A network meta-analysis of 391 randomized controlled trials (RCTs) confirmed modest but consistent reductions in systolic blood pressure (SBP) in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. The analysis included 197 RCTs of exercise interventions (10 461 participants, only 56 RCTs of 3805 participants with SBP≥140 mmHg) and 194 RCTs of antihypertensive medications (29 281 participants). No RCTs compared directly exercise against medications. In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference −3.96 mmHg). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of angiotensin-converting enzyme inhibitors, angiotensin-2 receptor blockers, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. The findings suggest that different types of exercise interventions appear to be as equally effective as most antihypertensive medications, and should be considered as viable alternatives to medications. It has been known that exercise is effective in lowering SBP in healthy adults and has indisputable benefits for cardiovascular disease and beyond. Source: https://bjsm.bmj.com/
