What kind of exercise lowers high blood pressure the most?
Combined training produced the largest drop in 24-hour systolic blood pressure, lowering it by 6.18 mm Hg in adults with hypertension. High-intensity interval training reduced it by 5.71 mm Hg, and aerobic training alone by 4.73 mm Hg. All three beat a non-exercise control, but when the modalities were compared directly against each other, the results were inconclusive, so none of them was shown to be better than the others.
These numbers come from a network meta-analysis published in the British Journal of Sports Medicine. This is a pooled analysis of existing trials, not a new trial of its own. The researchers gathered 31 randomized controlled trials with 67 arms and 1,345 adults with hypertension, and every trial measured outcomes with 24-hour ambulatory blood pressure monitoring. That kind of monitoring matters because it captures what your blood pressure actually does as you go about your day, not just the single reading a doctor catches in the office.
What the data show
Compared with a non-exercise control, three modalities lowered 24-hour systolic blood pressure. Combined training, which pairs cardio with strength work, gave a reduction of 6.18 mm Hg (95% credible interval -11.45 to -1.21). High-intensity interval training, which alternates hard bursts with short rests, reduced it by 5.71 mm Hg (95% CrI -11.31 to -0.002). Aerobic training such as brisk walking, cycling, or jogging reduced it by 4.73 mm Hg (95% CrI -7.53 to -2.01).
For 24-hour diastolic blood pressure, four modalities showed reductions: high-intensity interval training by 4.64 mm Hg, pilates by 4.18 mm Hg, combined training by 3.94 mm Hg, and aerobic training by 2.76 mm Hg.
The authors were careful about what this does not settle. Evidence for dynamic and isometric resistance training remains uncertain. Data on non-conventional modalities such as pilates and recreational sports are limited and imprecise for managing ambulatory blood pressure. And the exercise-versus-exercise comparisons could not establish that any one modality is superior to another.
Dr. Kumar’s Take
I find this analysis useful because it asks the right question. Most blood pressure studies use office readings, which only capture one moment in time. Twenty-four hour monitoring tells you what is happening while you sleep, while you commute, and while you are under stress at work, which is what actually drives heart and brain risk over the years.
What I take from this is that you should not think of cardio and strength training as competing choices. The credible intervals for combined, interval, and aerobic training overlap heavily, and the head-to-head comparisons came back inconclusive, so I would not tell a patient that one of these is the winner. All three lowered 24-hour blood pressure against doing nothing, and that is the comparison most of my patients are actually making. A balanced program with both aerobic work and resistance training is what I recommend, and this analysis gives me no reason to steer someone away from the version they will actually keep doing.
How the studies were done
A network meta-analysis is a statistical method that lets researchers compare many treatments at once, even when individual trials only tested two or three of them. The authors searched MEDLINE, Embase, Cochrane CENTRAL, and the Regional Portal of the Virtual Health Library from November 2024 to August 2025. They included randomized controlled trials of at least four weeks of exercise training, compared either with a non-exercise control condition or with another exercise modality, that reported 24-hour systolic and diastolic blood pressure. That search yielded 31 trials, 67 arms, and 1,345 participants.
Every included trial measured outcomes with ambulatory blood pressure monitoring, which uses a cuff that takes readings throughout the day and night. The consistency of that outcome measure across studies is a strength of the pooled estimates.
Who benefits most
Adults already diagnosed with hypertension are the group these results apply to most directly. The trials enrolled people with hypertension, not healthy young athletes, so the findings translate well to a typical patient looking to lower readings without adding another pill or pushing an existing dose higher.
The intervention periods were at least four weeks, so this is about sustained training rather than the effect of a single workout.
Practical Takeaways
- If you have high blood pressure, aerobic training, high-intensity interval training, and combined aerobic plus resistance training all lowered 24-hour systolic blood pressure compared with not exercising. The analysis could not show that any one of them beats the others, so pick the one you will stick with.
- Combined training had the largest reduction in 24-hour systolic pressure at 6.18 mm Hg, but its credible interval overlaps the other modalities, so treat that as a reasonable option rather than a proven winner.
- High-intensity interval training is a defensible choice if you are short on time and cleared by your doctor, since it reduced 24-hour systolic pressure by 5.71 mm Hg and diastolic pressure by 4.64 mm Hg.
- If lowering 24-hour blood pressure is your main goal, do not build the plan around resistance training alone. The evidence for dynamic and isometric resistance training was uncertain in this analysis, and the data on pilates and recreational sports were limited and imprecise.
Related Studies and Research
- Optimal exercise dose for depression in older adults: network meta-analysis
- Systematic review and meta-analysis: postexercise cold water immersion and resistance training adaptations
- Meta-analysis: cold water immersion after exercise and fatigue recovery
- Physical exercise-based rehabilitation for long covid: meta-analysis of 23 studies
FAQs
Which exercise modality should I choose if the comparisons were inconclusive?
Three modalities cleared the bar against a non-exercise control for 24-hour systolic pressure: combined training at 6.18 mm Hg, high-intensity interval training at 5.71 mm Hg, and aerobic training at 4.73 mm Hg. The direct comparisons between modalities could not establish superiority, which means the honest reading is that all three work and the analysis cannot rank them. My advice is to choose based on what fits your schedule, your joints, and what your doctor clears you for, because adherence is the variable you control.
How long do I need to train to see these effects?
The trials in this analysis all ran interventions of at least four weeks. That is the minimum duration the authors required for a trial to be included, so these reductions reflect sustained training over weeks rather than the temporary dip that follows a single session.
Why is 24-hour blood pressure a better measure than a single doctor’s office reading?
Office readings only capture a snapshot, and they are often higher than your real average because of stress, recent caffeine, or what doctors call the white coat effect. A 24-hour monitor records readings as you work, eat, walk, and sleep, which gives a fuller picture of your blood pressure load. That is why this analysis restricted itself to trials using ambulatory monitoring rather than clinic readings.
Bottom Line
If you have high blood pressure, aerobic training, interval training, and combined aerobic plus resistance training all reduced 24-hour blood pressure compared with not exercising. Across 31 trials and 1,345 participants, combined training produced the largest 24-hour systolic reduction at 6.18 mm Hg, with high-intensity interval training at 5.71 mm Hg and aerobic training at 4.73 mm Hg, though the head-to-head comparisons between modalities were inconclusive. The evidence for dynamic and isometric resistance training remains uncertain, and the data on pilates and recreational sports are too limited to build a blood pressure plan around.
