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The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis


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 (

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We would like to thank the authors who provided their adverse event data.


MAW was supported by a Postgraduate Scholarship from the National Health and Medical Research Council of Australia, a School of Medical Sciences Top-Up Scholarship from the University of New South Wales, and a PhD Top-Up Scholarship from Neuroscience Research Australia.

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All authors contributed to the protocol. HJH conducted searches, screening and extraction, analysed the data and drafted the initial manuscript. BJP helped conceive the study, provided valuable clinical expertise. MAW designed the meta-analytic code, assisted with screening and extraction as well as providing valuable methodological expertise. KAM assisted with data extraction and provided clinical expertise. NAS and AES provided valuable content expertise and assistance throughout the project. MDJ conceived the study, helped conduct searches, screening and extraction, provided methodological expertise and assisted in drafting the manuscript. All authors provided valuable input when analysing and interpreting the results, approved the final manuscript and provided valuable input in the style and content.

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Correspondence to Harrison J. Hansford.

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AES reports speaker honoraria from Takeda, Servier, Novartis, and Omron Healthcare and serves as a scientific advisory for Abbott. All other authors declare that they have no conflicts of interest.

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Hansford, H.J., Parmenter, B.J., McLeod, K.A. et al. The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. Hypertens Res 44, 1373–1384 (2021).

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  • Blood pressure
  • Isometric resistance training
  • Exercise
  • Safety

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