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Exercise as ‘effective as drugs’ to lower high blood pressure

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Exercise may be as effective as prescribed drugs to lower high blood pressure, according to UK researchers.

Their analysis of all the available data, which is thought to be the first study of its kind, has been published this week by the British Journal of Sports Medicine.

“Different types of exercise interventions appear to be as equally effective as most antihypertensive medications”

Study authors

The researchers pooled data from 194 trials looking at the impact of drugs on lowering systolic blood pressure and 197 trials on the impact of structured exercise – involving a total of 39,742 people.

Structured exercise was categorised as endurance, such as jogging and swimming, or dynamic resistance, such as strength training, isometric resistance, such as push-ups, and a combination.

All types of exercise were compared with all classes of anti-hypertensive drugs, exercise types were compared with different drug types, and exercise intensities compared with different drug doses.

These analyses were then repeated, but in a group of trials that included only participants with hypertension, as most of the others involved young healthy participants with normal blood pressure.

Overall, the results showed that blood pressure was lower in people treated with drugs than in those following structured exercise programmes.

However, when the analyses were restricted to those with high blood pressure – defined as 140mmHg or over – exercise seemed to be just as effective as most drugs.

The study authors also highlighted that the effectiveness of exercise increased the higher the patient’s blood pressure was above 140mmHg.

In addition, the researchers said they found “compelling evidence that combining endurance and dynamic resistance training was effective” in reducing systolic blood pressure.

“We hope that our findings will inform evidence based discussions between clinicians and their patients”

Huseyin Naci

The researchers noted that prescriptions for anti-hypertensives have risen sharply in recent years. In England alone, the number of adults prescribed them increased by 50% between 2006 and 2016.

This trend was likely to continue, they said, given that major clinical practice guidelines have recently lowered the threshold for high systolic blood pressure to 130mmHg.

“In populations with hypertension, different types of exercise interventions appear to be as equally effective as most antihypertensive medications,” said the researchers.

But they cautioned that substituting exercise for drugs may be challenging as patients with hypertension often have several long term conditions and many people are also physically inactive.

Lead study author Dr Huseyin Naci, from the London School of Economics and Political Science, said: “We don’t think, on the basis of our study, that patients should stop taking their antihypertensive medications.

“But we hope that our findings will inform evidence based discussions between clinicians and their patients,” he added.

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