Exercise interventions are as effective as many antihypertensive medicines in reducing systolic blood pressure (SBP) in people with hypertension, according to the results of a network meta-analysis published in the British Journal of Sports Medicine (18 December 2018)
The researchers looked at results from 197 randomised controlled trials evaluating exercise interventions, which were divided into four categories — endurance, dynamic resistance, isometric resistance and a combination of endurance and dynamic resistance — and 194 evaluating antihypertensive medications. The trials involved nearly 40,000 participants.
They found that, overall, antihypertensive medicines were associated with greater reductions in SBP than exercise interventions (mean difference -3.96 mmHg, 95% credible interval -5.02 to -2.91). But, when they restricted the analyses to trials that only included hypertensive individuals, endurance and dynamic resistance exercise were as effective as angiotensin converting enzyme inhibitors, angiotensin-2 receptor blockers, beta blockers and diuretics in reducing SBP.
However, the team noted that the effect of exercise interventions on SBP remained understudied in relation to commonly used medicines. Only 56 exercise intervention trials included individuals with hypertension.
“The SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications,” they wrote.
“Generalisability of these findings to real-world clinical settings should be further evaluated.”
 Naci H, Salcher-Konrad M, Dias S et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br J Sports Med 2018. doi: 10.1136/bjsports-2018-099921