High blood pressure, or hypertension, is a major risk factor for many cardiovascular diseases, such as stroke, heart attack, and heart failure. Research suggests that nearly half of U.S. adults have hypertension, with many unaware they have high blood pressure.
Although exercise has long been recommended as part of hypertension treatment, most studies have focused on aerobic exercise, highlighting it as the most consistent method for reducing 24-hour ambulatory blood pressure.
Ambulatory blood pressure monitoring (ABPM) describes a 24-hour, continuous, automated recording of a person’s blood pressure during daily activities and sleep.
Unlike blood pressure readings taken during a doctor’s appointment, ABPM measures fluctuations throughout daily life and during sleep. As such, many healthcare professionals consider it the ‘gold standard‘ for diagnosing hypertension.
Now, a pooled analysis, published in the British Journal of Sports Medicine, investigating other forms of exercise suggests that combining aerobic and resistance exercise, as well as participating in high intensity interval training (HIIT), may significantly reduce blood pressure across a 24-hour period in adults with high blood pressure.
To better understand how different forms of exercise affect blood pressure, the researchers reviewed comparative clinical trials published between November 2024 and August 2025.
The pooled analysis included structured exercise interventions lasting at least 4 weeks and covered several exercise types. This included:
In total, the researchers analyzed data from 31 randomized controlled trials involving more than 1,345 participants and 67 different exercise interventions.
Notably, the researchers found that aerobic exercise remained the most consistently effective approach for lowering blood pressure throughout the day and night. Combined exercise and HIIT also reduced blood pressure over 24 hours.
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In particular, the meta-analysis found that combined exercise training and HIIT were linked to meaningful reductions in systolic blood pressure over a 24-hour period. This refers to the top number in a blood pressure reading, which measures the pressure against the artery walls when the heart is pumping blood around the body.
The American Heart Association (AHA) recommends a target systolic blood pressure below 120 millimeters of mercury (mm Hg).
When compared with no exercise, combined exercise training reduced systolic blood pressure by an average of 6.18 millimeters of mercury (mm Hg). Additionally, HIIT reduced systolic blood pressure by 5.71 mm Hg, and aerobic exercise reduced it by 4.73 mm Hg.
Study author Rodrigo Ferrari, PhD, a professor at the Federal University of Rio Grande do Sul, Brazil, explained to Medical News Today why combined training may be effective for hypertension.
“Combined training is particularly beneficial because it integrates the physiological mechanisms of both aerobic and resistance exercise, offering a more comprehensive health profile,” he said.
“While it produced the largest point estimate for reducing 24-hour systolic blood pressure, this modality is also crucial for addressing age-related declines in functionally. By leveraging complementary pathways, combined training enhances both cardiovascular and neuromuscular functions simultaneously,” he explained.
Diastolic blood pressure, the lower number in a reading, describes the pressure in the arteries when the heart relaxes between beats. The AHA advises a target diastolic blood pressure below 80 mm Hg.
For diastolic blood pressure, the researchers observed average reductions of 4.64 mm Hg with HIIT, 4.18 mm Hg with pilates, 3.94 mm Hg with combined exercise, and 2.76 mm Hg with aerobic exercise.
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“HIIT serves as a realistic and effective alternative because it significantly reduces both 24-hour systolic and diastolic blood pressure while requiring less time than traditional continuous exercise,” Ferrari told MNT.
“This efficiency directly addresses time constraints, which are one of the most significant global barriers to exercise adherence. Although larger trials are still needed to broaden current recommendations, HIIT is a promising strategy for maintaining cardiorespiratory fitness and managing hypertension in time-pressed individuals,” he said.
Previous research has suggested that isometric exercise may be the most effective approach for lowering blood pressure.
However, the study authors suggest that aerobic exercise may offer unique cardiovascular benefits. They note that aerobic exercise may improve endothelial function, or how well blood vessels work, while also reducing vascular resistance through sustained vasodilation.
“Aerobic exercises works primarily by reducing systemic vascular resistance and improving endothelial function through sustained vasodilation,” Ferrari said.
“Furthermore, it remains the most evidence-based option due to the large volume of clinical trials and participants, which provides the highest level of statistical precision for its blood pressure-lowering effects,” he concluded.
Conversely, they add that resistance training may temporarily increase arterial stiffness due to the high-pressure demands placed on the cardiovascular system during lifting exercises. As such, they suggest that resistance exercise should be viewed as complementary for lowering blood pressure rather than a first-line strategy.
The researchers propose that these physiological differences may explain why their findings differed from previous reports.
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While other forms of exercise, such as yoga, pilates, and recreational sports, appeared to offer some benefit, the evidence was less conclusive. The researchers caution that further research is needed before recommending these exercise approaches as primary treatments for hypertension.
The research team also highlights that their analysis had several limitations. Many of the trials involved relatively small numbers of participants, side effects were often poorly reported, and information about whether participants followed their exercise programs consistently was frequently missing.
Still, the authors conclude that aerobic exercise, either continuous or interval-based, and combined exercise training should remain as the primary evidence-based recommendations for lowering 24-hour ambulatory blood pressure in adults with high blood pressure.
“The most effective strategy for lowering ambulatory blood pressure is to prioritize aerobic exercise as the foundation of your routine,” Ferrari said.
Ferrai also emphasized the importance of maintaining regular exercise for sustainability.
“For a more complete health approach, you should combine aerobic training with resistance exercise to gain additional benefits in muscular strength and physical function. Crucially, the success of any intervention depends on choosing strategies that individuals can realistically adhere to over the long term,” he explained.
“In this context, the latest evidence from this study expands the range of proven effective options, offering promising new modalities (HIIT, recreational sports, and Pilates, for example) for those who struggle to engage with more traditional programs,” he continued.
“These new alternatives are easier to overcome monotony and improve daily adherence, which remains the most critical factor in the successful management of hypertension,” he added.
