New approaches to exercise and high blood pressure

High blood pressure (hypertension) remains one of the most significant global health challenges, affecting more than 1.4 billion adults worldwide (1). It’s a major contributor to stroke, cardiovascular disease, kidney dysfunction, and is linked to over 10 million deaths every year (2). For health and fitness professionals, this makes hypertension not just a medical issue, but a critical area where effective exercise prescription can make a meaningful difference.

Traditionally, the management of hypertension has centred on medication and lifestyle changes. These include weight loss, a healthy, well-balanced diet, reduced alcohol intake, and no smoking. For decades, the exercise component of this advice has focused almost exclusively on low- to moderate intensity endurance training.

But the landscape is changing.

A growing body of research now shows that a wider range of exercise modalities—including some previously discouraged—can be safe, effective, and in some cases even more effective for reducing blood pressure.

In this article, we break down what the evidence says about these different approaches, and what fitness professionals need to understand to apply them safely and effectively.

The traditional approach

For many years, moderate intensity continuous training (MICT) was considered the gold standard for lowering blood pressure. It was viewed as safe and effective for reducing both systolic and diastolic values without placing excessive strain on the cardiovascular system.

However, this approach has limitations:

• Some individuals struggle to adhere to longer-duration sessions.
• Improvements can be modest, especially in those with more severe hypertension.
• Many clients simply prefer more varied or time-efficient training methods.

Recent research has expanded the exercise toolkit available to practitioners, offering new ways to support hypertensive clients while improving adherence, enjoyment, and long term outcomes.

HIIT vs. MICT: What the research shows

High intensity interval training (HIIT) has long been recognised for its ability to improve aerobic capacity, but its role in hypertension management is now gaining significant attention.

HIIT protocols typically involve:

• Intervals at 80–100% of peak heart rate
• Alternated with low intensity recovery periods
• Using modalities such as cycling or running
• Performed for 4 weeks or longer

A meta analysis by Leal et al., (3) found that both HIIT and MICT reduced blood pressure, but HIIT produced the larger effect:

• Systolic BP: HIIT −5.4 mmHg vs. MICT −4.6 mmHg
• Diastolic BP: HIIT −3.3 mmHg vs. MICT −2.4 mmHg

Both methods improved VO₂max, but HIIT again produced the greater increase.

Other reviews support these findings (4,5,6), showing comparable or superior reductions in resting blood pressure with HIIT, alongside better time efficiency and greater improvements in aerobic fitness.

However, not all studies agree. Some research reports only small reductions in systolic pressure and minimal changes in diastolic values (7). So while HIIT is effective, it is not universally superior, and individual responses vary.

Moderate intensity interval training: the middle ground

Moderate intensity interval training (MIIT) offers a practical alternative for clients who may not tolerate high intensity work.

MIIT typically involves:

• Intervals at 50–70% of peak heart rate
• Interspersed with rest or low intensity activity

This approach provides many of the benefits of interval training—variety, improved adherence, cardiovascular improvements—without the higher physiological demands of HIIT. Research shows MIIT can reduce blood pressure and improve cardiovascular health, making it a valuable option for less conditioned or higher risk individuals (5).

Dynamic resistance training

Resistance training has historically been approached with caution in hypertensive populations due to the acute rise in blood pressure during lifting. However, long term adaptations tell a different story.

Across the literature (6,8), dynamic resistance training has been shown to reduce:

• Systolic BP by ~4.55 mmHg
• Diastolic BP by ~3.04 mmHg

These reductions are clinically meaningful and comparable to those seen with aerobic exercise. The acute rise in blood pressure during training appears to stimulate beneficial chronic adaptations, including improved vascular function and reduced resting pressure (8).

Isometric exercise: from villain to hero

Perhaps the most dramatic shift in recent years concerns isometric exercise. Once widely discouraged, it is now one of the most effective non pharmacological interventions for lowering blood pressure.

Modern evidence based protocols typically involve:

• 2 minute holds
• At 30% of maximum voluntary contraction
• 4 sets, performed 3–4 times per week

A large body of research (6,9,10,11)—including more than 30 randomised controlled trials—shows that isometric training can reduce blood pressure by:

• Systolic BP: −7.4 mmHg
• Diastolic BP: −3.3 mmHg

These reductions are comparable to those achieved with single agent antihypertensive medication and are associated with a 13–22% reduction in major cardiovascular events (6).

Isometric exercise may be particularly beneficial for:

• Individuals unable or unwilling to engage in other exercise forms
• Those with resistant or uncontrolled hypertension
• Clients who need an adjunct to aerobic exercise and dietary interventions (9)

With sessions requiring as little as 17 minutes per week, adherence is often high.

Which is the most effective form of exercise?

A large comparative analysis of 270 randomised controlled trials ranked exercise modalities by their impact on blood pressure (10). The results showed:

1. Isometric exercise (most effective)
2. Combined aerobic + resistance training
3. Dynamic resistance training
4. Aerobic exercise
5. HIIT

Interestingly, isometric wall squats and running emerged as the most effective sub modes for reducing systolic and diastolic pressure, respectively.

For practitioners, the key takeaway is not to replace traditional methods, but to recognise the value of a broader exercise toolkit.

How exercise lowers blood pressure

Although still not fully understood, it appears regular exercise lowers blood pressure through a number of interacting mechanisms. These include:

• Improved vascular elasticity
• Enhanced endothelial function
• Increased nitric oxide availability
• Reduced sympathetic nervous system activity
• Lower vascular resistance
• Reduced resting heart rate
• Improved cardiac efficiency
• Reduced inflammation
• Better insulin sensitivity and body composition

Together, these adaptations create meaningful and sustained reductions in blood pressure.

What this means for personal trainers

The evidence shows that a range of exercise modalities, including some previously discouraged, can be as effective as, or even more effective than, traditional low- to moderate-intensity endurance training. This doesn’t mean the traditional approach should be abandoned, as it remains a core recommendation and may be more suitable or appealing for many individuals.

Instead, these additional exercise options expand the toolkit available to health and fitness professionals, enabling you to better accommodate the needs, abilities, and preferences of hypertensive clients.

References

1) World Health Organization. Hypertension [Internet]. Geneva: World Health Organization; 2025 Sep 25 [cited 2026 Jan 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension

2) Death stat: Resolve to Save Lives; World Health Organization. Hypertension: a neglected global health crisis [Internet]. 2023 [cited 2026 Jan 10]. Available from: https://resolvetosavelives.org/wp-content/uploads/2023/09/WHO-HTN-Report-Overview_Fact-Sheet.pdf

3) Leal JM, Galliano LM, Del Vecchio FB. Effectiveness of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in Hypertensive Patients: a Systematic Review and Meta-Analysis. Curr Hypertens Rep. 2020 Mar 3;22(3):26. doi: 10.1007/s11906-020-1030-z. PMID: 32125550.

4) Costa EC, Hay JL, Kehler DS, Boreskie KF, Arora RC, Umpierre D, Szwajcer A, Duhamel TA. Effects of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training On Blood Pressure in Adults with Pre- to Established Hypertension: A Systematic Review and Meta-Analysis of Randomized Trials. Sports Med. 2018 Sep;48(9):2127-2142. doi: 10.1007/s40279-018-0944-y. PMID: 29949110.

5) Adeloye OO, Smith D, Headley S. Comparing the impact of high intensity interval training (HIIT), moderate intensity interval training (MIIT), and isometric training on hypertension: a comprehensive study. Am J Hypertens Res. 2024;9(2):15 21. doi:10.12691/ajhr-9-2-2

6) Edwards JJ, Deenmamode AHP, Griffiths M, Arnold O, Cooper NJ, Wiles JD, O’Driscoll JM. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Br J Sports Med. 2023 Oct;57(20):1317-1326. doi: 10.1136/bjsports-2022-106503. Epub 2023 Jul 25. PMID: 37491419

7) Romero-Vera L, Ulloa-Díaz D, Araya-Sierralta S, Guede-Rojas F, Andrades-Ramírez O, Carvajal-Parodi C, Muñoz-Bustos G, Matamala-Aguilera M, Martínez-García D. Effects of High-Intensity Interval Training on Blood Pressure Levels in Hypertensive Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Life (Basel). 2024 Dec 14;14(12):1661. doi: 10.3390/life14121661. PMID: 39768368; PMCID: PMC11728122.

8) Barcelos GT, Bandeira ACN, Coneglian JC, Farah BQ, Ritti Dias RM, Gerage AM. Acute and chronic effect of dynamic and isometric resistance exercise on blood pressure: a review with meta analysis. Motriz: Revista de Educação Física. 2025;31:e10248467. doi:10.5016/s1980-6574e10248467.

9) Baffour-Awuah B, Pearson MJ, Dieberg G, et al. An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension and clinical implications. Clin Hypertens. 2023;29:9. doi:10.1186/s40885-

10) Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc. 2014 Mar;89(3):327-34. doi: 10.1016/j.mayocp.2013.10.030. PMID: 24582191.

11) Edwards J, De Caux A, Donaldson J, Wiles J, O’Driscoll J. Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis. Br J Sports Med. 2022 May;56(9):506-514. doi: 10.1136/bjsports-2021-104642. Epub 2021 Dec 15. PMID: 34911677.

Author

Paul Orridge

Paul Orridge BSc (Hons)

Paul Orridge is a graduate in the field of sport, exercise and health, and has over 30 years’ experience within the fitness industry. In this time, he has performed a variety of roles including personal training, lecturing and writing. Paul now works as a freelance technical author and subject matter expert within the fitness industry. His work is based on his practical experience gained working with a diverse range of people from very unfit, overweight individuals to highly conditioned athletes, and is underpinned by the latest research.