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Can Exercise Be As Effective As Blood Pressure Medications In Lowering Blood Pressure?

Once again, a study found health benefits from exercise. This time a large review of studies found that the blood pressure lowering effect of exercise for persons with high blood pressure (hypertension) appears to be similar to that of commonly used blood-pressure (antihypertensive) medications. The study was designed to compare the effect of exercise and medications on systolic blood pressure (greater than 140 mmHg). Unfortunately no study directly compared the two, but the researchers were able to draw conclusions from 391 studies that had used randomly controlled trials (people assigned randomly to different conditions).

The American and UK researchers found that all programs of exercise and all blood pressure medications lowered blood pressure. They did find greater reductions in blood pressure in taking blood pressure lowering medications vs just exercise ("structured exercise regimens"), but pointed out that when studies just focused on people with high blood pressure (instead of everyone), then the results looked more impressive. Meaning the higher the blood pressure, the more effective the exercise.

Other findings: They did not observe a dose-response relationship between exercise intensity and blood pressure reduction. They found that even low-intensity exercise may be effective in reducing blood pressure. The researchers stressed the need for studies that directly compare  exercise programs to blood pressure medications, but point out that pharmaceutical companies are the ones doing the vast majority of studies and they don't have any incentive to do such a study (it could mean the loss of profits from medicines!). Many of the studies compared blood pressure medicines + exercise vs just blood pressure medicines. Thus the researchers said the topic of exercise and blood pressure is currently under studied.

Bottom line: get out and move, move, move for your health! All activity and movement is better than none. Yes, it's easier to just take daily pills, but all medications have side-effects and cost money. Exercise is free and the health benefits are many. Some health benefits of exercise from other studies: lowers blood pressure, lower risk of heart (cardiovascular) disease, lower the waist circumference (get rid of belly rolls!), and lowers triglyceride levels (in the blood).

From Science Daily: Exercise may be as effective as prescribed drugs to lower high blood pressure

Exercise may be as effective as prescribed drugs to lower high (140 mm Hg) blood pressure, suggests a pooled analysis of the available data, in what is thought to be the first study of its kind, and published online in the British Journal of Sports Medicine.  

But there are no direct head to head comparative trials of exercise and blood pressure lowering drugs, and the numbers of participants in some of the included studies were relatively small, caution the researchers.

While promising, the findings shouldn't persuade patients to ditch their blood pressure lowering drugs in favour of an exercise regimen just yet, although patients might want to boost their physical activity levels, advises the lead study author in a linked podcast.

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. But 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, the researchers pooled the 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, and involving a total of 39,742 people. Structured exercise was categorised as: endurance, to include walking, jogging, running, cycling and swimming, and high intensity interval training; dynamic resistance, to include strength training -- for example, with dumbbells or kettle bells; isometric resistance, such as the static push-up (plank); and a combination of endurance and resistance.

Three sets of analyses were done: all types of exercise compared with all classes of blood pressure lowering drugs; different types of exercise compared with different types of drug; and different intensities of exercise compared with different drug doses. And finally, these analyses were repeated, but in a group of exercise trials that included only participants with high blood pressure, as most of these trials were of young healthy participants with normal blood pressure.

The results showed that blood pressure was lower in people treated with drugs than in those following structured exercise programmes. But when the analyses were restricted to those with high blood pressure, exercise seemed to be just as effective as most drugs. What's more, the effectiveness of exercise increased the higher the threshold used to define high blood pressure -- that is, anything above 140 mm Hg.

The researchers also found "compelling evidence that combining endurance and dynamic resistance training was effective in reducing [systolic blood pressure]." But structured exercise trials were fewer and smaller than those for drugs, they caution.

The researchers point out that 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, say the researchers, given that major clinical practice guidelines have recently lowered the threshold for high systolic blood pressure to 130 mm Hg. But substituting exercise for drugs may be challenging 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, they say.

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