Supervised versus non-supervised exercise intervention for blood pressure reduction in patients with hypertension and prehypertension: a systematic review and meta-analysis

Objective The purpose of this systematic review and meta-analysis was to compare the effects of supervised versus non-supervised exercise interventions, in which both groups performed exercise training, on blood pressure reduction in individuals with hypertension and prehypertension, and to determine which exercise modalities provide the greatest benefits for clinical practice. Methods Three databases (EMBASE, MEDLINE/PubMed, and Cochrane CENTRAL) were searched from inception to July 2025. Adults with hypertension or prehypertension were included. The intervention of interest was supervised exercise training, compared with non-supervised exercise training. Primary outcomes were systolic and diastolic blood pressure. Only randomized controlled trials reporting pre- and post-intervention blood pressure outcomes were included. Mean differences and standard deviations (SDs) for systolic and diastolic blood pressure were extracted. A random-effects meta-analysis was performed, and heterogeneity was assessed using the I² statistic. Subgroup analyses were conducted by training program. Study quality was assessed using the PEDro scale. Results Eleven studies were included in the systematic review, with 10 proceeding to the meta-analysis. The included studies had an average PEDro score of 5.3±1.6, ranging from fair to good methodological quality. Interventions included continuous aerobic training, high-intensity interval training, isometric handgrip, and combined exercise. Meta-analysis showed a significant between-group difference in systolic blood pressure reduction favoring supervised exercise (mean difference = -3.46 mmHg; 95% CI: -5.94, -0.97; p = 0.006), although heterogeneity was substantial ( I² = 74%), particularly during continuous aerobic training in the subgroup analysis ( p = 0.003, I 2 = 64%). In contrast, no significant between-group difference was observed in diastolic blood pressure reduction (mean difference = -0.99 mmHg; 95% CI: -3.38, 1.39; p = 0.41), with high heterogeneity ( I² = 89%). Conclusion Supervised exercise interventions may be more effective than non-supervised programs in lowering systolic blood pressure, particularly with continuous aerobic training. However, no significant between-group differences were observed for diastolic blood pressure reduction, and the influence of supervision on diastolic blood pressure outcomes remains uncertain. These findings should be interpreted with caution due to the substantial heterogeneity and methodological limitations among the included studies.