Aerobic Exercise Reduces Blood Pressure in Patients with Resistant Hypertension


Data show the change in 24-hour ambulatory systolic blood pressure was significant between treatment and control groups with a reduction of 7.1 mm Hg.

Fernando Ribeiro, PhD

Fernando Ribeiro, PhD

Despite the recommendation of exercise as a primary approach for the treatment of hypertension, there is a lack of specificity in care recommendations to patients with treatment-resistant hypertension.

As a result, a recent study aimed to determine if an aerobic exercise training intervention reduces ambulatory blood pressure (BP) in this patient population.

Investigators, led by Fernando Ribeiro, PhD, Institute of Biomedicine, School of Health Sciences, University of Aveiro, observed a 12-week aerobic exercise program resulted in reductions of 24-hour and daytime ambulatory blood pressure in patients with resistant hypertension.


In doing so, the team designed the Exercise Training in the Treatment of Resistant Hypertension (ENRICH) randomized clinical trial to determine if exercise training reduced ambulatory blood pressure in the patient population.

It was a prospective, two-center, single-blinded randomized clinical trial with a parallel two-arm group and it was performed in Portugal from March 2017 - December 2019.

In the study, patients were randomly assigned to either a 12-week aerobic exercise training program plus usual care or to usual care (control group). Primary and secondary outcomes were assessed at baseline, as well as after the 12-week intervention.

Enrolled patients had a diagnosis of resistant hypertension observed at the hospital hypertension outpatient clinic, with an age of 40 - 75 years. They were required to have a mean systolic blood pressure of ≥130 mm Hg on 24-hour ambulatory blood pressure monitoring and/or a 135 mm Hg or greater during daytime hours while taking maximally tolerated doses of at least 3 antihypertensive agents

The study noted the primary endpoint was change in 24-hour ambulatory systolic blood pressure from baseline to 3 months. Further, secondary outcomes included mean change in all other variables, heart rate, body composition, cardiorespiratory fitness, and adverse events.


Although a total of 60 patients participated in the trial, 7 patients terminated the study prematurely, leaving 53 patients included in the analysis. Patient data show 24 women (45%) and a mean age of 60.1 years.

In comparison with the control group, the change in 24-hour ambulatory systolic BP was significant between groups with a reduction of 7.1 mm Hg (95% CI, -12.8 to -1.4, P = .02).

The team noted the 24-hour ambulatory diastolic BP was also significantly reduced in the exercise group compared to the control arm at -5.1 mm Hg (95% CI, −7.9 to −2.3; P = .001).

In addition, the daytime ambulatory systolic BP and diastolic BP were significantly reduced in the exercise arm, at -8.4 mm HG (95% CI, −14.3 to −2.5; P = .006) and -5.7 mm Hg (95% CI, −9.0 to −2.4; P = .001), respectively.

Investigators observed improvements in the exercise arm with office systolic BP (-10.0 mm Hg; 95% CI, -17.5 to -2.5, P = .01) and cardiorespiratory fitness, with an improvement of 14%.

They noted a difference in cardiorespiratory fitness at 5.05 mL/kg per minute of oxygen consumption (95% CI, 3.5 - 6.6, P <.001) in the exercise arm compared to those in the control group.

Lastly, investigators noted patients in the exercise arm attended 98.8% of 36 exercise sessions, with no major adverse events reported during the study.


Investigators concluded aerobic exercise as first-line treatment for hypertension should be extended to patients with a resistance to pharmacological treatment.

“From a clinical perspective, these results are encouraging because the exercise prescription tested in the EnRicH trial is easily reproducible and has the potential to be applied on a larger scale in a setting more representative of clinical practice for which integrating drug treatment and exercise training are recommended,” investigators wrote.

The study, “Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension: A Randomized Clinical Trial,” was published online in JAMA Cardiology.

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