Do the Combined Blood Pressure Effects of Exercise and Antihypertensive Medications Add Up to the Sum of Their Parts? A Systematic Meta-review

Overview

Journal BMJ Open Sport Exerc Med

Specialty Orthopedics

Date 2021 Jun 30

PMID 34192008

Citations 11

Authors

Linda S Pescatello

Yin Wu

Simiao Gao

Jill Livingston

Bonny Bloodgood Sheppard

Ming-Hui Chen

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.

Data Sources: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.

Eligibility Criteria: Randomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.

Design: A systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.

Outcome: The BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.

Results: Twelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.

Conclusions: The combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.

Prospero Registration Number: The protocol is registered at PROSPERO CRD42020181754.

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Hayes P, Ferrara A, Keating A, McKnight K, ORegan A Rev Cardiovasc Med. 2024; 23(9):302.

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Charchar F, Prestes P, Mills C, Ching S, Neupane D, Marques F J Hypertens. 2023; 42(1):23-49.

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Ferreira M, Dos Santos Ferreira Silva M, Dias D, Bernardes N, Irigoyen M, De Angelis K PLoS One. 2023; 18(8):e0289715.

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Chang S, Chang Y, Jeng W, Wai J Sci Rep. 2023; 13(1):10358.

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