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Exercise may be as good at lowering blood pressure as drugs

But no direct head to head comparative trials have been conducted so far

Ingrid Torjesen

Wednesday, 19 December 2018

Exercise may be as effective as prescribed drugs in lowering high blood pressure, suggests a pooled analysis* of the available data, published online in the British Journal of Sports Medicine.

While promising, patients should not stop their blood pressure lowering drugs in favour of an exercise regimen, the researchers warn, as no direct head to head comparative trials of exercise and blood pressure lowering drugs have been conducted, and the numbers of participants in some of the studies they looked at were relatively small.

Exercise is known to be able to lower systolic blood pressure, but what isn’t clear is how exercise compares with blood pressure lowering drugs, of which there are several types, as no direct head to head clinical trials have been carried out.

In what is thought to be the first study of its kind, the researchers pooled data from 194 clinical trials looking at the impact of drugs on lowering systolic blood pressure and 197 trials looking at the impact of structured exercise. In total the trials involved 39,742 people.

Structured exercise was categorised as: endurance, to include walking, jogging, running, cycling, swimming, and high intensity interval training; dynamic resistance, to include strength training (e.g. dumbbells or kettle bells); isometric resistance, such as the static push-up (plank); and a combination of endurance and resistance.

Three sets of analyses were done: all types of exercise compared with all classes of blood pressure lowering drugs; different types of exercise compared with different types of drug; and different intensities of exercise compared with different drug doses.

Finally, the analyses were repeated but only for participants with high blood pressure, as most of trials primarily included healthy participants with normal blood pressure.

The results showed that blood pressure was lower in people treated with drugs than in those following structured exercise programmes, but when the analyses were restricted to those with high blood pressure (above 140 mm Hg), exercise seemed to be just as effective as most drugs. The effectiveness of exercise also increased the higher the threshold used to define high blood pressure.

The researchers also found “compelling evidence that combining endurance and dynamic resistance training was effective in reducing [systolic blood pressure].”

Prescriptions for drugs to lower blood pressure have risen sharply in recent years. In England alone the number of adults prescribed them increased by 50% between 2006 and 2016. That trend is likely to continue, the researchers predicted, given that the threshold for high systolic blood pressure has recently been lowered to 130 mm Hg.

They admitted that substituting exercise for drugs may be challenging as people with high blood pressure often have several long-term conditions, and many adults in the US and European countries are physically inactive.

“We don’t think, on the basis of our study, that patients should stop taking their antihypertensive medications,” says lead author Dr Huseyin Naci, Department of Health Policy, London School of Economics and Political Science, in a linked podcast.

“But we hope that our findings will inform evidence-based discussions between clinicians and their patients.”

As to whether doctors should be handing out prescriptions for exercise to patients with high blood pressure, there are some issues to consider, he suggests.

*Naci H, Salcher-Konrad M, Dias S, et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br J Sports Med Published Online First: 18 December 2018. doi: 10.1136/bjsports-2018-099921

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