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High blood pressure : Exercise vs. Drugs

by A. Manolova | 1 October 2019

hypertension, high blood pressure, health, heart, exercise, drugs, physical activity, hypertensive, systolic, science, sport, prevention, cardiovascular diseases

In the European Union, 49 million people live with cardiovascular disease. Every year about 1.8 million people die from these diseases, accounting for about 37% of all deaths. High blood pressure is said to be responsible for nearly half of these deaths, and would represent more than 8 million deaths worldwide each year. WHO estimates that by 2025, 1.56 billion people will have high blood pressure. Increasing blood pressure is a major risk factor for cardiovascular disease (heart attack, stroke, and coronary artery disease, among others). The blood pressure is quantified by two values, the systolic (maximum pressure in the systemic circulation when the blood is ejected by the heart) and diastolic (minimum pressure in the systemic circulation when the heart is "relaxed") pressures. For most adults, normal blood pressure is 100-130 / 60-80 mmHg. But when these values exceed at rest 140/90 mmHg daily, we speak of hypertension. Many factors influence systolic and diastolic blood pressure, including blood volume, arterial wall compliance, and peripheral resistance. While some genetic factors and diseases can lead to hypertension, the main cause is often behavioral (diet, alcohol consumption, smoking, sedentary lifestyle, etc.).

Since 2017, and the new clinical practice guidelines, the limit of hypertension has decreased from 140 to 130 mmHg, which logically increased the number of people with hypertension, and therefore potentially the number of patients to treat via taking specific medications. In addition to these pharmacological treatments, exercise (endurance or resistance training) is often recommended for the prevention, treatment and control of high blood pressure. It improves various muscular (read our article) and cardiovascular (read our article) functions (including endothelial function) which have the effect of lowering blood pressure. Nevertheless, there are few studies that directly compare the impact of medication and exercise on hypertension. Is physical exercise as effective as drugs for high blood pressure ? Is there one type of exercise more effective than another to lower blood pressure ?

The Study

To answer this question, an international team of researchers conducted a meta-analysis (ie, an analysis combining the results of several studies on a specific topic) comparing the effects of a pharmacological treatment to those of physical exercise in decreasing systolic blood pressure. The researchers analyzed a total of 391 randomized controlled trials involving 39 742 individuals. Of these studies, 194 studied the impact of drugs on blood pressure (angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-2 receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCBs) and diuretics). These studies included 29 281 participants. And 197 studied the impact of exercise on blood pressure (endurance, resistance training (dynamic and isometric), and a combination of endurance and resistance training). These studies included 10 461 people.

Results & Analyzes

The main results of this study show that drugs or sports can significantly reduce blood pressure compared to the control group. But people receiving drug therapy experience greater decreases in systolic blood pressure (-8.80 mmHg) than those who follow regular training (endurance, resistance training or a combination of both) (-4.84 mmHg). The different types of drugs and the different types of exercise can significantly reduce blood pressure. But at the level of the exercises, the combination endurance-resistance training is that which allows the most important fall (-6.49 mmHg).

However, looking more closely at the distribution of the total sample, it appears first that studies that used exercise as a means of blood pressure reduction recruited significantly fewer people, about one-third of the total sample (10 461 vs. 29 281); and secondly, the majority of people who took part in the exercise protocols did not have high blood pressure. Mean baseline blood pressure was 132 mmHg for exercise protocols, and greater than 150 mmHg for groups participating in pharmacological protocols. And only one-tenth of people with hypertension greater than or equal to 140 mmHg came from exercise groups.

When the researchers investigated the impact of the two experimental conditions by limiting themselves to people with hypertension greater than or equal to 140 mmHg, they realized that exercise was as effective as drug treatments for lowering blood pressure (-8.96 mmHg). For the endurance-resistance training combination, the reduction was even as high as 13.51 mmHg (95% confidence interval from -16.55 to -10.45 mmHg).

Practical Applications

With the threshold decrease of hypertension, the number of people diagnosed has logically increased. The drugs prescribed for this disease are effective and can significantly reduce blood pressure in patients. However, physical exercise, and the combination of endurance and resistance training, in particular, appears as a reliable alternative to improve the health status of patients. However, too few studies directly comparing sports and drugs in people with hypertension exist to date. And this is understandable since most pharmaceutical companies that sponsored the majority of clinical studies have little interest in comparing their products with alternative methods over which they will have no financial control. Moreover, most participants in studies involving exercise are healthy and it is usually more difficult to lower the blood pressure when it is relatively normal.

Finally, there is still a lot of information missing about the specific exercise protocols to be put in place with patients in order to propose a replacement of certain drug treatments with exercise. In addition to knowing the type, duration and intensity of workouts, it is imperative to take into consideration that one of the most important challenges is adherence to an exercise program by the patient so that he receives all the benefits. And this last point still requires a lot of work. In addition, depending on the age and physical condition of some patients, it still seems utopist to eliminate the total use of medical treatment. As we often say, sport is a great tool for prevention, and prevention begins at our youngest age.


  1. Naci H, Salcher-Konrad M, Dias S, Blum MR, Sahoo SA, Nunan D and Ioannidis JPA. 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 53 : 859-869, 2019.

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