The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis

ABSTRACT High blood pressure (BP) is a global health challenge. Isometric resistance training (IRT) has demonstrated antihypertensive effects, but safety data are not available, thereby

limiting its recommendation for clinical use. We conducted a systematic review of randomized controlled trials comparing IRT to controls in adults with elevated BP (systolic ≥130 

mmHg/diastolic ≥85 mmHg). This review provides an update to office BP estimations and is the first to investigate 24-h ambulatory BP, central BP, and safety. Data were analyzed using a

random-effects meta-analysis. We assessed the risk of bias with the Cochrane risk of bias tool and the quality of evidence with GRADE. Twenty-four trials were included (_n_ = 1143; age = 56 

± 9 years, 56% female). IRT resulted in clinically meaningful reductions in office systolic (–6.97 mmHg, 95% CI –8.77 to –5.18, _p_ < 0.0001) and office diastolic BP (–3.86 mmHg, 95% CI

–5.31 to –2.41, _p_ < 0.0001). Novel findings included reductions in central systolic (–7.48 mmHg, 95% CI –14.89 to –0.07, _p_ = 0.035), central diastolic (–3.75 mmHg, 95% CI –6.38 to

–1.12, _p_ = 0.005), and 24-h diastolic (–2.39 mmHg, 95% CI –4.28 to –0.40, _p_ = 0.02) but not 24-h systolic BP (–2.77 mmHg, 95% CI –6.80 to 1.25, _p_ = 0.18). These results are very

low/low certainty with high heterogeneity. There was no significant increase in the risk of IRT, risk ratio (1.12, 95% CI 0.47 to 2.68, _p_ = 0.8), or the risk difference (1.02, 95% CI 1.00

to 1.03, _p_ = 0.13). This means that there is one adverse event per 38,444 bouts of IRT. IRT appears safe and may cause clinically relevant reductions in BP (office, central BP, and 24-h

diastolic). High-quality trials are required to improve confidence in these findings. PROSPERO (CRD42020201888); OSF (https://doi.org/10.17605/OSF.IO/H58BZ). Access through your institution

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OTHERS SAFETY, EFFICACY AND DELIVERY OF ISOMETRIC RESISTANCE TRAINING AS AN ADJUNCT THERAPY FOR BLOOD PRESSURE CONTROL: A MODIFIED DELPHI STUDY Article Open access 12 January 2022 ISOMETRIC

HANDGRIP TRAINING, BUT NOT A SINGLE SESSION, REDUCES BLOOD PRESSURE IN INDIVIDUALS WITH HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS Article 15 November 2022 RESISTANCE EXERCISE HAS

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2017;96:34–44. Download references ACKNOWLEDGEMENTS We would like to thank the authors who provided their adverse event data. FUNDING MAW was supported by a Postgraduate Scholarship from the

National Health and Medical Research Council of Australia, a School of Medical Sciences Top-Up Scholarship from the University of New South Wales, and a PhD Top-Up Scholarship from

Neuroscience Research Australia. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New

South Wales, Sydney, NSW, Australia Harrison J. Hansford, Belinda J. Parmenter, Kelly A. McLeod, Michael A. Wewege & Matthew D. Jones * Centre for Pain IMPACT, Neuroscience Research

Australia, Sydney, NSW, Australia Harrison J. Hansford, Michael A. Wewege & Matthew D. Jones * School of Science and Technology, University of New England, Armidale, NSW, Australia Neil

A. Smart * School of Population Health, University of New South Wales, Sydney, NSW, Australia Aletta E. Schutte * The George Institute for Global Health, Sydney, NSW, Australia Aletta E.

Schutte Authors * Harrison J. Hansford View author publications You can also search for this author inPubMed Google Scholar * Belinda J. Parmenter View author publications You can also

search for this author inPubMed Google Scholar * Kelly A. McLeod View author publications You can also search for this author inPubMed Google Scholar * Michael A. Wewege View author

publications You can also search for this author inPubMed Google Scholar * Neil A. Smart View author publications You can also search for this author inPubMed Google Scholar * Aletta E.

Schutte View author publications You can also search for this author inPubMed Google Scholar * Matthew D. Jones View author publications You can also search for this author inPubMed Google

Scholar CONTRIBUTIONS All authors contributed to the protocol. HJH conducted searches, screening and extraction, analysed the data and drafted the initial manuscript. BJP helped conceive the

study, provided valuable clinical expertise. MAW designed the meta-analytic code, assisted with screening and extraction as well as providing valuable methodological expertise. KAM assisted

with data extraction and provided clinical expertise. NAS and AES provided valuable content expertise and assistance throughout the project. MDJ conceived the study, helped conduct

searches, screening and extraction, provided methodological expertise and assisted in drafting the manuscript. All authors provided valuable input when analysing and interpreting the

results, approved the final manuscript and provided valuable input in the style and content. CORRESPONDING AUTHOR Correspondence to Harrison J. Hansford. ETHICS DECLARATIONS CONFLICT OF

INTEREST AES reports speaker honoraria from Takeda, Servier, Novartis, and Omron Healthcare and serves as a scientific advisory for Abbott. All other authors declare that they have no

conflicts of interest. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. _Hypertens Res_ 44, 1373–1384 (2021).

https://doi.org/10.1038/s41440-021-00720-3 Download citation * Received: 14 April 2021 * Revised: 03 July 2021 * Accepted: 11 July 2021 * Published: 12 August 2021 * Issue Date: November

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