Hyperinsulinemia, lipid abnormalities, and impaired fibrinolytic capacity may accompany hypertension, and comprise the metabolic cardiovascular syndrome. They are all independent risk factors for coronary artery disease. Lifestyle modifications can reduce the coronary artery risk. Physical activity has been shown to improve insulin sensitivity, reduce hypertriglyceridemia, improve fibrinolytic capacity, and reduce the blood pressure. A sedentary lifestyle is associated with increased mortality compared to a physically active lifestyle. Hypertensive patients, who often have other atherothrombogenic risk factors, should be encouraged to undertake physical activity as an adjuvant to other nonpharmacological interventions as well as to pharmacological treatment.