive sleep apnea, it does not address the hypertension. Alternative therapeutic modalities are thus warranted. One such therapy, exercise, has been shown to have a positive influence on blood pressure in hypertensive and normotensive individuals and may potentially be used as a therapeutic modality to reduce blood pressure in individuals with resistant hypertension. Objectives: The purpose of this review was to explore the evidence in support of exercise as a valuable therapeutic modality to reduce blood pressure in adults with resistant hypertension. Major findings: All types of exercise have been shown to reduce blood pressure in hypertensives and normotensives. Aerobic exercise has the greatest effect on reducing blood pressure in individuals with resistant hypertension and thus also reduces morbidity and mortality risk. Conclusions: Exercise has been shown to reduce blood pressure in hypertension and resistant hypertension and is an effective, safe modality.