Meds Beat Exercise for BP Reduction

Exercise and medication both help reduce blood pressure, although the magnitude was larger with antihypertensives, a meta-analysis showed.

Exercise interventions reduced systolic pressure by an average 4.84 mm Hg compared with controls (95% credible interval −5.55 to −4.13), while antihypertensives reduced it by a mean of 8.80 mm Hg (95% CrI −9.58 to −8.02) vs controls across clinical trials.

Antihypertensive medications cut SBP by a mean 3.96 mm Hg (95% CrI -5.02 to -2.91) more than did exercise interventions, reported Huseyin Naci, PhD, MHS, of the London School of Economics and Political Science, and colleagues in the British Journal of Sports Medicine.

Exercise is medicine, and everyone, even people with hypertension should exercise, noted John Higgins, MD, MBA, MPHIL, of McGovern Medical School at UTHealth in Houston, who was not involved in the study.

“It may be possible in a patient with hypertension, especially mild hypertension, to use exercise to bring their BP down and potentially ultimately reduce or remove their medication,” he continued.

This paper is consistent with the existing clinical guidelines, noted Daniel Blumenthal, MD, MPH, of Morehouse School of Medicine in Atlanta.

“For patients with mild hypertension, non-drug therapy is always preferred. This would usually involve exercise as well as dietary interventions and weight loss if the patient is overweight or obese. Other non-drug interventions, such as meditation, could also be tried. Drugs can be added as needed. Even if drugs are needed, exercise, weight loss, should be employed as well,” Blumenthal told MedPage Today.

The researchers evaluated a total of 391 randomized controlled trials (RCTs) with 39,742 participants. There were 194 trials on antihypertensive medications, which accounted for 29,281 of the participants, and 197 trials on exercise intervention trials, with a total of 10,461 participants.

There were no RCTs to draw direct comparisons between prescription drugs and physical activity. “There are methodological problems in trying to conduct such a study,” commented Blumenthal, noting that such a trial couldn’t be blinded.

Trials assessing the effectiveness of medications all looked at hypertensive populations, while there were only 56 physical activity trials looking at hypertensive populations.

The findings indicated that all antihypertensive medications were beneficial in reducing SBP when compared with controls. The mean differences were as follows:

• ACE inhibitor: −7.33 mm Hg (95% CrI −8.75 to −5.91)
• Calcium channel blocker: −10.58 mm Hg (95% CrI −12.03 to −9.14)
• Angiotensin-2 receptor blocker: −8.14 mm Hg (95% CrI −9.62 to −6.69)
• Diuretic: −8.06 mm Hg (95% CrI −9.48 to −6.64)

All types of exercise were also beneficial in reducing SBP when compared with controls. The mean differences were:

• Endurance exercise: −4.88 mm Hg (95% CrI −5.69 to −4.06)
• Isometric exercise: −5.65 mm Hg (95% CrI −8.21 to −3.13)
• Resistance exercise: −3.50 mm Hg (95% CrI −4.91 to –2.09)
• Combination of endurance and resistance: −6.49 mm Hg (95% CrI −8.17 to −4.82)

Exercise was significantly more effective than controls across intensity levels, with a mean difference of 3.87 mm Hg for high intensity, 5.41 for moderate intensity, and 4.60 for low intensity.

Low-dose antihypertensives reduced SBP by a mean 8.29 mm Hg (95% CrI −9.13 to −7.46) vs controls, while high-dose medications lowered SBP by an average of 10.71 mm Hg (95% CrI −11.94 to −9.46) more than controls.

For hypertensive cohorts (using the older threshold of 140 mm Hg), exercise lowered SBP by a mean difference of 8.96 mm Hg (95% CrI −10.27 to −7.64). There were no differences between SBP reductions with exercise and medications (mean difference 0.18 mm Hg, 95% CrI −1.35 to 1.68).

There were lower SBPs among hypertensive participants who engaged in dynamic resistance exercise (mean difference −7.23 mm Hg, 95% CrI −10.58 to −3.87), endurance exercise (mean difference −8.69 mm Hg, 95% CrI −10.13 to −7.25), and both forms of exercise (mean difference −13.51 mm Hg, 95% CrI −16.55 to −10.45) when compared to control participants.

“Whether the reliability of estimates from exercise trials is similar to those from trials of antihypertensive medications should be evaluated in the future,” the researchers concluded.