Sports and hypertension

By Dr. Gianfranco De Angelis

In the latter period, studies on the relationship between hypertension and physical activity are innumerable. I will try to summarize them to give the reader the basic news.

The adaptations of the cardiovascular apparatus consequent to the motor activity are manifold, I will limit myself to highlight those that are in relationship with our problem: the hypertension.

We have seen that following physical activity there is a reduction in sympathetic tone and an increase in capillary density. Although these two effects show that physical activity is good for the hypertensive, it is not so simple, as during a demanding physical activity the pressure increases, putting the hypertensive sportsman in danger. So, to summarize, when physical activity is practiced the pressure increases, but in the long period of time (ie following a prolonged training) the pressure decreases. These statements of mine may seem contradictory, but so far I have spoken neither of the type of exercise nor of the degree of hypertension. We can classify hypertensives into two groups: borderline hypertensives, with a maximum pressure of 135-140 mmHg and a minimum 85-95 mmHg, and true hypertensives, which have systolic levels greater than 140-160 mmHg and diastolic greater than 90-95 mmHg. We have seen that, following adequate physical activity, in borderline hypertensive patients there is a considerable reduction in both maximum and minimum pressure values; in stable hypertensives, on the other hand, research is discordant, but according to several authors (Hanson, Bonanno, Comasink) even in stable hypertensives the pressure decreases.

Now let's see the recommended physical activity and the way to do the training without risks. Hypertension is a sick person and as such needs special precautions: physical activity must be of an aerobic and dynamic type; the physical effort should be graduated so as to cause an increase in heart rate up to values ​​equal to about 70% of the theoretical maximum; the training program should include at least three training sessions per week, lasting about 45 minutes each, which are sufficient to achieve a good drop in blood pressure (Lewis and Comann of the International Board of Medicine). We must start with a bit of free body gymnastics, then we choose sport, which must be of an aerobic and dynamic type; this is because isometric efforts increase the pressure, both systolic and diastolic. Examples of aerobic and dynamic sports are walking, running, swimming, cross-country skiing and cycling. There is no doubt that even in this case, since we are dealing with patients, we need strict medical supervision.