Hypertension (High Blood Pressure)

Hypertension is elevated arterial blood pressure. The current 2025 AHA/ACC multisociety guideline (which replaced the 2017 ACC/AHA guideline) keeps the same categories: normal <120/<80 mmHg; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90. Some other international guidelines still use ≥140/90 as the hypertension threshold.

What the current guideline recommends: lifestyle change for everyone with elevated BP or hypertension — healthy weight, a heart-healthy eating pattern such as DASH, less sodium, more dietary potassium, a moderate physical activity programme, stress management, and less or no alcohol. Its physical-activity recommendation (Class 1, strongest) is to increase activity through a structured exercise programme that includes aerobic exercise and/or resistance training to prevent or treat elevated BP and hypertension.

Exercise prescription (ACSM Position Stand, Exercise and Hypertension, 2004):

• Frequency: most, preferably all, days of the week.
• Intensity: moderate (40–<60% of VO2 reserve; roughly RPE 12–13 on the 6–20 scale).
• Time: ≥30 min/day of continuous or accumulated activity.
• Type: primarily endurance (aerobic) activity, supplemented by resistance exercise.
• Expected effect: in people with hypertension, endurance exercise lowers BP by about 5–7 mmHg, both after a single session and after training, and BP can stay lower for up to 22 hours after a session.

• Avoid Valsalva / breath-holding during resistance training — it spikes BP; exhale on exertion (Breathing Technique & the Valsalva Effect).
• People on beta-blockers have blunted HR responses → use RPE/talk test rather than target HR; beta-blockers and diuretics can affect thermoregulation/hydration.
• Antihypertensives can add to post-exercise hypotension → emphasise gradual cool-downs; rise slowly to avoid dizziness.
• Favour dynamic, large-muscle aerobic work. Low-intensity isometric protocols (e.g., handgrip) are also studied for BP; heavy sustained isometric efforts are best avoided unless specifically prescribed.

• Readings in the severe range (>180/120 mmHg, the 2025 guideline's definition of severe hypertension) need prompt medical evaluation — don't start or continue training until a clinician has assessed them.
• The ACSM stand advises that people with controlled hypertension and no cardiovascular or kidney complications can exercise but should be evaluated and monitored; while that happens, most can begin moderate activity such as walking.
• Obtain medical clearance if there are CV symptoms or known CVD (Medical Clearance & Pre-Participation Screening).
• Stop and seek care for chest pain/pressure, severe breathlessness, dizziness/syncope, palpitations (Cardio Safety, Contraindications & Warning Signs).

• 2025 AHA/ACC categories (unchanged from 2017): elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90.
• 2025 guideline: a structured exercise programme with aerobic and/or resistance training is a Class 1 recommendation.
• ACSM 2004: most/all days, ≥30 min/day, moderate intensity, aerobic first with resistance as a supplement.
• Typical BP reduction ~5–7 mmHg with aerobic exercise in people with hypertension.
• Avoid Valsalva; use RPE if on beta-blockers; readings >180/120 need medical evaluation before training.