Hypertension

Hypertension is high blood pressure, classified in adults as systolic pressure of 130 mmHg or higher or diastolic pressure of 80 mmHg or higher.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 564.} Normal blood pressure is below 120/80 mmHg; elevated pressure is 120 to 129 systolic with diastolic below 80.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 564.} Stage 1 hypertension is 130 to 139 systolic or 80 to 89 diastolic, and stage 2 is 140 systolic or 90 diastolic and above.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 564.} When the numbers fall in different categories, the higher category counts; diagnosis rests on an average of readings a physician takes on separate occasions.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 564.}

High blood pressure is a major risk factor for heart disease, stroke and kidney failure.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 675.} The NSCA text reports that about a third of Americans have it and close to a third of those don’t know.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 675.} Taking blood pressure during client screening lets trainers suspect a problem, but diagnosis and treatment are outside their scope of practice.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 675.}

In practice

• Clients with controlled hypertension can train with few restrictions, using free weights, machines, bands and aerobic work.^{3Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 566.} In a meta-analysis, long-term resistance and aerobic training lowered resting pressure by roughly 4 to 5 mmHg systolic and 3 to 4 mmHg diastolic.^{3Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 566.}
• Avoid a prolonged Valsalva maneuver (more than 2 seconds), progress gradually, especially intensity, and use an extended cooldown.^{3Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 566.}
• Stop the session if pressure reaches 220 mmHg systolic or 105 mmHg diastolic.^{3Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 566.}
• Clients whose pressure isn’t controlled should see their physician before exercising.^{3Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 566.}

Where sources differ

The NSCA says clients with stage 1 or higher readings shouldn’t begin a program until their pressure is controlled and they have medical clearance.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 564.} ACSM’s screening treats hypertension as a cardiovascular risk factor rather than a cardiac disease.^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 140.} Its clearance advice varies with blood pressure level, cardiovascular risk, current activity, planned intensity and symptoms.^{5Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 679.}