Higher Exercise Levels May Help Prevent Hypertension in Middle Age

To support heart health, it is not enough to be highly active only in youth. Research indicates that keeping exercise levels high throughout middle age may help protect against high blood pressure in later life.

However, a study involving more than 5,000 people in four US cities found that social circumstances can make this harder for certain groups than for others.

"Teenagers and those in their early 20s may be physically active but these patterns change with age," epidemiologist Kirsten Bibbins-Domingo of the University of California, San Francisco (UCSF), said in April 2021, when the study was published.

Physical activity and high blood pressure

Although many studies have established that exercise reduces blood pressure, the 2021 study indicates that "maintaining physical activity during young adulthood – at higher levels than previously recommended – may be particularly important," Bibbins-Domingo said.

Hypertension, or high blood pressure, is a serious condition that affects billions of people globally. It can cause heart attacks and stroke, and is also a risk factor for developing dementia later in life.

According to the World Health Organization, more than one in four men and roughly one in five women have hypertension. Yet many people with high blood pressure are unaware that they have it, which is why it is often described as the "silent killer".

There are, however, ways to reverse high blood pressure, and exercise was the central focus of this research.

The study enrolled more than 5,100 adults and followed their health for three decades using physical examinations and questionnaires covering exercise habits, smoking status and alcohol consumption.

During each clinical assessment, blood pressure was taken three times at 1-minute intervals. For the analysis, participants were divided into four groups according to race and gender.

Among men and women in both racial groups, physical activity declined between the ages of 18 and 40. In the decades that followed, hypertension rates increased as physical activity levels continued to fall.

The researchers say this points to young adulthood as a key opportunity to prevent hypertension in middle age through health-promotion programmes aimed at increasing exercise.

Higher exercise levels in young adulthood

"Nearly half of our participants in young adulthood had suboptimal levels of physical activity, which was significantly associated with the onset of hypertension, indicating that we need to raise the minimum standard for physical activity," said lead author Jason Nagata, a UCSF specialist in young adult medicine.

The researchers examined participants who completed 5 hours of moderate exercise per week in early adulthood, which is twice the minimum amount currently recommended for adults. They found that this amount of activity substantially reduced hypertension risk, particularly when people maintained their exercise routines up to the age of 60.

"Achieving at least twice the current minimum adult [physical activity] guidelines may be more beneficial for the prevention of hypertension than simply meeting the minimum guidelines," the researchers write in their paper.

Still, increasing weekly physical activity can be difficult while people navigate major life decisions and mounting responsibilities.

"This might be especially the case after high school when opportunities for physical activity diminish as young adults transition to college, the workforce, and parenthood, and leisure time is eroded," Nagata said.

Racial disparities in hypertension and exercise

The study also revealed a troubling reality: Black men and Black women followed markedly different health paths from their White counterparts. By the age of 40, physical activity levels had levelled off among White men and women, while activity among Black participants continued to decrease.

At 45, hypertension rates among Black women exceeded those of White men. White women in the study had the lowest hypertension rates throughout middle age.

By 60, between 80 and 90 percent of Black men and women had hypertension. This compared with just under 70 percent of White men and approximately half of White women.

The research team linked these widely recognised racial inequalities to numerous social and economic influences. These factors were not evaluated in the study, though high-school education was recorded.

"Although Black male youth may have high engagement in sports, socioeconomic factors, neighborhood environments, and work or family responsibilities may prevent continued engagement in physical activity through adulthood," Nagata said.

The study was published in the American Journal of Preventive Medicine.

An earlier version of this article was published in April 2021.