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

Linda S Pescatello; Yin Wu; Simiao Gao; Jill Livingston; Bonny Bloodgood Sheppard; Ming-Hui Chen

doi:10.1136/bmjsem-2020-000895

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

BMJ Open Sport Exerc Med. 2021 Jan 20;7(1):e000895. doi: 10.1136/bmjsem-2020-000895. eCollection 2021.

Authors

Linda S Pescatello¹, Yin Wu¹, Simiao Gao², Jill Livingston³, Bonny Bloodgood Sheppard⁴, Ming-Hui Chen²

Affiliations

¹ Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
² Department of Statistics, University of Connecticut, Storrs, Connecticut, USA.
³ Wesleyan University, Middletown, Connecticut, USA.
⁴ ICF Next, Fairfax, Virginia, USA.

Abstract

Objective: To compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.

Data sources: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.

Eligibility criteria: Randomised 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.

Design: A systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.

Outcome: The BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.

Results: Twelve 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.

Conclusions: The combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.

Prospero registration number: The protocol is registered at PROSPERO CRD42020181754.

Keywords: cardiovascular; exercise; heart disease; pharmacology; physical activity.

Publication types

Review