Hypertension is a significant health concern. Hypertension leads to compensatory pathologic hypertrophy and impaired cardiac function. Lifestyle modifications such as exercise are encouraged for hypertensive patients. Some studies have shown that exercise training can reverse pathological hypertrophy. Conversely, studies on animal models of hypertension have shown increased cardiac growth with exercise training. Despite the further induction of hypertrophy, exercise training seems protective against cell death and may increase cardiomyocyte proliferation, leading to a putative phenotype. One of the hallmark beneficial effects of exercise in hypertension is an improvement in myocardial β adrenergic responsiveness. The focus of this paper is to discuss how exercise training impacts cardiac remodeling and function in the hypertensive heart with specific reference to β adrenergic signaling. 1. Hypertension and Blood Pressure with Exercise Hypertension is a significant health concern, as it afflicts over 65 million individuals in the United States [1] and 1 billion people worldwide [2]. The residual lifetime risk for developing hypertension in middle and older ages is 90% [1, 3] and its prevalence has increased by 30% over the last decade [1]. Moreover, with the number of older individuals on the rise, the prevalence of hypertension is certain to increase. This is a significant issue in the epidemiology of cardiovascular disease, as hypertension increases the risk of ischemic heart disease, stroke, and heart failure [1]. A key initiative in offsetting the consequences of hypertension is preventing or attenuating its negative sequelae in the first place. In this regard, several expert joint panel reports support the idea of lifestyle modifications such as exercise/physical activity, diet, and smoking cessation in the initial management of hypertension [1]. The effects of chronic exercise training on blood pressure have been well studied. In normotensive subjects, there is an approximate 3-4？mmHg reduction in resting systolic and diastolic blood pressure following training [4–6]. In hypertensive subjects, the reduction in blood pressure is even greater, that is, 6-7？mmHg reduction after training [6–9]. Aerobic exercise training has also been shown to reduce blood pressure during exercise [7, 10] and ambulation [7, 11, 12]. Acute aerobic exercise has even been shown to cause a relative hypotension during the postexercise recovery phase [13]. Thus the overall reduction in blood pressure with aerobic exercise training attenuates afterload on the heart and is the
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