Blood pressure reduction through stair-walking, rationale and design of the HYPERWALK trial

Abstract Background Lifestyle interventions, such as physical activity (PA), are critical for hypertension management but are rarely implemented despite established benefits. The HYPERWALK trial aims to evaluate the impact of stair walking and brisk walking, supported by remote monitoring and individualized goals, on systolic blood pressure (SBP). Methods HYPERWALK is a six-month, three-arm, multicenter randomized controlled trial conducted in the Stockholm region. Adults with hypertension, a sedentary lifestyle (150 minutes moderate-intensity PA per week), and a body mass index 27–40 kg/m² will be recruited from primary and specialized care. Following a one-week baseline activity assessment, 450 participants will be randomized, stratified by age and sex, into either 1) stair walking, 2) brisk walking, or 3) passive control. The active groups will aim to double PA levels, with the stair-walking group engaging in ≥200 steps/day (37.5 minutes) and ≥75 minutes walking per week, and the brisk walking group achieving ≥150 minutes of walking per week. Stair walking, a vigorous-intensity activity, corresponds to twice the time of moderate-intensity activity, such as brisk walking, which explains shorter target times listed for the stair-walking group. The control group will receive standard care without specific activity goals. Group allocation will be blinded to analysts and assessors. Outcomes: The primary outcome is the change in SBP at six months, comparing stair walking versus brisk walking, and active interventions versus control, with 80% power to detect a 4 mmHg SBP difference with 50 participants per arm. Secondary outcomes include cardiovascular risk markers (lipid profile, glycaemic status, insulin resistance) and adherence to guideline-recommended PA levels. Sub-studies will assess arrhythmia burden, lifestyle habits, and adherence predictors. Discussion: HYPERWALK will evaluate stair walking as a time-efficient, cost-effective PA strategy for reducing SBP in hypertensive individuals. The trial aims to provide actionable data to overcome challenges in implementing lifestyle interventions.