We conclude from our review that exercise and weight loss offer some promise as non-pharmacologic treatments for hypertension. Unfortunately, most available studies are methodologically unsound, and the mechanisms by which exercise lowers blood pressure are not known. The use of randomized controlled designs, precise and comprehensive measurements of blood pressure and fitness, and clearly described interventions will be necessary if we are to decide whether exercise and diet lower blood pressure in patients with hypertension. We are now about to embark on such a study (see sidebar) in hopes that it will provide a clear answer to the question of whether these non-pharmacologic treatments can help the large numbers of Americans (and North Carolinians) with high blood pressure.