Do baseline blood pressure and type of exercise influence level of reduction induced by training in hypertensive older adults? A meta-analysis of controlled trials

Background: Exercise recommendations for hypertensive individuals encourage the use of aerobic training (AT) for lowering blood pressure (BP). However, it is not clear whether equivalent BP-lowering effects are obtained with different exercise training types in older adults, among whom hypertension is more prevalent. Design: We meta-analyzed previous literature testing different types of training [AT, resistance (RT) and combined (CT)] effects on casual systolic BP (SBP) and diastolic BP (DBP), taking into account age and baseline BP influences. Methods: Randomized controlled trials (RCTs), published up to August 2019 (PubMed), assessing exercise training effects on BP in hypertensive older adults (aged >= 50 years) were included (11, 8 and 3 RCTs tested the effects of AT, RT and CT, respectively). Results and conclusions: First, both AT and RT reduced SBP ( -12.31 [ -16.39; - 8.24] and - 6.76 [ - 8.36; - 5.17] mm Hg, respectively) and DBP ( - 4.31 [ -5.96; - 2.65] and - 3.53 [ - 4.22; - 2.85] mm Hg, respectively) in older adults, while there was not enough evidence for the effects of CT on SBP, due to high variance among the small number of CT studies. Second, training-induced BP reductions were more prominent in patients < 65 years compared to those > 65 years. However, this difference was mostly driven by differences between AT and CT versus RT intervention on age subgroups. Third, baseline BP values, rather than type of exercise and age, were the main determinant of BP response to exercise (predicted 74% and 53% of SBP and DBP reduction, respectively), indicating this is a major confounding factor to be considered in studies evaluating the impact of exercise training on BP.