Place du sport dans le traitement de l'hypertension artérielle

Hypertension is the most frequent cardiovascular disease in our countries. Exercise training lowers significantly systolic and diastolic blood pressure. Consequently, all currently available guidelines recommend exercise training together with other non pharmacologic interventions in mild hypertension and as an adjunct to pharmacologic treatment in more severe hypertension. Furthermore, in patients at low cardiovascular risk, initiation of drug therapy should be considered only after pharmacologic approaches have been tried for 6 to 12 months. Pre-training assessment requires a specific clinical evaluation and a resting electrocardiogram. Exercise testing and echocardiogram should be performed, depending on the severity of hypertension, age and cardiovascular complications. Endurance training is the preferential exercise, from low to moderate intensity (40 to 85% of maximal oxygen consumption). Resistance training, particularly the “circuit weight training”, at 30-50% of maximum capacity, reduces blood pressure without adverse effects; heavy resistance training should be postponed until blood pressure is under control. Physicians should give a detailed exercise prescription and follow-up to improve compliance and motivation.