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.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 30563873 · doi:10.1136/bjsports-2018-099921
What was done
A random-effects network meta-analysis compared the effects of exercise regimens (endurance, dynamic resistance, isometric resistance, combined) and antihypertensive medications (ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, diuretics) on systolic blood pressure (SBP). Data were drawn from 391 randomized controlled trials (197 exercise RCTs with 10,461 participants; 194 medication RCTs with 29,281 participants) identified from Medline and Cochrane Library records up to September 2018. The primary outcome was the difference in mean change from baseline SBP between treatments (measured in mmHg) with 95% credible intervals (CrI).
What was found
Across combined populations, antihypertensive medications achieved greater reductions in baseline SBP compared with exercise interventions (mean difference -3.96 mmHg, 95% CrI -5.02 to -2.91). Compared with control, all exercise types and all medication classes lowered baseline SBP. Among hypertensive populations (56 exercise trials, n = 3,508), there were no detectable differences in SBP-lowering effects between endurance or dynamic resistance exercise and ACE inhibitors, ARBs, beta-blockers, or diuretics.
Why it matters
Among hypertensive individuals, structured exercise achieves blood pressure reductions comparable to standard first-line medications in indirect comparisons. This supports structured exercise interventions as an effective non-pharmacological strategy for blood pressure management.
Limits
No randomized trials directly compared exercise against medications; all comparative conclusions rely on indirect network meta-analysis. Only 56 of 197 exercise trials included hypertensive participants, resulting in far fewer evaluated hypertensive individuals for exercise (3,508) than for medications (29,281). Exercise trials had a higher risk of bias due to lack of blinding and incomplete outcome data, and small-study effects were present in both literatures.
Cited by
- context Meta-analyses demonstrate that exercise is as effective as pharmaceutical drugs in normalizing blood pressure.