Effect of exercise on vascular function in hypertension patients: A meta-analysis of randomized controlled trials

Abstract

ObjectiveThe purpose of this study was to systematically evaluate the effect of exercise on vascular function in patients with pre- and hypertension.MethodsA systematic review of articles retrieved via the PubMed, Embase, EBSCO, and Web of Science databases was conducted. All the randomized controlled trials published between the establishment of the databases and October 2022 were included. Studies that evaluated the effects of exercise intervention on vascular function in patients with pre- and hypertension were selected.ResultsA total of 717 subjects were included in 12 randomized controlled trials. The meta-analysis showed that in patients with pre- and hypertension, exercise can significantly reduce systolic blood pressure (SBP) (MD = –4.89; 95% CI, –7.05 to –2.73; P < 0.00001) and diastolic blood pressure (DBP) (MD = –3.74; 95% CI, –5.18 to –2.29; P < 0.00001) and can improve endothelium-dependent flow-mediated dilatation (MD = 2.14; 95% CI, 1.71–2.61; P < 0.00001), and exercise did not reduce pulse wave velocity (PWV) (MD = 0.03, 95% CI, –0.45–0.50; P = 0.92). Regression analysis showed that changes in exercise-related vascular function were independent of subject medication status, baseline SBP, age and duration of intervention.ConclusionAerobic, resistance, and high-intensity intermittent exercise all significantly improved SBP, DBP, and FMD in pre- and hypertensive patients, however, they were not effective in reducing PWV, and this effect was independent of the subject’s medication status, baseline SBP, age and duration of intervention.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022302646.

Global burden of cardiovascular diseases attributed to low physical activity: An analysis of 204 countries and territories between 1990 and 2019

“…Numerous advantages of physical exercise for cardiovascular health include decreasing blood pressure, raising insulin sensitivity, improving lipid profiles, reducing inflammation, and avoiding obesity [20] . Through processes such as lowered sympathetic tone, enhanced vascular endothelial function, and decreased arterial stiffness, exercise lowers blood pressure [21] . While reducing LDL and triglycerides, exercise can increase HDL cholesterol [22] .…”

Exercise interventions for the effect of endothelial function in hypertensive patients: A systematic review and meta‐analysis

“…In a study conducted by Pedralli, it was observed that various aerobic exercise, resistance exercise, and combined exercise improve significantly in the flow‐mediated dilation (FMD) indices among hypertensive patients 67 . A total of 571 participants in nine studies were enrolled in a meta‐analysis to evaluate the effects of exercise on FMD in hypertensive patients, it showed that exercise significantly improved FMD in patients compared to controls 18 . Results from another meta‐analysis of endothelial function in diabetic patients found that exercise training improved FMD in type 2 diabetic patients by 1.77% overall 65 .…”

“… 17 A meta‐analysis conducted by Zhou noted that exercise intervention significantly improved systolic and diastolic blood pressure and FMD in hypertensive patients, but was ineffective in reducing PWV. 18 Some other studies have discovered that exercise does not significantly improve endothelial function in hypertension, possibly because of different exercise styles and exercise intensities. 19 , 20 In addition, no consistent conclusions have been drawn given the small sample sizes and varying exercise intervention programs of previous studies in the field.…”

“…A subset of studies suggests that regular exercise improves the dynamic regulation of vascular tone mediated by NO and ET‐1 and attenuates endothelial dysfunction and atherosclerosis in hypertensive patients 17 . A meta‐analysis conducted by Zhou noted that exercise intervention significantly improved systolic and diastolic blood pressure and FMD in hypertensive patients, but was ineffective in reducing PWV 18 . Some other studies have discovered that exercise does not significantly improve endothelial function in hypertension, possibly because of different exercise styles and exercise intensities 19,20 .…”

Vascular Aging: Pathophysiological Mechanisms, Clinical Implications, and Preventive Strategies

“…Also, AT and RT were found to reduce 24-hour systolic BP, whereas CT did not have the same effect. Only two randomized controlled trials have investigated the persistent impact of various exercise modalities on endothelial function in individuals diagnosed with arterial hypertension [45]. These studies provide valuable clinical insights into combating endothelial dysfunction as a significant cardiovascular risk factor among patients about 40 years with prehypertension or arterial hypertension.…”