The Rising Role of Isometric Exercise in the Non-Pharmacological Management of Hypertension: A Review of Current Evidence and Clinical Guidelines

Abstract

Background: Arterial hypertension is a major modifiable cardiovascular risk factor, which remains one of the most significant challenges of contemporary medicine. Despite the availability of effective pharmacotherapy, non-pharmacological interventions, such as physical activity, constitute an important element of hypertension management.   Aim: This paper aims to systematise the knowledge regarding the beneficial effects of physical activity on blood pressure control in hypertensive patients, taking into account physiological aspects, the type of physical exertion, and its dosage based on the latest guidelines.   Material and methods: A systematized review of the literature was conducted using PubMed and Google Scholar databases, covering the period from 2013 to 2026. The inclusion criteria focused on large-scale meta-analyses, systematic reviews, and current clinical guidelines (ESC 2024, ESH 2023, PTNT 2024) evaluating the hypotensive efficacy of various physical exertion modalities in adult populations.   Results: Physical exercise reduces blood pressure by enhancing endothelial function (increased NO bioavailability, decreased ET-1), reducing oxidative stress and modulating autonomic nervous system. While aerobic exercise is the standard recommendation, recent data highlight isometric resistance training as the most effective intervention for lowering blood pressure, both systolic blood pressure (SBP) and diastolic blood pressure (DBP).   Conclusions: Physical activity overall is effective in lowering blood pressure, with the most pronounced effect in hypertensive patients. All exercise modalities - aerobic, isometric, resistance, combined training - help to maintain blood pressure control. Isometric exercise demonstrates the most favourable outcomes in hypertension management. A finding that should be taken into account when formulating recommendations for hypertensive patients in clinical practice.