Borderline isolated systolic hypertension in the elderly. Significance and influence of physical exercise

Older persons with borderline isolated systolic hypertension (ISH, SBP 140-159, DBP < 90 mmHg) are at increased risk for cardiovascular morbidity and mortality and for developing overt hypertension. Physical activity appears to be a promising nonpharmacologic therapy for persons with borderline ISH. Epidemiological evidence suggests that persons who are more physically active have lower blood pressure than sedentary controls and are less likely to develop overt hypertension. Available evidence from experimental studies suggests that both aerobic training and resistance training may lower blood pressure. However, it is generally recognized that major design limitations hinder the interpretation of these studies. Despite the potential benefits of traditional exercise prescription on blood pressure and other variables, it is difficult to get older persons to participate in formal exercise programs. Furthermore, epidemiological evidence suggests that intermittent physical activity at levels below that required for physiological training may have health benefits. As a result of these two premises, the Center for Disease Control has recently advocated an active lifestyle to gain potential benefits of physical activity. This recommendation was made without sufficient information regarding the effects of such an approach on variables such as blood pressure, lipids and glucose tolerance. Thus, further studies comparing the effects of aerobic and resistance training programs and of lifestyle intervention programs on blood pressure, lipids, and markers of glucose tolerance in older persons with borderline ISH are needed.