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Exercise prescription for the prevention and treatment of arterial hypertension: targeting blood pressure is not necessarily the goal
  1. Erik H Van Iterson,
  2. Luke J Laffin
  1. Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
  1. Correspondence to Dr Erik H Van Iterson, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA; vanitee{at}

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Hypertension and low cardiorespiratory fitness (CRF) are proven risk factors for the development and progression of atherosclerotic cardiovascular disease (ASCVD).1–6 The evidence also indicates that these risk factors are highly prevalent in the general population, seldom occur in isolation and are rarely static among most adults.1–6 This risk factor milieu has resulted in the need for multidisciplinary interventions that directly account for the multifactorial nature of ASCVD risk and its prognostic correlates. The inclusion of aerobic-based exercise prescription as a core lifestyle therapy for both the primary and secondary prevention of ASCVD is not only effective for benefitting blood pressure control but also known to directly elicit favourable effects on CRF to yield clinically relevant reductions in cardiovascular-related morbidity and mortality risk over the short, middle and long term.1–8 Evidence for an alternative exercise training paradigm specifically aimed at lowering blood pressure has been equivocal and lacks clear clinical relevance beyond evaluating the change in blood pressure measurement itself.2 Indeed, exercise prescription should aim to provide multi-system benefits.

In a recent issue of the British Journal of Sports Medicine, Edwards et al reported a network meta-analysis describing the effects of specific exercise training interventions on resting blood pressure among a pooled sample of adults exhibiting various cardiovascular health histories.2 This update of the evidence not only extends firm support for the blood pressure lowering effect of aerobic-based exercise training (number of effect sizes=182; weighted mean: −4.49 and −2.53 mm Hg, p<0.001; systolic and diastolic pressure, respectively) but also …

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  • Contributors All information and materials in the manuscript are original. Each author contributed to the writing of the manuscript and provided final review. Each author takes responsibility for all aspects of the reliability and freedom from bias of the submitted work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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