Physical Activity, Blood Pressure, Blood Viscosity, and Hypertensive Heart Disease Risk: A Narrative Review

Hypertension is a major cardiovascular risk factor that can induce structural and functional cardiac alterations and ultimately contribute to the development of hypertensive heart disease (HHD). Persistently elevated blood pressure increases cardiac workload, while changes in blood viscosity may affect blood flow characteristics and vascular function. Physical activity is an established nonpharmacological component of hypertension management; however, its effects on blood viscosity and the risk of HHD progression warrant further investigation. This narrative review examines the effects of physical activity on blood pressure and blood viscosity and explores their relationship with mechanisms underlying HHD development. Relevant literature was identified through PubMed, scientific journal and publisher websites, and the reference lists of pertinent publications. Interventional and observational studies, clinical reviews, systematic reviews, and meta-analyses were synthesized descriptively and organized thematically. The available evidence suggests that aerobic exercise, dynamic resistance training, combined training, high-intensity interval training (HIIT), and isometric exercise may reduce resting blood pressure. Improvements in 24-hour ambulatory blood pressure have been reported more consistently with aerobic, combined, and HIIT interventions. Physical activity may also influence hemorheological parameters, including hematocrit, erythrocyte aggregation, and blood viscosity, although findings vary across studies. Exercise-related blood pressure control may alleviate the hemodynamic burden contributing to cardiac structural alterations. Nevertheless, evidence that changes in blood viscosity directly mediate the prevention of HHD remains limited. Physical activity is important for hypertension management, but further research is needed to clarify its effects on blood viscosity and HHD progression.