title: Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning.
abstract: BACKGROUND
  Lifestyle modifications have been recommended as the initial treatment strategy for lowering high blood pressure (BP). However, evidence for the efficacy of exercise and weight loss in the management of high BP remains controversial.
  
  
  METHODS
  One hundred thirty-three sedentary, overweight men and women with unmedicated high normal BP or stage 1 to 2 hypertension were randomly assigned to aerobic exercise only; a behavioral weight management program, including exercise; or a waiting list control group. Before and following treatment, systolic and diastolic BPs were measured in the clinic, during daily life, and during exercise and mental stress testing. Hemodynamic measures and metabolic functioning also were assessed.
  
  
  RESULTS
  Although participants in both active treatment groups exhibited significant reductions in BP relative to controls, those in the weight management group generally had larger reductions. Weight management was associated with a 7-mm Hg systolic and a 5-mm Hg diastolic clinic BP reduction, compared with a 4-mm Hg systolic and diastolic BP reduction associated with aerobic exercise; the BP for controls did not change. Participants in both treatment groups also displayed reduced peripheral resistance and increased cardiac output compared with controls, with the greatest reductions in peripheral resistance in those in the weight management group. Weight management participants also exhibited significantly lower fasting and postprandial glucose and insulin levels than participants in the other groups.
  
  
  CONCLUSIONS
  Although exercise alone was effective in reducing BP, the addition of a behavioral weight loss program enhanced this effect. Aerobic exercise combined with weight loss is recommended for the management of elevated BP in sedentary, overweight individuals.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, PO Box 3119, Duke University Medical Center, Durham, NC 27710, USA. blume003@mc.duke.edu.
authors.forename: J A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: A
authors.initials: A
authors.lastname: Sherwood
authors.forename: E C
authors.initials: EC
authors.lastname: Gullette
authors.forename: M
authors.initials: M
authors.lastname: Babyak
authors.forename: R
authors.initials: R
authors.lastname: Waugh
authors.forename: A
authors.initials: A
authors.lastname: Georgiades
authors.forename: L W
authors.initials: LW
authors.lastname: Craighead
authors.forename: D
authors.initials: D
authors.lastname: Tweedy
authors.forename: M
authors.initials: M
authors.lastname: Feinglos
authors.forename: M
authors.initials: M
authors.lastname: Appelbaum
authors.forename: J
authors.initials: J
authors.lastname: Hayano
authors.forename: A
authors.initials: A
authors.lastname: Hinderliter
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D018660:Blood Pressure Monitoring, Ambulatory; D001823:Body Composition; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007328:Insulin / Q000097:blood; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010349:Patient Compliance; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D007328:Insulin