Background: Physical activity has been shown to be beneficial for the prevention and management of hypertension. In the general population, physical activity has been shown to decrease mortality. Purpose: The purpose of this systematic review was to identify and synthesize the literature examining the impact of physical activity on mortality in patients with high blood pressure (BP). Methods: An extensive search was conducted by two independent authors using Medline, Embase and Cochrane Library electronic databases (between 1985 and January 2012) and manual search from the reference list of relevant articles. Inclusion criteria were as follows: longitudinal design with minimum 1-year follow-up; hypertensive status of the cohort was indicated; and BP, physical activity, and mortality were measured. Results: Six articles evaluating a combined total of 48 448 men and 47 625 women satisfied the inclusion criteria. Cardiovascular and/or all-cause mortality were shown to be inversely related to physical activity in all studies. For example, patients with high BP who participated in any level of physical activity had a reduced risk (by 16–67%) of cardiovascular mortality, whereas a greater than twofold increase in risk of mortality was noted in nonactive individuals. However, activity classification and parameters, such as frequency, duration, intensity, and volume, as well as BP status, were not consistent across studies. Conclusions: Regular physical activity is beneficial for reducing mortality in patients with high BP. More research is needed to establish the impact of specific kinds of physical activity and whether any differences exist between sexes.