BACKGROUND AND PURPOSE:

• Exercise lowers systolic blood pressure (SBP)
• Often, exercise and medication are studied in isolation
• Naci et al. (British Journal of Sports Medicine, 2018) sought to compare exercise regimens and medications on systolic blood pressure (SBP)

METHODS:

• Systematic review and meta-analysis of randomized controlled trials (RCTs)
• Agents studied included
  • Angiotensin-converting enzyme inhibitors (ACE-I)
  • Angiotensin-2 receptor blockers (ARBs)
  • Beta-blockers
  • Calcium channel blockers (CCBs)
  • Diuretics
• The meta analysis also included RCTs testing the SBP-lowering effects of
  • Endurance | Dynamic resistance | Isometric resistance | Combined endurance and resistance exercise interventions
• Primary outcome: Difference in mean change from baseline SBP

RESULTS:

• 391 RCTs were included
  • Exercise interventions: 197 studies | 10,461 participants
  • Antihypertensive medications: 194 studied | 29,281 participants
  • No RCTs compared exercise directly against medication
• Mean SBP at baseline was considerably higher for medication studies vs exercise studies
  • Exercise intervention studies: 132 mmHg
  • Medication RCTs: >150 mmHg
• In a 10% random sample, risk of bias was higher in exercise RCTs
  • Lack of blinding | Incomplete outcome data
• Combining all populations
  • Antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions
  • Mean difference: −3.96 mmHg (95% CI, −5.02 to −2.91)
• Compared with controls, the following were effective in lowering baseline SBP
  • All types of exercise (including combination of endurance and resistance)
  • All classes of antihypertensive medications
• Among hypertensive populations
  • There were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications vs endurance or dynamic resistance exercise

CONCLUSION:

• Authors recognize that evidence was indirect as no studies compared exercise and medications head to head
• There was substantial heterogeneity in the RCTs included and therefore results should be interpreted with caution
• Both exercise and antihypertensive medications were effective in lowering systolic blood pressure
• The authors state

Many studied types and intensities of exercise interventions demonstrate modest but consistent reductions in SBP across diverse populations and settings

Learn More – Primary Sources:

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

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