Performance
B · Reasonable confidenceExercise or blood pressure drugs: which lowers systolic pressure more
Subject: 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
What this means
Medications lowered systolic pressure somewhat more than exercise on average. In people with high blood pressure, no difference was seen between endurance or resistance training and most drug classes.
Huseyin Naci, Maximilian Salcher-Konrad, Sofia Dias, Manuel R Blum, Samali Anova Sahoo, David Nunan, John P A Ioannidis · 2019 · British Journal of Sports Medicine
What does this rating mean?
A solid systematic review with caveats, or consistent indications with a limited scope.
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.
Who this applies to
People in blood pressure trials. All drug trials and 56 exercise trials involved high blood pressure (140 mmHg or more).
Size of the research
391 trials: 197 on exercise (10 461 participants) and 194 on medication (29 281 participants).
What to keep in mind
No trial compared exercise directly with medication. Exercise trials more often had weaknesses, such as incomplete data and participants knowing which treatment they received.
Practical conclusion for REZA
Important for clients hoping to avoid medication for high blood pressure: exercise demonstrably lowers blood pressure, but REZA positions it as complementary to medication, not a replacement.
View method and source
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
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
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This information is general education about scientific research. It is not personal medical advice and does not replace diagnosis or treatment by a doctor or other healthcare professional. If you have symptoms, a medical condition or take medication, consult your GP or treating professional before changing your training or nutrition.