Isometric activity has previously been associated with exaggerated hypertensive responses, but recent work has suggested isometric handgrip activity may become a new tool in the nonpharmacological treatment of high BP. Current thinking varies with respect to the preferred type of physical activity for BP historically endurance training has been preferred. Isometric exertion involves sustained contraction against an immovable load or resistance with no or minimal change in length of the involved muscle group. Dynamic resistance training involves concentric and/or eccentric contractions of muscles while both the length and the tension of the muscles change. According to the type of muscle contraction, resistance training can be divided into 2 major subgroups: “dynamic” versus “static or isometric” resistance training. Resistance training is activity in which each effort is performed against a specific opposing force generated by resistance and is designed specifically to increase muscular strength, power, and/or endurance. Dynamic aerobic endurance exercise involves large muscle groups in dynamic repetitive activities that result in substantial increases in heart rate and energy expenditure. As such, the optimal exercise training prescription remains unclear. The effects of exercise training may vary with different exercise modalities (eg, endurance training or resistance exercise) and dose parameters, specifically program length, session duration, frequency, and workload or intensity. The American College of Sports Medicine position stand on exercise and HTN 6 recommends dynamic aerobic endurance training for at least 30 minutes daily, preferably supplemented with dynamic resistance exercise. 4 There is Class I, Level B evidence that 150 minutes of weekly physical activity offers an alternative that may be used to complement antihypertensive medication. 3 Both national and international treatment guidelines for the primary and secondary prevention of HTN recommend nonpharmacological lifestyle modifications as the first line of therapy, including increasing levels of physical activity. 2 Although antihypertensive medications are efficacious and most have minimal side effects, the economic health care costs are increasing. 1 HTN, or the chronic elevation of resting arterial blood pressure (BP) >140 mm Hg systolic (SBP) and/or 90 mm Hg diastolic BP (DBP), remains one of the most significant modifiable risk factors for cardiovascular disease (eg, coronary artery disease, stroke, heart failure). BP reductions after dynamic resistance training were largest for prehypertensive participants (−4.0 /−3.8 mm Hg) compared with patients with hypertension or normal BP.Ĭurrent National Health and Nutrition Examination Survey data suggest that the prevalence of hypertension (HTN) varies with ethnicity and gender but lies between 25% and 43% in the US population, with an upward trend during the past 3 National Health and Nutrition Examination Surveys. BP reductions after endurance training were greater ( P<0.0001) in 26 study groups of hypertensive subjects (−8.3 /−5.2 mm Hg) than in 50 groups of prehypertensive subjects (−2.1 /−1.7 ) and 29 groups of subjects with normal BP levels (−0.75 /−1.1 ). Reductions in diastolic BP ( DBP) were observed after endurance (−2.5 mm Hg ), dynamic resistance (−3.2 mm Hg ), isometric resistance (−6.2 mm Hg ), and combined (−2.2 mm Hg ) training. Systolic BP ( SBP) was reduced after endurance (−3.5 mm Hg ), dynamic resistance (−1.8 mm Hg ), and isometric resistance (−10.9 mm Hg ) but not after combined training. We included 93 trials, involving 105 endurance, 29 dynamic resistance, 14 combined, and 5 isometric resistance groups, totaling 5223 participants (3401 exercise and 1822 control). Random effects models were used for analyses, with data reported as weighted means and 95% confidence interval. Randomized controlled trials lasting ≥4 weeks investigating the effects of exercise on BP in healthy adults (age ≥18 years) and published in a peer‐reviewed journal up to February 2012 were included. Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).