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Can exercise lower blood pressure as effectively as drugs?

Millions of people live with high blood pressure, which can place them at risk of developing cardiovascular diseases. For this condition, doctors typically prescribe blood-lowering drugs, but could exercise help just as well?
people jogging
A new study suggests that exercise can be just as effective as drugs when it comes to keeping blood pressure under control.

According to the Centers for Disease Control and Prevention (CDC), approximately 75 million adults in the United States have to manage high blood pressure, where it exceeds the threshold of 140 millimeters of mercury (mm Hg).

The condition can increase their risk of developing heart disease or experiencing a stroke, both of which are leading causes of death in the U.S.

Moreover, high blood pressure drives an expense of around $48.6 billion per year nationally, including the cost of medication, accessed health care, and absence from work.

People with high blood pressure typically follow an antihypertensive or blood pressure-lowering treatment, which includes special medication. At the same time, specialists sometimes advise that people make lifestyle changes to help them manage their blood pressure.

One such change is to take regular, structured exercise that can be of several types:

endurance exercises, such as walking, jogging, or swimming high-intensity interval training, involving short bursts of intensive exercise dynamic resistance, including strength training isometric resistance, such as the plank exercise a combination of endurance and resistance exercises

However, no studies have yet compared the effectiveness of physical activity in lowering blood pressure with that of antihypertensive medication.

A new study in the British Journal of Sports Medicine — a BMJ publication — aims to address this gap in the literature.

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Findings indicate similar effects

Since there are no studies that directly compare the effects of blood pressure medication with those of structured exercise, the study analyzed the data of various research projects that focused on one or other of these approaches.

The researchers — from institutions across Europe and the U.S., including the London School of Economics and Political Science in the United Kingdom, and the Stanford University School of Medicine in California — explain that structured exercise helps lower systolic blood pressure, which measures the blood pressure in the blood vessels as the heart beats.

In the current study, they looked at the data from 194 clinical trials that focused on antihypertensive drugs and their impact on systolic blood pressure, and another 197 clinical trials, looking at the effect of structured exercise on blood pressure measurements. In total, these trials collected information from 39,742 participants.

Dr. Huseyin Naci — from the Department of Health Policy at the London School of Economics and Political Science — and colleagues conducted several sets of analyses on the data from the trials.

First, they compared the effects of all types of antihypertensive drugs with those of all kinds of exercise. Then, they looked at specific drug types versus specific types of exercise. Finally, they compared the impact of different exercise intensities with those of different drug dosages.

In the first instance, the investigators conducted these analyses by using data from healthy participants with normal blood pressure. Then, they repeated them with data from individuals with high blood pressure only.

They found that antihypertensive drugs were more effective in lowering blood pressure than structured exercise in the case of the general population. However, when they looked specifically at people with high blood pressure, they saw that exercise was as effective as most blood-lowering medication.

Moreover, the study authors concluded that there is "compelling evidence that combining endurance and dynamic resistance training was effective in reducing [systolic blood pressure]."

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More exercise is beneficial

Still, the research team cautions that they based their analyses on many small-scale trials, and others should replicate their results with more extensive studies.

Dr. Naci and colleagues also strongly advise against giving up on antihypertensive medication and replacing it with exercise.

"We don't think, on the basis of our study, that patients should stop taking their antihypertensive medications," the researcher says in a podcast in which he speaks about the current research.

"But," Dr. Naci adds, "we hope that our findings will inform evidence-based discussions between clinicians and their patients."

The lead researcher notes that many people in the U.S. and throughout Europe lead sedentary lives and that they would benefit from taking more exercise.

At the same time, however, he emphasizes that doctors should make sure their patients can adhere to prescribed exercise regimens.

"It's one thing to recommend that physicians start prescribing exercise to their patients, but we also need to be cognizant of the resource implications and ensure that the patients that have been referred to exercise interventions can adhere to them and so really derive benefit."

Dr. Huseyin Naci

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