STRENGTH TRAINING AND HYPERTENSION

True. I’m not a medical doctor. But I’m a strength coach - which most medical doctors aren't.

If we look at the effects of strength training on managing blood pressure, does it become a topic of strength training, a topic of medicine, or both?

In the end, it doesn’t even matter. What matters is that we make information transparent to the general public which they might not hear elsewhere. This shall allow them to make an informed decision on how they wish to proceed with matters about their health.

Disclaimer: The information presented in this article is not medical advice. I present to you what I have found, and what you do with this information is up to you. I am neither a doctor, nor am I your doctor. I’m just a curious person.

Hypertension is one of the leading causes of death from cardiovascular disease and affects approximately one in three adults, equalling one billion people worldwide. Out of all hypertensive cases, 40% are unaware of their condition (1,2,3).

Current guidelines define hypertension as a systolic blood pressure (SBP) equal or greater 130 mm Hg, or a diastolic blood pressure (DBP) equal or greater 80 mm Hg. A systolic blood pressure of 120-129 mm Hg or diastolic blood pressure of greater than 80 is considered elevated, while a blood pressure of 120:80 mm Hg is considered normal (4).

The higher your blood pressure, the greater the risk of suffering a cardiovascular-related death, according to research. A 20 mm Hg higher SBP and 10 mm Hg higher DBP are each associated with a doubling of your risk in dying from a stroke, heart disease, or any other vascular-related disease (5,6).

EFFECTS OF STRENGTH TRAINING ON BLOOD PRESSURE

Across studies looking at pre-hypertensive people, strength training has shown to reduce SBP by an average 4.87 mm Hg, as well as reducing DBP by an average 2.77 units (7).

The strongest effects of strength training on lowering blood pressure have so far been observed in people who have actually fallen into the category of hypertension. Assessing nearly 43.000 people, the average decrease in SBP has been shown to be 8.85 mm Hg, with an average decrease of 4 mm Hg in DBP (7,8,9,10,11). This was demonstrated in the most compelling way by Naci and colleagues (11) in 40.000 subjects where the effects of strength training were put head to head with control groups who took anti-hypertensive medication, but did not undergo an exercise regime.

The results showed that strength training was equally effective in lowering blood pressure in hypertensive people compared to taking anti-hypertensive medication only.

Bearing in mind the numerous other health benefits strength training produces compared to merely taking drugs, current recommendations hypertensive people are given in terms of their physical activity levels need to be urgently reviewed. Indeed, only a quarter of patients diagnosed with hypertension are advised to exercise, despite its well-known efficacy for improving it (25). This demonstrates how poorly the general public is currently being educated on the benefits of getting stronger for managing blood pressure.

TRAINING INTENSITY

Evidence of large-scale studies has shown that a certain level of training intensity is required in order to significantly reduce blood pressure. The literature reports this as 60-80% of 1RM, which is considered ‘moderate intensity' (7,8).

If we look at the fact that most training sessions in the above studies were carried out using machines or dumbbells, this begs the question of how much more effective heavy strength training done with barbells could have been in managing blood pressure in those subjects.

Barbell lifts place the highest systemic stress on the body when compared to any other form of equipment. If we gradually increase the load over time, can we therefore assume that the body reacts in a ‘stronger’, more potent way? In other words: is a 5RM squat going to challenge our body to regulate blood pressure to a greater degree compared to sitting on a leg extension machine and carrying out a movement with a far lower intensity?

What if we keep increasing the demands placed on our cardiovascular system over time by getting stronger on compound lifts – compared to how long we can progress on the limiting nature of using equipment such as machines, bands, or dumbbells?

Furthermore, if the training intensity keeps going up over many years of lifting, will this have an even stronger effect on lowering blood pressure compared to the average 12-week duration used in most studies?

Questions we so far don’t have definite answers for – but the logical conclusion is that the longer you train, and stronger you are, the greater the potential of managing your blood pressure .

POSSIBLE MECHANISMS EXPLAINING OUTCOMES

Several physiological adaptations have been proposed as drivers behind better blood pressure management. This includes improved vascular function expressed as better flow-mediated dilation (12), reduced arterial stiffness and greater elasticity (13), increased nitric oxide (NO) production for greater vasodilation (14), reduced insulin resistance (15), lower adrenaline production (16), as well as a reduction in inflammation (17).

The results from large-scale studies showing anti-hypertensive effects coincide with studies demonstrating a positive relationship between muscle mass and lowered blood pressure (18,19), between strength and lowered blood pressure (20,21,22,23), as well as between sarcopenia and its pro-hypertensive effects (24).

For example, in a study assessing 50.000 people with an average age of 51.6 years, researchers concluded that the odds of becoming hypertensive are 2.5 times greater in people with low muscle mass compared to those with normal levels (19).

I am going to argue that the effects of building healthy levels of muscle are further potentiated by accompanied increases in strength as it would be seen in lifters undergoing barbell training.

Studies involving over 92.000 people from various ethnic backgrounds (Europe, China, India) support this notion (20,21,22,23). Subjects with the highest level of handgrip strength (HGS) showed an overall 25% lower risk of developing hypertension compared to people with the poorest results. As the subjects in those studies did not undergo any serious barbell training, we can again anticipate how much lower their odds of being hypertensive would have been had they been ‘properly’ training for strength over an extended period of time.

Key takeaways

• Strength training is equally effective in lowering blood pressure in hypertensive people compared to the most common anti-hypertensive medications.

  
  

• Studies show that blood pressure is more effectively reduced in people training at moderate to high intensities (i.e. 5RM) compared to training at lower intensities.

  
  

• We anticipate that the effects of getting stronger on barbell lifts are even greater for reducing blood pressure compared to using other types of equipment as the systemic stress placed on the body is higher.

  
  

• Both strength and muscle mass have shown to reduce the odds of becoming hypertensive.

Here is the conclusion: Get under the bar, and your blood pressure might just thank you.

References:

1 Eaton et al., 2016:  WHO methods and data sources for life tables 1990–2015.

2 Chockalingam, 2007: Impact of world hypertension day. Can. J. Cardiol. 23, 517–519

3 Farrar & Frieden, 2025: WHO global report on hypertension 2025. The Lancet. Volume 406, Issue 10517.

4 Jones et al., 2025: Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 82 (10).

5 Lim et al., 2012: A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. Volume 380, Issue 9859.

6 Danaei et al., 2009: The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLOS Medicine.

7 Henkin et al., 2023: Chronic effect of resistance training on blood pressure in older adults with prehypertension and hypertension: A systematic review and meta-analysis. Experimental Gerontology 177 (2023) 112193.

8 Igarashi et al., 2022: Effects of Differences in Exercise Programs With Regular Resistance Training on Resting Blood Pressure in Hypertensive Adults: A Systematic Review and Meta-Analysis. JSCR. 37(1)/253–263.

9 de Sousa et al., 2017: Resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals: meta-analysis. Hypertension Research (2017) 40, 927–931.

10 Correia et al., 2023: Strength training for arterial hypertension treatment: a systematic review and meta‑analysis of randomized clinical trials. Scientific Reports. 13:201

11 Naci et al., 2018: How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br J Sports Med. 53:859–869.

12 Shivgulam et al., 2023: Impact of Exercise Training Interventions on Flow-Mediated Dilation in Adults: An Umbrella Review. Sports Med. 53(6):1161-1174.

13 Miyachi, 2013: Effects of resistance training on arterial stiffness: a meta-analysis. Br J Sports Med.47(6):393–6

14 Maiorana et al., 2001: The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. J Am Coll Cardiol.38(3):860–6.

15 Jiahao et al., 2021: Effects of resistance training on insulin sensitivity in the elderly: A meta-analysis of randomized controlled trials. J Exerc Sci Fit. 19(4):241–251.

16 Athanasiou et al., 2022: Endocrine responses of the stress system to different types of exercise. Rev Endocr Metab Disord. 24(2):251–266.

17 Calle & Fernandez, 2010: Effects of resistance training on the inflammatory response. Nutr Res Pract. 4(4):259–269.

18 Viken et al., 2025: Is more muscle mass linked to less hypertension? Exploring sex‑specific effects and the role of body composition in older European adults. Journal of Public Health.

19 Han et al., 2018: Associations of body fat and skeletal muscle with hypertension. J Clin Hypertens (Greenwich). 21(2):230-238.

20 Luo et al., 2023: Association between relative muscle strength and hypertension in middle-aged and older Chinese adults. BMC Public Health. 23:2087.

21 Polo-Lopez et al., 2023: Dose-Response Association Between Handgrip Strength and Hypertension: A Longitudinal Study of 76,503 European Older Adults. Current Problems in Cardiology. 48 (19).

22 Yogesh et al., 2024: Gripping insights: prevalence of hypertension and its association with relative muscle strength—a cross-sectional study in an adult Indian population. Journal of Health, Population, and Nutrition. 43:215.

23 Bai et al., 2023: Muscle quality is negatively related to hypertension prevalence in adults: Results from NHANES 2011–2014. J Clin Hypertens (Greenwich). 25(11).

24 Quan et al., 2024: Geriatric sarcopenia is associated with hypertension: A systematic review and meta‐analysis. J Clin Hypertens (Greenwich). 25(9).

25 Mellen et al., 2004: Prevalence of Nutrition and Exercise Counseling for Patients with Hypertension. J Gen Intern Med 2004. 19(9).

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