Exercise may be as effective as drugs to cut high blood pressure

We hope that our findings will inform evidence-based discussions between clinicians and their patients
- Dr Huseyin Naci
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Exercise may be as effective as prescribed drugs to lower high blood pressure, according to a new LSE-led analysis of health data, published this week in the British Journal of Sports Medicine (BJSM). 

Discussing the findings in a BJSM podcast, lead researcher Dr Huseyin Naci said while the findings are promising, they shouldn’t persuade patients to ditch their medication in favour of an exercise regimen just yet.

It is well established that exercise can lower systolic blood pressure─ the amount of pressure in the arteries when the heart is beating (and expressed as the top number in any blood pressure reading). What isn’t clear is how exercise compares with blood pressure-lowering drugs, of which there are several types, as no direct head-to-head clinical trials have been carried out.

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

The results showed, overall, blood pressure was lower in people treated with drugs than in those following structured exercise regimens. But when the analyses were restricted to those categorised with high blood pressure exercise seemed to be just as effective as most drugs. What’s more, exercise appeared to be more effective for those with particularly high blood pressure (over 140 mm Hg). However, the researchers caution that the structured exercise trials were fewer and smaller than those for drugs. 

Prescriptions for drugs to lower blood pressure have risen sharply in recent years. In England alone the number of adults prescribed them increased by 50 per cent between 2006 and 2016. This trend is likely to continue, given that major clinical practice guidelines have recently revised the classification for ‘high systolic blood pressure’ to a lower level at 130 mm Hg.

Substituting exercise for drugs may be challenging, however, as people with high blood pressure often have several long-term conditions, and an estimated 40 per cent of adults in the US and many European countries are physically inactive. “We don’t think, on the basis of our study, that patients should stop taking their antihypertensive medications,” says lead author Dr Huseyin Naci, assistant professor in LSE’s Department of Health Policy.

“But we hope that our findings will inform evidence-based discussions between clinicians and their patients, especially for individuals who are newly indicated for antihypertensive drug therapy.”

He adds, “It’s one thing to recommend that physicians start prescribing exercise to their patients, but we also need to be cognisant 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.”

Behind the article

Read the full research paper: 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.

Listen to the BJSM podcast with lead author Dr Huseyin Naci: