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

Methodology

Meta-analysis

Population

391 RCTs: 197 exercise trials (10,461 participants) and 194 antihypertensive medication trials (29,281 participants). Only 56 exercise trials (3,508 individuals) included hypertensive participants (≥140 mmHg)

Intervention

Endurance, dynamic resistance, isometric resistance and combined endurance-plus-resistance exercise interventions compared with ACE inhibitors, ARBs, beta-blockers, calcium channel blockers and diuretics via random-effects network meta-analysis

Findings

No RCTs directly compared exercise against medication. When all populations were combined, antihypertensive medications achieved greater systolic blood pressure reductions than exercise, but all exercise types significantly reduced blood pressure versus control. The exercise trials largely enrolled non-hypertensive participants, biasing the comparison — exercise should be positioned as complementary to, not a substitute for, pharmacotherapy.

Outcome measures

Difference in mean change from baseline systolic blood pressure (mmHg) with 95% credible intervals

Limitations

No direct head-to-head exercise-vs-medication trials exist, so the entire comparison is indirect; a major population mismatch systematically disadvantaging exercise; risk of bias was higher in exercise RCTs than in medication RCTs, primarily due to lack of blinding.

Original source

DOI: 10.1136/bjsports-2018-099921 · PMID: 30563873