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).

高血压 (BP) 是一项全球性的健康挑战。等长阻力训练 (IRT) 已显示出抗高血压作用，但没有安全性数据，因此限制了其对临床使用的推荐。我们对在血压升高（收缩压≥130 mmHg/舒张压≥85 mmHg）的成人中比较 IRT 与对照组的随机对照试验进行了系统评价。这篇综述提供了办公室血压估计的更新，并且是第一个调查 24 小时动态血压、中心血压和安全性的综述。使用随机效应荟萃分析对数据进行分析。我们使用 Cochrane 偏倚风险工具评估偏倚风险，并使用 GRADE 评估证据质量。包括 24 项试验（n = 1143; 年龄 = 56 ± 9 岁，56% 为女性）。IRT 导致诊室收缩压（–6.97 mmHg，95% CI –8.77 至 –5.18，p  < 0.0001）和诊室舒张压（–3.86 mmHg，95% CI –5.31 至 –2.41，p  < 0.0001）具有临床意义的降低。新发现包括中心收缩压降低（–7.48 mmHg，95% CI –14.89 至 –0.07，p  = 0.035），中心舒张压（–3.75 mmHg，95% CI –6.38 至 –1.12，p  = 0.005）和 24- h 舒张压（–2.39 mmHg，95% CI –4.28 至 –0.40，p  = 0.02）但不是 24 小时收缩压（–2.77 mmHg，95% CI –6.80 至 1.25，p = 0.18)。这些结果的确定性非常低/低，异质性高。IRT 风险、风险比（1.12，95% CI 0.47 至 2.68，p  = 0.8）或风险差异（1.02，95% CI 1.00 至 1.03，p  = 0.13）没有显着增加。这意味着每 38,444 次 IRT 中有一个不良事件。IRT 似乎是安全的，并可能导致临床相关的血压降低（诊室、中心血压和 24 小时舒张压）。需要高质量的试验来提高对这些发现的信心。普罗斯佩罗 (CRD42020201888); OSF (https://doi.org/10.17605/OSF.IO/H58BZ)。