Failure of Exercise to Reduce Hypertension-Reply

In Reply. —We share the concern that the conclusions of our study not be misinterpreted. A direct comparison between our study and that of Keleman et al¹may not be appropriate because Keleman and colleagues did not include a nonexercising control group; therefore, it is impossible to separate the effects of exercise from other blood pressure lowering effects, such as regression to the mean, placebo, or nonspecific factors. We demonstrated the importance of controlling for study participation and attention for adequately interpreting treatment effects. A higher-intensity exercise program than the one we used may have been more effective at lowering blood pressure. Indeed, we reported a post hoc analysis suggesting that those patients with the greatest increase in aerobic fitness exhibited the greatest decrease in clinic diastolic blood pressure. Although Keleman et al claim that their subjects exercised at 80% to 85% of maximum, compared with 70% to 75%