The impact of aerobic exercise on systolic and diastolic blood pressure in hypertensive individuals: a systematic review and meta-analysis of randomized controlled trials

Background Hypertension is one of the most common cardiovascular risk factors worldwide. Aerobic exercise is considered an important non-pharmacological intervention; however, its effects on resting blood pressure in different populations remain controversial. This study aims to systematically evaluate and perform a Meta-analysis on the impact of aerobic exercise on systolic and diastolic blood pressure in individuals with hypertension. Methods This study adheres to PRISMA and Cochrane methodological guidelines and is registered in PROSPERO (CRD420251127000). A systematic search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from 1990 to February 2026, and a total of 49 randomized controlled trials (RCTs) were included. Random-effects models were used to pool effect sizes, followed by subgroup analysis, Meta-regression, sensitivity analysis, and publication bias assessment. Results A total of 49 randomized controlled trials were included. These trials contributed 53 comparisons for systolic blood pressure and 52 comparisons for diastolic blood pressure. Aerobic exercise significantly reduced systolic blood pressure (53 comparisons; MD = −8.73 mmHg, 95% CI −10.39 to −7.08; *P* < 0.001; *I* 2 = 95.0%) and diastolic blood pressure (52 comparisons; MD = −4.71 mmHg, 95% CI −5.75 to −3.68; *P* < 0.001; *I* 2 = 92.1%) . Subgroup analyses showed that various exercise modalities significantly lowered both systolic and diastolic blood pressure. Meta-regression indicated that baseline blood pressure was significantly associated with systolic blood pressure reduction ( *P* = 0.01), whereas age, exercise frequency, and intervention duration were not. Exploratory nonlinear meta-regression suggested a possible nonlinear pattern between weekly exercise dose and SBP reduction; however, the overall moderating effect was not statistically significant, and no definitive dose–response relationship was established. Conclusion Aerobic exercise significantly reduces systolic and diastolic blood pressure in individuals with hypertension. Greater benefits may be observed in males and in those with higher baseline blood pressure, whereas the dose–response relationship between weekly exercise dose and blood pressure reduction remains uncertain. These findings support aerobic exercise as an important non-pharmacological intervention in the management of hypertension.