Objective To compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension. Data sources PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library. Eligibility criteria Randomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses. Design A systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system. Outcome The BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other. Results Twelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone. Conclusions The combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone. PROSPERO registration number The protocol is registered at PROSPERO CRD42020181754.

中文翻译：

---

运动和降压药物对血压的综合影响是否加起来呢？系统的元审查

目的比较单独运动（EXalone），单独使用药物（MEDSalone）和联合（EX + MEDScombined）对高血压成年人的血压（BP）影响。数据来源PubMed，Scopus，护理和相关健康文献累积索引，SPORTDiscus和Cochrane图书馆。资格标准对照试验的随机对照试验（RCTs）或荟萃分析（MAs）：（1）涉及18岁以上健康成年人的高血压；（2）调查运动与血压；（3）报告了干预前和干预后BP，而（4）用英语发表。RCT具有EX + MEDS组合臂；和一个EXalone臂和/或一个MEDSalone臂；MA进行主持人分析。设计系统的网络MA和meta审查，并使用《美国人体育锻炼指南》咨询委员会系统对证据进行分级。结果将EXalone，MEDSalone和EX + MEDS的BP响应组合在一起并进行了比较。结果12项RCT符合342名受试者（60％为女性）的资格，这些受试者大多身体不活跃，中年至老年人。有13个合格的MA，有28468名参与者（女性占50％），其中大多数是白种人或亚洲人。大多数RCT是有氧运动（占83.3％），而MA涉及传统运动类型（占46％）和替代运动类型（占54％）。有力的证据表明，EXalone，MEDSalone和EX + MEDScombined降低BP，而EX + MEDScombined引起的BP降低小于其总和。有力的证据表明EX + MEDS联合可增强MEDSalone的BP效果。尽管有证据表明替代疗法比传统运动更为有效，但EXalone的血压降低幅度比MEDSalone更大。结论运动和药物的联合BP效果不是相加或协同的，但组合起来可增强MEDSalone的降压作用。PROSPERO注册号该协议已在PROSPERO CRD42020181754注册。