Guidelines for Hypertension & Hypotension Management

Let’s talk about what happens to your heart when you’re working out. Blood pressure rises during exercise as the heart beats harder to pump blood around the body and deliver oxygen to the muscles. This change in blood pressure is natural and a sign of a healthy heart.

However, there are recommended limits to how high blood pressure should rise, and people with low or high resting blood pressure have specific considerations to keep in mind.

In this guide, we will explain the effects of exercise on blood pressure. We’ll also provide guidance on how to exercise safely.

Effects of exercise on blood pressure

The normal blood pressure range is between 90/60 mmHG – 120/80 mmHG, but it will increase during exercise. Your BP should return to normal after you finish working out. Over time, exercise strengthens the heart and makes it pump blood around your body more efficiently.

Here are three reasons why exercise can help reduce blood pressure:

1. It makes your heart stronger

Exercise gives your heart a workout, pumps more blood around the body, and over time leads to changes that reduce the force on your arteries. Healthy arteries equate to healthy blood pressure levels, leading to reduced risks of hypertension, heart disease, and stroke.

A 2016 study showed BP was reduced after exercise, with a greater reduction in “physically active individuals who were not yet medicated.”

For more information on how blood pressure is measured, read our guide on how to take your blood pressure.

2. It makes your mind and body stronger

Exercise also makes your bones and muscles stronger, improves your agility, and improves your sleep quality. There are also benefits to your respiratory system and overall mood. A recent study by JAMA Psychiatry showed that running for 15 minutes a day or walking for an hour reduced the risk of major depression.

3. It could prevent increases in blood pressure through alterations in the body

A 2013 study by Keith M. Diaz and Daichi Shimbo looked at physical activity and how it helped prevent hypertension. In it, they examined numerous studies and findings from animal studies that suggested how different types of exercise could prevent increases in blood pressure.

For example, aerobic exercise may prevent increases in BP through “beneficial alterations in insulin sensitivity and autonomic nervous system function.”Resistance training may prevent increases in BP through “beneficial alterations in vasoconstriction regulation” (the narrowing of blood vessels by small muscles found in the vessel walls).

Exercise and high blood pressure: What you should know

Hypertension, also known as high blood pressure, is a condition that affects over one billion people in the world. People who have high blood pressure have an increased risk of strain on their blood vessels, which can lead to serious health conditions.

Exercise can help to reduce high blood pressure. However, people with hypertension should always speak to their GP to ensure that they can exercise safely. In some cases, a doctor may prescribe medicine to lower blood pressure before engaging in physical activity.

That’s because during exercise the blood pressure increases, which can be dangerous for people who already have hypertension. Test your blood pressure before engaging in exercise to make sure you can exercise safely. To make sure you can exercise safely, regularly monitor your blood pressure – learn more about how Aktiia monitors your BP 24/7.

According to European Society of Cardiology (ESC) and the European Society of Hypertension guidelines, blood pressure classification is as below:

How to exercise safely with high blood pressure

1. Talk to your doctor

It’s always sensible to speak to your doctor before starting any new physical activity. Since exercise will cause your blood pressure to rise for a short time before returning to normal, your doctor may prefer your reading to be lower before you start. Medication can also alter the way your heart rate and blood pressure responds to exercise.

2. Build up slowly

The ESC recommends that adults should aim for at least 2.5 hours of moderate-intensity aerobic activity a week – equivalent to exercising for 30 minutes a day, five times a week.

However, it’s absolutely fine to split your 30 minutes into two 15-minute or three 10-minute sessions when you first start out, says Blood Pressure UK.

Joining a gym class? Stick to beginner-level classes to start with. Fancy giving running a go? Try Couch to 5K. Start small and gradually increase the intensity.

3. Practice little and often

If you’re short on time, it’s far better to break your weekly exercise down into shorter sessions than cramming it all into one intense workout on the weekend.

For example, let’s say you normally spend about an hour at the gym. But if you literally only have 10 minutes to exercise, that’s okay, too – a simple home workout is better than nothing.

A sedentary lifestyle can increase the risk factor for several health conditions, including high blood pressure. Try taking a quick walk at lunch, going to the kitchen to get a cup of tea, or going to talk to a colleague in another part of the building during your workday – it all helps.

4. Warm up, cool down

Warming up before exercise helps your body prepare for the increased activity. It gently increases your heart rate and blood pressure, enabling more oxygen to reach your muscles. Plus, warming up activates the connections between your nerves and muscles, helping you move more efficiently and reducing the risk of injury.

As you finish, cool down by reducing the intensity of the exercise – for example, slowing to a walk from a jog. This will help you reduce your heart rate and blood pressure gradually.

5. Get an exercise buddy

It’s a great idea to exercise with a partner or friend who’s aware of your high blood pressure. Not only is this safer, it also makes exercise more fun – and helps you stay on track on those days when you don’t feel like getting active.

6. Know when to stop

Exercise makes you breathe harder and increases your heart rate. If you’re not used to physical activity, it may take your body a while to get used to it. That’s perfectly normal.

But it’s important to know the difference between being active and overexerting yourself. As a guide, you should feel warmer and breathe harder, but you should still be able to talk without panting heavily between words. If you feel very short of breath, or if you feel like your heart is beating too quickly, slow down and rest.

You should also stop exercising and get medical attention straight away if you experience:

• Pain or tightness in your chest, neck, jaw, or arm
• Dizziness or faintness
• Severe shortness of breath
• Nausea or vomiting
• An irregular heartbeat

You could also wear a medical ID bracelet for extra peace of mind when you’re out on a run or at the gym.

Exercise for people with low blood pressure

People with low blood pressure, also known as hypotension, sometimes experience orthostatic hypotension during exercise. Orthostatic hypotension causes people to feel lightheaded while standing up or sitting down, including other symptoms, such as:

• Nausea
• Blurred vision
• Confusion
• Fainting

Sudden changes in posture cause less blood to circulate back to the heart. In turn, this causes the body’s blood pressure levels to drop. People with already-low blood pressure may consequently struggle to pump enough blood to the brain and experience the symptoms listed above.

Many forms of physical activity that involve sudden changes in posture can result in orthostatic hypotension, including yoga, cardio exercises, and weight training. Therefore, people with low blood pressure should take precautions: change your posture slowly while doing an exercise that involves raising your head, and make sure to cool down gradually following an aerobic activity.

If you experience dizziness or any other symptoms listed above, sit down until the symptoms pass.

Speak to your GP to see what they recommend. You should also monitor your blood pressure before and after exercise using a clinically validated BP monitor.

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Why you should monitor your blood pressure around exercise

While there are benefits to exercising as a way to reduce your blood pressure, it’s important to keep an eye on your levels before, during, and after any physical activity.

If your heart rate spikes

When you are exercising, if your heart rate exceeds your suggested max heart rate zone, stop immediately and wait for your heart rate to return to normal.

Hypertensive patients or those at risk of hypertension should avoid any exercises that are likely to raise blood pressure, such as endurance sports or weightlifting. If you notice any blood pressure spikes during safer exercise, such as walking or swimming, it could be a sign of a deeper health issue.

You can check your blood pressure trends in the Aktiia app, which offers 24/7 insights about your cardiovascular health.

If your blood pressure drops

Blood pressure drops are common after exercise (specifically known as postexercise hypotension, or PEH). High-temperature environments can cause further decreases in blood pressure, so skip the shower or sauna until you’ve fully cooled down after working out.

Exercising regularly at a low-moderate intensity level may benefit you, but you should always discuss the kind of exercise you do with your medical providers before starting on an exercise program.

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Conclusion

Exercise has proven benefits for heart health and managing blood pressure. However, people with hypertension or hypotension must take precautions before engaging in physical activity to keep their blood pressure at a healthy level. A normal blood pressure level varies depending on the person, so always speak to your GP to understand the necessary precautions to take.

Disclaimer: If you have hypertension and you plan to start blood pressure exercises, we encourage you to speak to your healthcare professional.

Sources

Blood pressure parameters, October 23, 2019 –  https://www.nhs.uk/high-blood-pressure-hypertension

Acute Effects of Exercise on Blood Pressure, May, 2016 – https://www.ncbi.nlm.nih.gov/pmcarticles-PMC4914008

More evidence that exercise can boost mood, May 1, 2019 – https://www.health.harvard.edu/more-evidence-that-exercise-can-boost-mood

Physical Activity and the Prevention of Hypertension, December 1, 2014 –  https://www.ncbi.nlm.nih.gov/articles-PMC3901083

Preventive role of exercise training, January 17, 2013 – https://pubmed.ncbi.nlm.nih.gov/23329818

Impact of World Hypertension Day, May 15, 2007 – https://www.ncbi.nlm.nih.gov/articles-PMC2650754

2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease, November 24, 2020 –  https://www.escardio.org/esc-guidelines-on-sports-cardiology-and-exercise-in-patients-with-cardiovas

Exercise, physical activity and your blood pressure, 2021 – https://www.bloodpressureuk.org/healthy-living-exercise-physical-activity

NHS, Get running with Couch to 5K, October 2, 2020 – https://www.nhs.uk/exercise-get-running-with-couch-to-5k

Post Exercise Hypotension, 2015 – https://www.sciencedirect.com/medicine-and-dentistry-post-exercise-hypotension

Potential causes, mechanisms, and implications of post exercise hypotension, April 16, 2022 – https://www.nature.com/articles-1001377