High blood pressure affects more than 1.4 billion adults globally, yet nearly half remain undiagnosed, earning hypertension its label as a “silent killer,” according to the World Health Organization. New research led by University of California, San Francisco suggests that insufficient physical activity may be a major contributor to high blood pressure in midlife, and that current exercise guidelines may not go far enough to protect long-term heart health.
Longitudinal Study
Published in the American Journal of Preventive Medicine, the study followed more than 5,000 adults over nearly 30 years. Researchers found that engaging in around five hours of moderate exercise per week – double the current recommendation of 150 minutes – was associated with a significantly lower risk of developing hypertension, particularly when sustained through midlife.
The study drew on data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, tracking 5,115 participants aged 18 to 30 at baseline from four U.S. cities. Over time, researchers monitored exercise habits, blood pressure, weight, smoking and alcohol use. Hypertension was defined using modern clinical thresholds of 130/80 mmHg or higher.
Across all racial and gender groups, physical activity levels dropped sharply between the ages of 18 and 40, while rates of hypertension rose steadily with age. Only about 18% of participants consistently exercised for at least five hours per week during early adulthood. This group had an 18% lower risk of developing hypertension compared with those who exercised less, with even stronger protection among those who maintained high activity levels later in life.
Routine Health
Senior author Kirsten Bibbins-Domingo emphasised that maintaining higher levels of physical activity during young adulthood may be particularly important for preventing hypertension later on. Lead author Jason Nagata noted that nearly half of young adults failed to meet even minimum activity levels.
The authors argue that physical activity should be treated as a routine health metric, alongside blood pressure and cholesterol, and that interventions should focus on schools, workplaces and communities, especially during the transition into adulthood, when opportunities for movement often decline.
