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Grand Rounds

How Does Exercise Compare to Hypertension Drugs to Treat High Blood Pressure?

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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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Related ObG Topics:

Is Midlife Cardiovascular Fitness Associated with Reduced Risk for Dementia?
How Does Exercise Affect Health Postmenopause?
The Relationship between Exercise and Heart Disease – Does Genetics Matter?

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