Key result
Isometric handgrip training reduces awake ambulatory systolic BP by ~2 mmHg compared with control.
Why the study?
The comparative effects of upper-limb (handgrip) and lower-limb (knee extension) isometric training on ambulatory blood pressure in individuals with controlled hypertension required evaluation.
Does 4 weeks of supervised upper-limb (handgrip) or lower-limb (knee extension) isometric exercise training reduce 24-hour, awake, and sleep ambulatory blood pressure compared with a non-exercise control group in adults with controlled hypertension receiving antihypertensive medication?
RCT (n=67)
Single-blind (assessor-blinded)
1:1:1 simple randomization
No
Does 4 weeks of supervised upper-limb (handgrip) or lower-limb (knee extension) isometric exercise training reduce 24-hour, awake, and sleep ambulatory blood pressure compared with a non-exercise control group in adults with controlled hypertension receiving antihypertensive medication?
Four weeks of supervised isometric handgrip training modestly reduced awake ambulatory systolic and diastolic blood pressure in medicated hypertensive adults compared to control, whereas larger muscle mass knee extension training did not yield superior or statistically significant ambulatory blood pressure reductions.
Modest awake BP reductions support adjunctive handgrip training in medicated hypertension; extends RCT evidence for isometric exercise on ambulatory measures.
We compared the effects of upper-limb (handgrip) and lower-limb (knee extension) isometric training on ambulatory blood pressure in individuals with controlled hypertension. In this randomized controlled trial, 67 adults receiving antihypertensive medication were allocated to a control group (CG, n = 22), small muscle mass isometric training (SMM, handgrip; n = 22), or large muscle mass isometric training (LMM, knee extension; n = 23). Participants completed 12 supervised sessions over 4 weeks, with the exercise protocols performed at 30% of upper-limb MVC or lower-limb maximal isometric load, respectively. Ambulatory blood pressure outcomes were compared using analysis of covariance (ANCOVA), adjusting for the corresponding baseline office blood pressure. Hourly 24-h profiles were analyzed using generalized estimating equations with Bonferroni-adjusted post hoc tests. Significant between-group differences were observed only for awake ambulatory blood pressure. Compared with CG, SMM showed lower awake systolic blood pressure (121.8 ± 3.1 vs. 124.2 ± 2.6 mmHg; p = 0.017) and awake diastolic blood pressure (76.3 ± 3.6 vs. 80.8 ± 4.2 mmHg; p = 0.009). No significant differences were observed between LMM and CG, between the two exercise groups, or for 24-h and sleep blood pressure. These findings indicate that, after 4 weeks of supervised isometric training, modest between-group differences in awake ambulatory blood pressure were observed only for handgrip training compared with the control group. Greater muscle mass recruitment did not result in superior antihypertensive effects, suggesting that the chronic blood pressure response to isometric exercise is not determined solely by the amount of muscle mass involved. Trial registration: "ClinicalTrials.gov," "NCT07147595."
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Oliveira et al. (2026) conducted an RCT in Controlled hypertension (n=67). Isometric handgrip training (small muscle mass) or isometric knee extension training (large muscle mass) vs. Seated rest control group (no exercise) was evaluated on Awake ambulatory systolic blood pressure (mmHg) (MD -2.4 mmHg, p=0.017). Four weeks of isometric handgrip training resulted in lower awake ambulatory systolic (121.8 vs 124.2 mmHg; p=0.017) and diastolic (76.3 vs 80.8 mmHg; p=0.009) blood pressure compared with control.
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