Should sports activity be encouraged or contraindicated in hypertensive subjects?

Hypertension is considered one of the major risk factors for cardiovascular disease. There are a number of different approaches to the prevention, control and treatment of hypertension. One of these provides lifestyle modification as a means to facilitate drug step-down or drug withdrawal in hypertensive patients subjected to a pharmacological treatment, but also as a means to control blood pressure and reduce the risk of developing hypertension in subjects that have abnormal blood pressure but are not candidates for drug therapy. Lifestyle modification includes physical activity, and there is an ever-increasing amount of evidence that physical activity can modify the history of hypertension, acting as a reducer either of blood pressure or of the other cardiovascular risk factors. The aim of this article was to analyse the effects of exercise on blood pressure (neuro-hormonal, hormonal and vessel effects), illustrate which are the influences of age and gender on exercise-induced reduction of blood pressure, indicate how much exercise (in terms of intensity, frequency and duration) is required to induce positive modification of blood pressure and evaluate current Italian criteria for sports ability in athletes with hypertension.