Additional blood-pressure-lowering effect of exercise in adults on stable antihypertensive medication: a systematic review and meta-analysis of randomised controlled trials.
Paula Etayo-Urtasun, Mikel L Sáez de Asteasu, Mikel Izquierdo
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In 30 seconds
This systematic review and meta-analysis pooled randomised controlled trials of exercise in adults taking stable antihypertensive medication. Across 48 studies involving 2085 participants, exercise compared with usual care was associated with lower office systolic blood pressure (mean difference −7.9 mmHg; 95% CI −10.3 to −5.6) and diastolic blood pressure (−4.4; −5.8 to −3.1). Several other blood-pressure and cardiovascular risk measures improved, but effects varied across outcomes. The authors judged certainty low to moderate for most estimates and noted substantial heterogeneity and risk of bias.
Key findings
- Exercise reduced office systolic blood pressure by −7.9 mmHg (95% CI −10.3 to −5.6) versus usual care on stable medication.
- Office diastolic blood pressure was lower by −4.4 (95% CI −5.8 to −3.1) with exercise.
- Improvements were also reported in office mean blood pressure, selected ambulatory diastolic and nighttime measures, body weight, BMI, HDL-c, triglycerides, fasting glucose, and cardiorespiratory fitness.
- No exercise modality was significantly superior to another for any outcome.
Why it matters
The findings suggest structured exercise may provide additional blood-pressure lowering and broader risk-factor benefits alongside stable antihypertensive therapy. However, effects were not consistent across ambulatory blood-pressure measures, and the evidence is not strong enough to assume a uniform response or to infer that medication can be reduced. The results support considering exercise as part of hypertension management while recognising uncertainty in the estimates.
What to keep in mind
Heterogeneity was substantial for office blood-pressure estimates, and risk of bias contributed to low-to-moderate certainty for most outcomes. Evidence quality was low to very low for ambulatory systolic blood pressure.