How to safely exercise with high blood pressure

Exercise is important for our overall health. By last December, you were probably ready to say good riddance to 2021, and you may have set some health and exercise goals for 2022. But what if you have high blood pressure? Do high blood pressure and exercise mix safely? Are some exercises better than others, and does blood pressure medication interfere with exercise?

Is it safe to exercise with high blood pressure?

Physical activity plays an important role in preventing and managing high blood pressure. Research from the American Heart Association found that people who worked out for four (or more!) hours a week were 19% less likely to have high blood pressure than people who were less active. But, there are some special considerations if you already have elevated numbers.

Exercise-induced hypertension

“Exercise hypertension occurs when blood pressure rises abnormally during exercise,” according to Anne Doroba, MD, a physiatrist in Orland Park, Illinois. A normal blood pressure for an adult is less than 120 systolic (upper number) and less than 80 diastolic (lower number). 

Exercise naturally causes a rise in blood pressure, but Dr. Doroba says exercise hypertension occurs when blood pressure reaches over 210 systolic in men, over 190 systolic in women, and over 110 diastolic in both genders. It’s a risk factor for permanent, serious high blood pressure even when at rest.

Blood pressure medications

Antihypertensive medication works well to normalize blood pressure. But, it is important to be aware that certain blood pressure medications can interfere with exercise. “Many, if not most, antihypertensives will impact blood pressure response and/or heart rate,” says Dr. Doroba. “Beta blockers will cause a slower heart rate so you likely will not reach target heart rates. Diuretics and ACE inhibitors can result in lower post workout blood pressures.”

For aerobic exercise, it’s a good idea to start with shorter exercise sessions at an intensity that is challenging but not overwhelming, and gradually build up to being active for 30 minutes a day, a few days a week. If you take a beta blocker or any other medication that affects your heart rate, always cool down slowly as some medications can rapidly reduce blood pressure if you abruptly stop exercising.

RELATED: What’s a normal heart rate?

Supplements

Supplements can also affect blood pressure. Minerals that our body receives from foods or supplements that have been shown to be beneficial for blood pressure include calcium, magnesium, and potassium. 

A few popular supplements, however, may contribute to high blood pressure or be potentially harmful to those on blood pressure medications. They include:

• St. John’s Wort is an herbal remedy sometimes used to treat depression. Studies show that St. John’s Wort speeds up the metabolism of some medications; which makes blood pressure medication less effective. 
• Ginseng is thought to increase energy levels and may be an immunity booster, but it can also cause an increase in blood pressure.

• Ephedra was once a popular weight loss supplement, but this product is now banned in the U.S. It may cause cardiovascular problems, including high blood pressure, palpitations, and even heart attacks.

• Echinacea is most commonly used to fight infections, especially the common cold, and the flu. It has also been shown to affect how medications are metabolized and should be avoided by those taking blood pressure medicines. 

Other risk factors

It’s always a good idea to check with your doctor before starting an exercise regimen. “Exercising with hypertension is highly recommended as long as the baseline blood pressure is not very high and the patient does not have a high-risk condition such as a blood vessel aneurysm,” says Sonal Chandra, MD, an assistant professor of Cardiology Rush University Medical Center in Chicago.  

What are the best exercises for high blood pressure?

When it comes to high blood pressure and exercise, aerobic activity is recommended for lowering blood pressure, but stretching and strength-building exercises are important as well.  

“Much depends on the condition of the person at the start, but moderate cardiovascular exercise with slow cool downs for someone who has not been sedentary is a good place to start,” says Dr. Doroba. She recommends walking and even some more intense aerobic activities such as jogging and swimming. 

As for strength training, Dr. Doroba recommends avoiding heavy weights that cause a Valsalva response (when you hold your breath and strain it causes increased blood pressure). “A balanced program—including aerobic exercise, strength training, and stretching—should be part of everyone’s program and can help those with hypertension improve their cardiovascular health,” she says. “Just start where you feel comfortable, perhaps slightly challenged, and progress.”

Consider increasing your activity level while doing everyday things you enjoy. Try walking, gardening, or dancing. Start by walking for just a few minutes every other day and increase every few weeks.

Exercises to avoid with high blood pressure

There is no one exercise prescription that’s appropriate for all adults. An individualized exercise prescription should be tailored to your specific capabilities, with the goals of preventing injuries and maximizing incentives for maintaining a consistent regimen. Those with high blood pressure don’t need to avoid exercise but should be cognizant of when they are over-exerting themselves. 

“Exercising regularly contributes to lower blood pressure,” Dr. Chandra says. “However, we recommend avoidance of moderate-high intensity exercise if blood pressure is expected to rise above 190 mmHg at peak exercise.” 

So, how can you tell if you are overexerting yourself during exercise? Some signs to watch out for include:

• Feeling dizzy or lightheaded 
• Nausea or vomiting 
• Pain 
• Fatigue 

Avoid very intensive bouts of exercise, such as weightlifting or sprinting.

How much exercise do you need to lower blood pressure?

Lifestyle changes can help lower blood pressure along with medications your doctor prescribes. One study found that even “relatively modest increases in physical activity above sedentary levels” can result in clinically significant decreases in blood pressure. 

According to the Department of Health and Human Services, all adults including hypertensives should aim to get at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity. Several medical societies recommend at least 30 minutes of moderate daily exercise to be beneficial for blood pressure, weight loss, diabetes control, and heart health.  

Along with exercise, diet also impacts blood pressure. To lower blood pressure, Dr. Chandra recommends the DASH eating plan, which emphasizes low sodium-based eating by relying on fresh foods, including vegetables, fruits, whole grains, lean meats, low fat dairy, seeds, and nuts. 

There are also some foods that may contribute to high blood pressure. “Salt and artificial preservatives in food can promote high blood pressure via endocrine disruption and impaired sodium excretion, and alcohol can also contribute to high blood pressure in some individuals,” says Dr. Chandra. “A correct diet can at most lower the risk of developing blood pressure and obviate the need for blood pressure medication and at the very least, minimize the risk of escalation in blood pressure therapy.”

Exercise is one of the best ways to maintain a healthy blood pressure. Those with hypertension should consult with their doctor who can help direct them to an exercise routine that will fit their needs.