Exercise Found to Rival Meds at Lowering Blood Pressure
For people with hypertension, an exercise program may lower blood pressure (BP) almost as effectively as antihypertensive medications, conclude the authors of a meta-analysis of randomized controlled trials (RCTs).
In an analysis of studies that included almost 40,000 patients, evidence-based medical therapy was associated with a greater drop in systolic BP compared to interventions that consisted of exercises for endurance, dynamic resistance, isometric resistance, or both endurance and resistance. But the difference in average BP change was only 3.96 mmHg.
There was no significant difference in the extent to which BP was reduced in an analysis limited to persons with a baseline systolic BP ≥140 mmHg. The study by Huseyin Naci, PhD, London School of Economics and Political Science, United Kingdom, and colleagues was published online December 18 in the British Journal of Sports Medicine.
“These findings could be used to examine and improve the evidence base supporting exercise recommendations,” particularly in light of the fact that recommendations “are primarily based on observational evidence and highly variable across different settings,” the group writes.
On the other hand, the authors highlight the wide variation in sample sizes and methods used in the exercise RCTs. These variations “highlight the need for a more standardized approach to the design, conduct, analysis and reporting of exercise trials,” the investigators state.
Their meta-analysis included 194 studies of the impact of exercise interventions on systolic BP and 197 antihypertensive drug trials reported from 2012 to 2018.
“We need to be cautious about what types of data we’re looking at here,” especially inasmuch as not one RCT compared exercise and medications directly, Naci told theheart.org | Medscape Cardiology.
“We’re just starting to scratch the surface by providing this piece of information,” he said. “We may want to think about nondrug interventions as potential alternatives to drugs in some cases, and blood-pressure lowering seems to be a good start.”
Naci pointed out that recent guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) lower the threshold for stage 1 hypertension from 140 mmHg to 130 mmHg, which “may result in more people being prescribed antihypertensive medication.”
It’s possible, he said, “that some of those individuals may be indicated instead for exercise interventions. But this is very much something that patients should discuss with their doctors, one on one, thinking about all the constraints, as well as their preferences and values and what they want to achieve with their therapies.”
The researchers stress that “it would be very important to evaluate the comparative systolic BP-lowering effects of exercise and medication interventions.”
Guidelines such as those from the AHA/ACC underline the importance of exercise and other lifestyle interventions in managing and treating hypertension, but they tend to consider pharmacologic and nonpharmacologic interventions separately.
Br J Sports Med. Published online December 18, 2018. Full text