BY now, we all should be very familiar with the benefits of exercise.

Some of these benefits include reducing obesity, protecting against heart disease and stroke, reducing the risk for some cancers, reducing blood sugar, reducing back pain and osteoporosis (that is brittle, fragile bones), improving one’s frame of mind and better management of stress, and improving the likelihood of living longer. However, today I wish to draw our attention specifically to the issue of exercise and hypertension (high blood pressure).

A recent study that involved almost 40,000 patients, found that for people with hypertension, an exercise programme may also lower blood pressure almost as effectively as anti-hypertensive medication.

A meta-analysis (a comprehensive review of numerous research studies on the subject) of randomised controlled trials (the evidence-based ‘gold standard’ in research for proving scientific theories) was conducted by researchers at the London School of Economics and Political Science in the United Kingdom, and published in the British Journal of Sports Medicine recently.

High blood pressure

As previous exercise recommendations have been primarily based on observational studies that are highly variable across different settings, these findings have improved the evidence base supporting exercise recommendations.

The meta-analysis included 194 research studies of the impact of exercise interventions on systolic blood pressure and 197 anti-hypertensive drug research trials, that were reported from 2012 to 2018.

Hypertension was defined as having a systolic blood pressure reading above 140 mmHg. All the research trials involving medication included people who had hypertension, as did the research trials involving exercise. Both anti-hypertensive medication and exercise were found to reduce systolic blood pressure levels from baseline measurement in comparison with control interventions (that is, the treatment that is used as a comparison or control).

Mean reductions were 8.80 mmHg for anti-hypertensive medication, and 4.84 mmHg for exercise. Overall, medication use achieved greater average reductions in systolic blood pressure than did the exercise interventions. However, both produced a lowering of systolic blood pressure readings.

Effects of exercise and medication

Different forms of exercise were associated with similar reductions in systolic blood pressure, although endurance (aerobic exercise) and resistance training (exercise that causes the muscles to contract against an external resistance such as weights, or one’s own body weight) when done together, were more effective in reducing systolic blood pressure than was dynamic resistance alone (a mean reduction difference of 3 mmHg).

Further, all classes of anti-hypertensive drugs were associated with similar reductions in systolic blood pressure.

Interestingly, most classes of these medications yielded results that were not significantly different from those seen with isometric resistance (strength training exercise where the muscles are flexed and do not visibly move), and with the combination of endurance and dynamic resistance training. Further, individuals who had high blood pressure at the start of the research experienced an average 8.96 mmHg greater reduction when they began using exercise interventions.

The research analysis indicated that the benefit of exercise interventions on the systolic blood pressure in people with high blood pressure was driven by endurance training, dynamic resistance, as well as a combination of both.

New guidelines

Not many readers may be aware that the American College of Cardiology and the American Heart Association recently issued new guidelines that set a lower limit for the commencement of treatment for high blood pressure.

Previously catalogued at 140 mmHg, the new “cut-off” point for treating hypertension is 130 mmHg.

With the current research findings, it may be possible that some of these individuals with blood pressure readings just above 130 mmHg may be better indicated for exercise interventions rather than commencing medications. Patients may therefore want to discuss these possibilities with their doctors in keeping with their preferences and values, and what they wish to achieve with their treatment.

These findings also mean that further research is needed to ascertain whether other non-drug interventions could also be potential alternatives to anti-hypertensive medications in lowering blood pressure.

Future research possibilities could also include comparing the systolic blood pressure-lowering effects of exercise with interventions using various medications.

However, the take-away message from all this is that exercise and other lifestyle interventions are of great importance in managing and treating high blood pressure.

Dr Derrick Aarons MD, PhD, is a consultant bioethicist and family physician; a specialist in ethical issues in health care, research, and the life sciences; the health registrar and head of the health secretariat for the Turks and Caicos Islands; and a member of UNESCO’s International Bioethics Committee.