Condition background

Pre-hypertension is a condition characterised by elevated blood pressure (BP) levels, defined as a systolic blood pressure (SBP) of 120–139 mmHg or a diastolic blood pressure (DBP) of 80–89 mmHg (Chobanian et al., 2003). It reflects early, asymptomatic dysregulation of cardiovascular control mechanisms, including increased total peripheral resistance, reduced arterial elasticity and altered autonomic balance (Carretero and Oparil, 2000). 

Around one-third of adults have hypertension (WHO, 2025), while a further 36% fall within the pre-hypertensive range (Guo et al., 2011). Vasan et al. (2001) demonstrated that 37.3% of adults with high-normal BP progressed onto hypertension within 4 years. Furthermore, evidence displays a continuous relationship between BP and cardiovascular mortality risk, with risk doubling for every 20 mmHg SBP increase above 115 mmHg (Lewington, 2002). 

Key modifiable risk factors include physical inactivity, obesity, high salt intake, poor sleep and chronic stress. In contrast, non-modifiable risk factors include age, sex, ethnicity and genetic predisposition (WHO, 2025). Importantly, pre-hypertension is highly responsive to lifestyle interventions, presenting a key window to prevent progression towards hypertension (Chobanian et al., 2003; Vasan et al., 2001). 

Intervention evidence

Across randomised trials and meta-analyses, regular moderate-intensity aerobic exercise (60-75% max heart rate), such as brisk walking and cycling, has been shown to reduce SBP by 7–12 mmHg and DBP by 4–6 mmHg in those with hypertension, making it comparable to many antihypertensive drugs (Cao et al., 2019; Jabbarzadeh Ganjeh et al., 2024; Saco-Ledo et al., 2020). 

A dose–response meta-analysis by Jabbarzadeh Ganjeh et al. (2024) in individuals with hypertension found that SBP and DBP decreased by approximately 1.78 mmHg and 1.23 mmHg respectively for every additional 30 minutes of aerobic exercise performed per week, with reductions plateauing at around 150 minutes. These findings align with CMO physical activity guidelines (DHSC, 2019). 

High-intensity interval training and dynamic resistance training have also been shown to cause clinically significant BP reductions in those with pre-hypertension and hypertension (Edwards et al., 2023). However, these interventions can cause greater inter-workout BP spikes than other modalities (Feng et al., 2025; Millenaar et al., 2020), which may be associated with an increased long‑term cardiovascular and all‑cause mortality risk (Perry et al., 2021). 

A randomised controlled trial by Taylor et al. (2019) investigated 24 unmedicated adults with stage 1 hypertension, who completed 4 weeks of home-based isometric wall‑squat training (four 2‑min squat bouts per session, three times per week) and a 4‑week control period, separated by a 3‑week washout. Compared with the control group, isometric training produced substantial office SBP and DBP reductions of 12.4 mmHg and 6.2 mmHg respectively, reaching clinically significant levels. Additional cardiovascular benefits were observed, including reductions in inflammatory markers, increased stroke volume, and improved autonomic control. 

Similarly, Ogbutor et al. (2019) demonstrated comparable findings in a larger clinical sample of 400 adults with pre-hypertension, who completed a 24-day isometric handgrip training programme consisting of two 2-minute 30% maximum voluntary contractions on a hand grip dynamometer separated by 5-minute rest periods. At the end of the intervention, SBP and DBP decreased by 7.48 mmHg and 6.41 mmHg respectively. However, the short duration of both interventions (Ogbutor et al., 2019; Taylor et al., 2019) limits conclusions about long-term sustainability.

Although research on the role of isometric exercise in preventing the progression of pre-hypertension is limited and further large-scale randomised controlled trials are required, existing evidence suggests that it may be one of the most effective exercise modalities (De Oliveira et al., 2022; Edwards et al., 2023). If handgrip exercises alone are truly effective at lowering BP it could be prescribed as an alternative exercise approach for those who are not able to perform isometric leg exercises or other exercise interventions due to mobility limitations or underlying health conditions (De Oliveira et al., 2022; Ogbutor et al., 2019). This is particularly practical, as people with severe mobility limitations may be more likely to be pre-hypertensive (Saha et al., 2024), likely due to a lack of physical activity (Zhu et al., 2019).

A recent meta analysis by Edwards et al. (2023) reviewed 270 randomised control trials, and found that combined aerobic plus dynamic resistance training produces greater reductions in resting SBP than any other exercise modality alone, except for isometric exercises. It is therefore plausible that engaging in multiple different exercise modalities is most effective at reducing BP in those with pre-hypertension by targeting complementary and/or differing physiological pathways (Kodil et al., 2023).

The blood pressure–lowering effects observed across different exercise modalities are mediated through multiple physiological adaptations, including improved endothelial function, reduced arterial stiffness, enhanced autonomic regulation, modulation of renal function, improved body composition and favourable cardiac remodelling (Edwards et al., 2023; Ganjeh et al., 2024; Saco-Ledo et al., 2020).

Resource design justification

The resource is aimed towards bed-bound individuals with pre-hypertension who are in the pre-contemplation stage, where awareness of realistic physical activity options is low. The communication approach therefore emphasises making messages feel personally relevant, emotionally reassuring, and effort-light (Velicer et al., 1998). This approach also aligns with the Make Every Contact Count initiative by using brief, accessible health messaging to encourage small, achievable behaviour change (Nichol et al., 2024). In addition, plain English, short sentences and a supportive, non-directive tone is used throughout, in accordance with UK health literacy and patient communication guidance (NHS England, 2016).

In developing this poster, the three domains of the Physical Activity Messaging Framework proposed by Williamson et al. (2021) were addressed to maximise clarity, relevance and adherence. The aim and pathway component was addressed by identifying bed-bound individuals and drawing attention to the frequently under-recognized prevalence of pre-hypertension, and its health consequences. The message content component was used to implement clear, evidence‑informed guidance on how regular isometric handgrip exercise can prevent the progression of pre-hypertension in a safe and accessible manner. The message format and delivery component is covered by tailoring the poster to the target audience, with information presented in an organised, visually engaging layout to support comprehension, recall and practical uptake.

The COM-B model underpins the poster to ensure that the target audience will understand the message, but also feel willing and able to act on it (Michie et al., 2011; Howlett et al., 2019). It builds capability by simply explaining what pre-hypertension is, why it matters, and giving clear step‑by‑step instructions for isometric handgrip exercises. It creates opportunity by emphasising that the exercise needs minimal equipment or assistance and can be performed while bed‑bound. It strengthens motivation by highlighting the risks of progression to hypertension, and using encouraging, reassuring wording and visuals to develop positive associations and self-efficacy (Timkova et al., 2024). 

Reference list

Cao, L., Li, X., Yan, P., Wang, X., Li, M., Li, R., Shi, X., Liu, X. and Yang, K., 2019. The effectiveness of aerobic exercise for hypertensive population: a systematic review and meta‐analysis. The Journal of Clinical Hypertension, 21(7), pp.868-876.

Carretero, O.A. and Oparil, S., 2000. Essential hypertension: part I: definition and etiology. Circulation, 101(3), pp.329-335.

Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo Jr, J.L., Jones, D.W., Materson, B.J., Oparil, S., Wright Jr, J.T. and Roccella, E.J., 2003. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama, 289(19), pp.2560-2571.

de Oliveira, P.C., Lehnen, A.M. and Waclawovsky, G., 2022. Effect of isometric exercise on blood pressure in prehypertensive and hypertensive individuals: protocol for a systematic review and meta-analysis of randomized controlled trials. Systematic Reviews, 11(1), p.100.

Department of Health and Social Care (2019) UK Chief Medical Officers’ physical activity guidelines. London: DHSC. Available at: https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report (Accessed: 25/11/25).

Edwards, J.J., Deenmamode, A.H., Griffiths, M., Arnold, O., Cooper, N.J., Wiles, J.D. and O'Driscoll, J.M., 2023. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. British journal of sports medicine, 57(20), pp.1317-1326.

Feng, W., Yu, W.L., Zhao, Z., Guo, Y.D., Zhou, X.J., Zhai, K.Q., Liu, X. and Yan, Z.W., 2025. Acute effects of high-intensity interval exercise and moderate-intensity continuous training on arterial stiffness and endothelial function in hypertension: A crossover trial. Scientific Reports, 15(1), p.37086.

Guo, X., Zou, L., Zhang, X., Li, J., Zheng, L., Sun, Z., Hu, J., Wong, N.D. and Sun, Y., 2011. Prehypertension: a meta-analysis of the epidemiology, risk factors, and predictors of progression. Texas heart institute journal, 38(6), p.643.

Howlett, N., Schulz, J., Trivedi, D., Troop, N. and Chater, A., 2019. A prospective study exploring the construct and predictive validity of the COM-B model for physical activity. Journal of health psychology, 24(10), pp.1378-1391.

Jabbarzadeh Ganjeh, B., Zeraattalab-Motlagh, S., Jayedi, A., Daneshvar, M., Gohari, Z., Norouziasl, R., Ghaemi, S., Selk-Ghaffari, M., Moghadam, N., Kordi, R. and Shab-Bidar, S., 2024. Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials. Hypertension research, 47(2), pp.385-398.

Kodli, U., 2023. Physiological adaptations to endurance, strength and interval training: implications for health and performance. Int J Phys Educ Sports Health, 10, pp.350-6.

Lewington, S., Clarke, R., Qizilbash, N., Peto, R. and Collins, R., 2002. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet, 360(9349), pp.1903–1913.

Michie, S., Van Stralen, M.M. and West, R., 2011. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), p.42.

Millenaar, D., Boehm, M. and Mahfoud, F., 2020. Risk prediction with blood pressure during physical activity: A METter of exercise?. European Journal of Preventive Cardiology, 27(9), pp.975-977.

NHS England (2016) Accessible Information Standard. London: NHS England. Available at: https://www.england.nhs.uk/accessible-information-standard/ (Accessed: 26 February 2026).

Nichol, B., Kemp, E., Wilson, R., Rodrigues, A.M., Hesselgreaves, H., Robson, C. and Haighton, C., 2024. Establishing an updated consensus on the conceptual and operational definitions of Making Every Contact Count (MECC) across experts within research and practice: an international Delphi Study. Public Health, 230, pp.29-37.

Ogbutor, G.U., Nwangwa, E.K. and Uyagu, D.D., 2019. Isometric handgrip exercise training attenuates blood pressure in prehypertensive subjects at 30% maximum voluntary contraction. Nigerian Journal of Clinical Practice, 22(12), pp.1765-1771.

Perry, B.G. and Lucas, S.J., 2021. The acute cardiorespiratory and cerebrovascular response to resistance exercise. Sports medicine-open, 7(1), p.36.

Saha, A., Muhammad, T., Mandal, B., Govil, D. and Ali, W., 2024. Moderating role of functional/mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India. Preventive Medicine Reports, 38, p.102589.

Saco‐Ledo, G., Valenzuela, P.L., Ruiz‐Hurtado, G., Ruilope, L.M. and Lucia, A., 2020. Exercise reduces ambulatory blood pressure in patients with hypertension: a systematic review and meta‐analysis of randomized controlled trials. Journal of the American Heart Association, 9(24), p.e018487.

Taylor, K.A., Wiles, J.D., Coleman, D.A., Leeson, P., Sharma, R. and O’Driscoll, J.M., 2019. Neurohumoral and ambulatory haemodynamic adaptations following isometric exercise training in unmedicated hypertensive patients. Journal of hypertension, 37(4), pp.827-836.

Timkova, V., Minarikova, D., Fabryova, L., Buckova, J., Minarik, P., Katreniakova, Z. and Nagyova, I., 2024. Facilitators and barriers to behavior change in overweight and obesity management using the COM-B model. Frontiers in Psychology, 15, p.1280071.

Velicer, W.F., Prochaska, J.O., Fava, J.L., Norman, G.J. and Redding, C.A., 1998. Detailed overview of the transtheoretical model. Homeostasis, 38(5–6), pp.216-233.

Vasan, R.S., Larson, M.G., Leip, E.P., Evans, J.C., O'Donnell, C.J., Kannel, W.B. and Levy, D., 2001. Impact of high-normal blood pressure on the risk of cardiovascular disease. New England journal of medicine, 345(18), pp.1291-1297.

Williamson, C., Baker, G., Tomasone, J.R., Bauman, A., Mutrie, N., Niven, A., Richards, J., Oyeyemi, A., Baxter, B., Rigby, B. and Cullen, B., 2021. The physical activity messaging framework (PAMF) and checklist (PAMC): international consensus statement and user guide. International Journal of Behavioral Nutrition and Physical Activity, 18(1), p.164.

World Health Organization (2025). Hypertension fact sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/hypertension (Accessed: 23/2/2026).

Zhu, Z., Feng, T., Huang, Y., Liu, X., Lei, H., Li, G., Deng, D., Zhang, N. and Huang, W., 2019. Excessive physical activity duration may be a risk factor for hypertension in young and middle-aged populations. Medicine, 98(18), p.e15378.