Exercise Could be as Effective as Drug Intervention for Lowering High Blood Pressure

  Exercise could be just as effective as antihypertensive drugs in lowering systolic blood pressure below 140 mm Hg. The study analyzed pooled data from clinical trials that separately evaluated the impact of exercise and medications in lowering blood pressure. The study has been published in the British Journal of Sports Medicine, which belongs to the BMJ group of journals. The lead author of the study was Dr. Huseyin Naci, who is an Assistant Professor of Health Policy at the Department of Health Policy, London School of Economics and Political Science (LSE), London, UK.

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Study Background

Research proves that systolic blood pressure can be lowered by exercise. The systolic blood pressure is the pressure exerted by the heart while pumping blood out of the heart by contraction of the heart muscles. It represents the top value in a blood pressure reading. However, there are no clinical trials that have directly compared exercise with blood pressure lowering drugs head-to-head, in order to assess which is more effective.

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Study Procedure

In order to circumvent the above problem, the research team carried out their analyses based on combined data from a large number of clinical trials. The study pooled together data from 194 clinical trials that evaluated the impact of drugs in lowering the systolic blood pressure and 197 clinical trials that evaluated the impact of structured exercise on the same parameter. The total number of subjects in the two combined sets of clinical trials (total 391 trials) was 39,742.

The structured exercise regimen was categorized into the following types:

• Endurance Exercises: Walking, jogging, running, cycling, swimming, high-intensity interval training
• Dynamic Resistance Exercises: Strength training with dumbbells or kettlebells
• Isometric Resistance Exercises: Static push-ups (plank)
• Combined Exercises: Combination of endurance and resistance exercises

The above types of exercises were compared with several classes of blood pressure lowering drugs, based on which the analyses were done. The analyses were based on the following three types of combinations:

• All types of exercise compared with all classes of drugs
• Different types of exercise compared with different classes of drugs
• Different intensities of exercise compared with different doses of drugs

Since the above analyses were based on trials carried out mostly on young participants having normal blood pressure, the study was repeated in a group of exercise trials that only involved participants having high blood pressure.

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Study Findings

The research findings included the following:

• Blood pressure was lower in individuals treated with blood pressure-lowering drugs than those who followed a structured exercise regimen
• Exercise was found to be just as effective as the drugs when only those individuals with high blood pressure were included in the analyses
• The effectiveness of the exercise regimen increased the more the threshold for defining high blood pressure was raised above 140 mm Hg
• Combining endurance and dynamic resistance training was more effective in reducing systolic blood pressure than when applied individually

Study Implications

• Prescriptions for high blood pressure lowering drugs have increased by 50 percent between 2006 and 2016 in UK
• Since UK medical guidelines have lowered the threshold for high systolic blood pressure to 130 mm Hg, the number of prescriptions are likely to increase further
• Replacing drugs with exercise may not be feasible as most hypertensive patients suffer from lifelong co-morbidities such as diabetes and ~40 percent of adults in the USA and Europe have inactive lifestyles

Study Limitations

Some of the major limitations of the study include the following:

• None of the trials included in the analyses compared head-to-head, the exercise regimen vs drug intervention
• The number of participants in the trials included in the analyses were uneven – some included a lesser number of participants than others
• The number of drug intervention trials was much more and the sample size was also larger than those for the structured exercise regimens

Concluding Remarks

"While promising, the findings shouldn't persuade patients to ditch their blood pressure lowering drugs in favor of an exercise regimen just yet, although patients might want to boost their physical activity levels," advises Dr. John Ioannidis, the study’s senior author, in a linked podcast.

"We don't think, on the basis of our study, that patients should stop taking their antihypertensive medications," says Dr. Naci, in a linked podcast."But we hope that our findings will inform evidence-based discussions between clinicians and their patients," he adds.

With reference to prescriptions for exercise to hypertensive patients, there are some issues to consider, he suggests. "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," he emphasizes.

Funding Source

The study was funded by grants from the Higher Education Funding Council for England, the Medical Research Council, UK and the Swiss National Science Foundation.

Reference:

1. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomized controlled trials assessing exercise and medication effects on systolic blood pressure - (http://dx.doi.org/10.1136/bjsports-2018-099921)

Source-Medindia