Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review

Abstract

ObjectiveTo compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.Data sourcesPubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.Eligibility criteriaRandomised 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.DesignA systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.OutcomeThe BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.ResultsTwelve 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.ConclusionsThe combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.PROSPERO registration numberThe protocol is registered at PROSPERO CRD42020181754.

Endurance Exercise Training reduces Blood Pressure according to the Wilder’s Principle

“…Thus, our data dispel the speculation that AHM intake could prevent the effects of exercise-training on lowering BP. Furthermore, in agreement with a recent metanalysis [26], our data indicates that exercise may have similar effects on lowering BP regardless the use of antihypertensive medication in hypertensives patients with metabolic syndrome. Thus, exercise training lowers BP on those subjects with low responsiveness to medication (i. e., Med-Hyper, ▶ Fig.…”

Exercise to Treat Hypertension: Late Breaking News on Exercise Prescriptions That FITT

“…As a subgroup analysis in their meta-review, Pescatello and colleagues (6) examined seven meta-analyses that compared the BP lowering effects of mind-body exercise combined with medication versus mind-body exercise alone or medication alone. They found strong evidence mind-body exercise combined with antihypertensive medication potentiated the BP lowering effects of medication alone (6). Similarly, in a network meta-analysis by Dai and colleagues (23) found Tai Chi and medication combined elicited greater SBP reductions by 12.4 mm Hg and DBP reductions by 7.6 mm Hg than medication alone (23).…”

The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

“…Indeed, although there is currently a paucity of data available with respect to the effect of exercise interventions on submaximal exercise BP, one randomized controlled study has shown significant reductions in systolic BP measured at stages 3 and 4 of a modified Bruce protocol compared to a non-exercise control group [ 62 ]. It is also pertinent that exercise training can provide reductions in BP that are equivalent to pharmacological intervention [ 63 ], with the BP-lowering effects of exercise training enhanced when combined with pharmacotherapy [ 64 ]. Exercise training that improves cardiorespiratory fitness should also lead to improved systolic BP for a given fixed submaximal workload and theoretically lessen the rate of increase in BP during incremental exercise testing (although this likely depends on the health status of the individual) [ 21 ].…”