How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure

British Journal of Sports Medicine

Volumn 53, Issue 14, 2019, Pages 859-869

  Naci, Huseyin ^a   Salcher Konrad, Maximilian ^a   Dias, Sofia ^b,c   Blum, Manuel R ^d,e   Sahoo, Samali Anova ^f   Nunan, David ^g   Ioannidis, John P A ^e  

^a LONDON SCHOOL OF ECONOMICS   (United Kingdom)

^b UNIVERSITY OF BRISTOL   (United Kingdom)

^c UNIVERSITY OF YORK   (United Kingdom)

^d UNIVERSITY OF BERN   (Switzerland)

^e STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

^f UNIVERSITY OF PENNSYLVANIA   (United States)

^g UNIVERSITY OF OXFORD   (United Kingdom)

Author keywords

evaluation; exercise

Indexed keywords

ANGIOTENSIN RECEPTOR ANTAGONIST; ANTIHYPERTENSIVE AGENT; CALCIUM CHANNEL BLOCKING AGENT; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT;

BLOOD PRESSURE; DRUG EFFECT; EXERCISE; HUMAN; HYPERTENSION; META ANALYSIS; NETWORK META-ANALYSIS; PATHOPHYSIOLOGY; PHYSIOLOGY;

ANGIOTENSIN RECEPTOR ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; ANTIHYPERTENSIVE AGENTS; BLOOD PRESSURE; CALCIUM CHANNEL BLOCKERS; DIURETICS; EXERCISE; HUMANS; HYPERTENSION; NETWORK META-ANALYSIS;

EID: 85058778083     PISSN: 03063674     EISSN: 14730480     Source Type: Journal    
DOI: 10.1136/bjsports-2018-099921     Document Type: Review

References (94)

1. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.
2. Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Intern Med 1993;153:598-615.
3. Rutan GH, Kuller LH, Neaton JD, et al. Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial. Circulation 1988;77:504-14.
4. Sesso HD, Stampfer MJ, Rosner B, et al. Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in men. Hypertension 2000;36:801-7.
5. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2224-60.
6. Moser M. Evolution of the treatment of hypertension from the 1940s to JNC V. Am J Hypertens 1997;10:2S-8.
7. Karmali KN, Lloyd-Jones DM, Berendsen MA, et al. Drugs for primary prevention of atherosclerotic cardiovascular disease: an overview of systematic reviews. JAMA Cardiol 2016;1:341-9.
8. Blood Pressure Lowering Treatment Trialists' Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 2014;384:591-8.
9. Moran AE, Forouzanfar MH, Roth GA, et al. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation 2014;129:1493-501.
10. Gu Q, Burt VL, Dillon CF, et al. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health And Nutrition Examination Survey, 2001 to 2010. Circulation 2012;126:2105-14.
11. NHS Digital. PrESCriptions Dispensed in the Community England 2006 to 2016. 2017 https:// files. digital. nhs. uk/ publication/ s/ o/ pres-disp-com-eng-2006-16-rep. pdf.
12. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in sdults: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:1269-324.
13. Khera R, Lu Y, Lu J, et al. Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: nationally representative cross sectional study. BMJ 2018;362:k2357.
14. Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation 2018;137:109-18.
15. Kantor ED, Rehm CD, Haas JS, et al. Trends in prESCription drug use among adults in the United States from 1999-2012. JAMA 2015;314:1818-31.
16. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007;5:345-51.
17. OECD. Health at a Glance. 2017 https://www. oecd-ilibrary. org/ social-issuesmigration-health/ health-at-a-glance-19991312.
18. Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prESCription drugs in the United States: origins and prospects for reform. JAMA 2016;316:858-71.
19. Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990;132:612-28.
20. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ 2006;174:801-9.
21. Li J, Siegrist J. Physical activity and risk of cardiovascular disease-a meta-analysis of prospective cohort studies. Int J Environ Res Public Health 2012;9:391-407.
22. Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med 2015;72:34-43.
23. Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 2011;34:1228-37.
24. Kelley GA, Kelley KS, Franklin B. Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials. J Cardiopulm Rehabil 2006;26:131-9. quiz 140-141, discussion 142-144.
25. Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med 2007;167:999-1008.
26. Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a metaanalysis of randomized, controlled trials. Ann Intern Med 2002;136:493-503.
27. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc 2013;2:e004473.
28. Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577.
29. National Institute for Health and Care Excellence. CG 127: Hypertension in adults: diagnosis and management. 2016 https://www. nice. org. uk/ guidance/ cg127.
30. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013;31:1925-38.
31. Dickson J. The British National Formulary: checking, medicines and clinicians. Stud Health Technol Inform 2015;215:41-51.
32. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1. 0: The Cochrane Collaboration, 2011.
33. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985;100:126-31.
34. Anon. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 1998;30:975-91.
35. Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
36. Salanti G, Kavvoura FK, Ioannidis JP. Exploring the geometry of treatment networks. Ann Intern Med 2008;148:544-53.
37. Chaimani A, Higgins JP, Mavridis D, et al. Graphical tools for network meta-analysis in STATA. PLoS One 2013;8:e76654.
38. Caldwell DM, Ades AE, Higgins JP. Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ 2005;331:897-900.
39. Mills EJ, Thorlund K, Ioannidis JP. Demystifying trial networks and network metaanalysis. BMJ 2013;346:f2914.
40. Salanti G, Higgins JP, Ades AE, et al. Evaluation of networks of randomized trials. Stat Methods Med Res 2008;17:279-301.
41. Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med 2004;23:3105-24.
42. Cipriani A, Higgins JP, Geddes JR, et al. Conceptual and technical challenges in network meta-analysis. Ann Intern Med 2013;159:130-7.
43. Lunn DJ, Thomas A, Best N, et al. WinBUGS-a Bayesian modelling framework: concepts, structure, and extensibility. Stat Comput 2000;10:325-37.
44. Dias S, Welton NJ, Sutton AJ, et al. NICE DSU technical support document 2: a generalised linear modelling framework for pairwise and network meta-analysis of randomised controlled trials. London: National Institute for Health and Care Excellence (NICE), 2011.
45. Dias S, Sutton AJ, Ades AE, et al. Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Making 2013;33:607-17.
46. Dias S, Welton NJ, Sutton AJ, et al. Evidence synthesis for decision making 1: introduction. Med Decis Making 2013;33:597-606.
47. Borenstein M, Hedges LV, Higgins JP, et al. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 2010;1:97-111.
48. Dias S, Welton NJ, Sutton AJ, et al. Inconsistency in networks of evidence based on randomised controlled trials. London: NICE Decision Support Unit, 2011. NICE DSU Technical Support Document 4.
49. Dias S, Welton NJ, Sutton AJ, et al. Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials. Med Decis Making 2013;33:641-56.
50. Lu G, Ades AE. Assessing evidence inconsistency in mixed treatment comparisons. J Am Stat Assoc 2006;101:447-59.
51. Dias S, Sutton AJ, Welton NJ, et al. Heterogeneity: subgroups, meta-regression, bias and bias-adjustment. London: National Institute for Health and Care Excellence (NICE), 2011.
52. Dias S, Sutton AJ, Welton NJ, et al. Evidence synthesis for decision making 3: heterogeneity-subgroups, meta-regression, bias, and bias-adjustment. Med Decis Making 2013;33:618-40.
53. Moreno SG, Sutton AJ, Turner EH, et al. Novel methods to deal with publication biases: secondary analysis of antidepressant trials in the FDA trial registry database and related journal publications. BMJ 2009;339:b2981.
54. Moreno SG, Sutton AJ, Ades AE, et al. Assessment of regression-based methods to adjust for publication bias through a comprehensive simulation study. BMC Med Res Methodol 2009;9:2.
55. Dias S, Welton NJ, Marinho VCC, et al. Estimation and adjustment of bias in randomized evidence by using mixed treatment comparison meta-analysis. J R Stat Soc Ser A Stat Soc 2010;173:613-29.
56. Heran BS, Wong MM, Heran IK, et al. Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension. Cochrane Database Syst Rev 2008:CD003822.
57. Heran BS, Wong MM, Heran IK, et al. Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension. Cochrane Database Syst Rev 2008:CD003823.
58. Ghamami N, Chiang SH, Dormuth C, et al. Time course for blood pressure lowering of dihydropyridine calcium channel blockers. Cochrane Database Syst Rev 2014;8:CD010052.
59. Musini VM, Nazer M, Bassett K, et al. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev 2014:CD003824.
60. Wong GW, Boyda HN, Wright JM. Blood pressure lowering efficacy of partial agonist beta blocker monotherapy for primary hypertension. Cochrane Database Syst Rev 2014:CD007450.
61. Wong GW, Boyda HN, Wright JM. Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension. Cochrane Database Syst Rev 2016;3:CD007451.
62. Wong GW, Wright JM. Blood pressure lowering efficacy of nonselective beta-blockers for primary hypertension. Cochrane Database Syst Rev 2014:CD007452.
63. Blood Pressure Lowering Treatment Trialists'Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. The Lancet 2000;356:1955-64.
64. Turnbull F. Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003;362:1527-35.
65. Turnbull F, Neal B, Ninomiya T, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008;336:1121-3.
66. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016;387:957-67.
67. Cornelissen VA, Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens 2005;23:251-9.
68. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 2005;46:667-75.
69. Hanson S, Jones A. Is there evidence that walking groups have health benefits A systematic review and meta-analysis. Br J Sports Med 2015;49:710-5.
70. Inder JD, Carlson DJ, Dieberg G, et al. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertens Res 2016;39:88-94.
71. Casonatto J, Goessler KF, Cornelissen VA, et al. The blood pressure-lowering effect of a single bout of resistance exercise: a systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol 2016;23:1700-14.
72. Kahlmeier S, Wijnhoven TM, Alpiger P, et al. National physical activity recommendations: systematic overview and analysis of the situation in European countries. BMC Public Health 2015;15:133.
73. NHS Choices. Physical activity guidelines for adults. https://www. nhs. uk/ live-well/ exercise/.
74. Pedersen BK, Saltin B. Evidence for prESCribing exercise as therapy in chronic disease. Scand J Med Sci Sports 2006;16(Suppl 1):3-63.
75. Pedersen BK, Saltin B. Exercise as medicine-evidence for prESCribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015;25:1-72.
76. Conn VS, Hafdahl AR, Mehr DR. Interventions to increase physical activity among healthy adults: meta-analysis of outcomes. Am J Public Health 2011;101:751-8.
77. Williams NH, Hendry M, France B, et al. Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review. Br J Gen Pract 2007;57:979-86.
78. Pavey TG, Taylor AH, Fox KR, et al. Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and metaanalysis. BMJ 2011;343:d6462.
79. Orrow G, Kinmonth AL, Sanderson S, et al. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ 2012;344:e1389.
80. Kohl HW, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet 2012;380:294-305.
81. Hallal PC, Andersen LB, Bull FC, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012;380:247-57.
82. European Commission. Special Eurobarometer 412-sport and physical activity. 2014 http:// ec. europa. eu/ commfrontoffice/ publicopinion/ archives/ ebs/ ebs-412-en. pdf.
83. Ioannidis JPA. Diagnosis and treatment of hypertension in the 2017 ACC/AHA guidelines and in the real world. JAMA 2018;319:115-6.
84. Hacke C, Nunan D, Weisser B. Do exercise trials for hypertension adequately report interventions A reporting quality study. Int J Sports Med 2018;39:902-8.
85. Lathyris DN, Patsopoulos NA, Salanti G, et al. Industry sponsorship and selection of comparators in randomized clinical trials. Eur J Clin Invest 2010;40:172-82.
86. Ioannidis J. Next-generation systematic reviews: prospective meta-analysis, individuallevel data, networks and umbrella reviews. Br J Sports Med 2017;51:1456-8.
87. Zarin W, Veroniki AA, Nincic V, et al. Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review. BMC Med 2017;15:3.
88. Nikolakopoulou A, Chaimani A, Veroniki AA, et al. Characteristics of networks of interventions: a dESCription of a database of 186 published networks. PLoS One 2014;9:e86754.
89. Salanti G, Nikolakopoulou A, Sutton AJ, et al. Planning a future randomized clinical trial based on a network of relevant past trials. Trials 2018;19:365.
90. Jansen JP, Naci H. Is network meta-analysis as valid as standard pairwise meta-analysis It all depends on the distribution of effect modifiers. BMC Med 2013;11:159.
91. Mills EJ, Ioannidis JP, Thorlund K, et al. How to use an article reporting a multiple treatment comparison meta-analysis. JAMA 2012;308:1246-53.
92. Armijo-Olivo S, Fuentes J, da Costa BR, et al. Blinding in physical therapy trials and its association with treatment effects: a meta-epidemiological study. Am J Phys Med Rehabil 2017;96:34-4.
93. Rezende LFM, Rey-Lopez JP, Sa TH, et al. Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality. PLoS Biol 2018;16:e2005761.
94. Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011;343:d4002.