By Robert Preidt
There's "compelling evidence that combining endurance and dynamic resistance training was effective in reducing [blood pressure]," according to the authors of a new report.
The British researchers stressed that it's still too early to recommend that people toss their antihypertensive meds, and exercise instead -- there's not yet been a head-to-head trial of drugs versus exercise for blood pressure.
But comparing the numbers from hundreds of blood pressure trials involving either exercise or medication suggests they have the same benefit, said the team led by Huseyin Naci. He's a health policy researcher at the London School of Economics and Political Science.
For now, one U.S. expert said, exercise should be considered an "and" rather than an "or" when it comes to treating high blood pressure.
"Exercise is a pillar in the foundation of treatment for hypertension, but for those patients that require drug therapy, exercise is not a replacement for medication," said Dr. Guy Mintz. He directs cardiovascular health at the Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.
The new research was published online Dec. 18 in the British Journal of Sports Medicine.
In the study, Naci's team analyzed data from 197 clinical trials that assessed the effects of structured workouts on lowering systolic blood pressure, the top number in a reading. The investigators also looked at data from 194 trials that examined the impact of prescription drugs on blood pressure. In total, the studies included nearly 40,000 people.
Overall, blood pressure was lower in people treated with drugs than in those who did an exercise regimen, the researchers reported. However, for people with high blood pressure in particular -- systolic readings over 140 mm Hg -- exercise appeared just as effective as most drugs in lowering blood pressure.
Also, the effectiveness of exercise against high blood pressure rose the higher the threshold that was used to define high blood pressure -- anything above 140 mm Hg.
The types of exercise in the studies included: endurance, such as walking, jogging, running, cycling and swimming; dynamic resistance, such as strength training with weights; isometric resistance, such as the static push-ups (planks); and a combination of endurance and resistance.
Naci and his colleagues stressed that there were no studies in which exercise and blood pressure-lowering drugs were compared head-to-head, and the number of people in some of the studies was relatively small.
All of that means that, for now, people shouldn't try to replace blood pressure meds with exercise.
"We don't think, on the basis of our study, that patients should stop taking their antihypertensive medications," Naci said in a journal news release. "But we hope that our findings will inform evidence-based discussions between clinicians and their patients."
Another U.S. heart specialist agreed with that assessment.
"Exercise, at any risk level for cardiovascular disease, is shown to improve not only how long one lives, but also lowers the risk of heart attacks and strokes," noted Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City.
People who are already taking a high blood pressure medication are among "the best to benefit from exercise," Bhusri said.
"It is possible to slowly take patients off blood pressure medications as they improve their lifestyle with exercise and diet management, but for most this is a very difficult goal to reach," Bhusri stressed. So, "we do not recommend stopping medications until close observation and discussion with their physician," he explained.
For his part, Mintz said exercise works its magic against high blood pressure through a combination of weight loss, improved artery health and changes in chemicals controlling blood flow.
"I feel that patients should adhere to the current exercise guidelines in the United States, of performing moderate exercise of 150 minutes per week (30 minutes, five times a week), or vigorous exercise for 75 minutes per week," he said. "This is a reasonable and obtainable goal for patients, as an adjunct to appropriate diet."
But for most people with high blood pressure, "exercise alone will not be enough to control their blood pressure," and that's where medication comes in, Mintz said.
"Patients should not stop their medications, even if they are involved in a regular aerobic exercise program, unless consistent control of their hypertension is corroborated by their physician," he said.