Effects of exercise-related interventions on blood pressure and related variables among individuals with hypertension: a systematic review and meta-analysis

Abstract

Hypertension is a leading contributor to global cardiovascular disease burden and premature mortality. Although pharmacological treatment is effective, long-term Blood Pressure (BP) control remains suboptimal for many patients, highlighting the importance of non-pharmacological strategies such as physical exercise. This systematic review and meta-analysis aimed to evaluate the effectiveness of exercise training interventions for improving BP outcomes among adults with hypertension. While a limited number of included randomized controlled trials involved participants with prehypertension, the review primary focus was hypertension management. A systematic literature search was conducted across five electronic databases (Scopus, AMED, MEDLINE, PUBMED, and CINAHL) to identify relevant clinical trials. A small number of trials involving participants with prehypertension or stage 1 hypertension were retained where they met the predefined eligibility criteria and contributed to the overall evidence regarding elevated BP management. Methodological quality of the included studies was assessed using the PEDro scale. Data were synthesized using random-effects meta-analysis, and pooled effects were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Statistical heterogeneity was evaluated using the I 2 statistic. Meta-analyses were conducted using Review Manager 5. Structured Narrative synthesis was performed where meta-analysis was not feasible. A total of 26 studies that recruited 1,576 participants met the inclusion criteria and were included in the review. Majority of the studies were of moderate-to-good methodological quality (∼70%). Aerobic training consistently produced statistically significant and clinically meaningful reductions in both SBP (SMD: −0.97; 95% CI −1.46 to −0.47; p  = 0.0001) and DBP (SMD: −1.55; 95% CI −2.19 to −0.90; p  < 0.00001). Combined aerobic and resistance training also resulted in significant reductions in SBP (SMD: −1.11; 95% CI: −2.11 to −0.11; p  = 0.03) and DBP (SMD: −1.25; 95% CI: −2.24 to −0.27; p  = 0.01), suggesting potential additive or complementary effects of multimodal exercise interventions. Resistance training alone demonstrated a significant and large reduction in DBP but showed inconsistent and non-significant effects on SBP. In addition to blood pressure reduction, several studies reported improvements in secondary outcomes, including cardiorespiratory fitness, heart rate variability, body composition, inflammatory markers, physical performance, and quality of life. However, substantial between-study heterogeneity was observed across most pooled analyses, warranting cautious interpretation of the findings. The available evidence suggests that aerobic exercise, either alone or combined with resistance training, is associated with some beneficial reductions in systolic and diastolic blood pressure among individuals with hypertension.