title: Will Exercise Advice Be Sufficient for Treatment of Young Adults With Prehypertension and Hypertension? A Systematic Review and Meta-Analysis.
abstract: Previous studies report benefits of exercise for blood pressure control in middle age and older adults, but longer-term effectiveness in younger adults is not well established. We performed a systematic review and meta-analysis of published randomized control trials with meta-regression of potential effect modifiers. An information specialist completed a comprehensive search of available data sources, including studies published up to June 2015. Authors applied strict inclusion and exclusion criteria to screen 9524 titles. Eligible studies recruited younger adults with a cardiovascular risk factor (with at least 25% of cohort aged 18-40 years); the intervention had a defined physical activity strategy and reported blood pressure as primary or secondary outcome. Meta-analysis included 14 studies randomizing 3614 participants, mean age 42.2±6.3 (SD) years. At 3 to 6 months, exercise was associated with a reduction in systolic blood pressure of -4.40 mm Hg (95% confidence interval, -5.78 to -3.01) and in diastolic blood pressure of -4.17 mm Hg (95% confidence interval, -5.42 to -2.93). Intervention effect was not significantly influenced by baseline blood pressure, body weight, or subsequent weight loss. Observed intervention effect was lost after 12 months of follow-up with no reported benefit over control, mean difference in systolic blood pressure -1.02 mm Hg (95% confidence interval, -2.34 to 0.29), and in diastolic blood pressure -0.91 mm Hg (95% confidence interval, -1.85 to 0.02). Current exercise guidance provided to reduce blood pressure in younger adults is unlikely to benefit long-term cardiovascular risk. There is need for continued research to improve age-specific strategies and recommendations for hypertension prevention and management in young adults.
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.). wilby.williamson@cardiov.ox.ac.uk.
authors.forename: Wilby
authors.initials: W
authors.lastname: Williamson
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Charlie
authors.initials: C
authors.lastname: Foster
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Hamish
authors.initials: H
authors.lastname: Reid
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Adam James
authors.initials: AJ
authors.lastname: Lewandowski
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Henry
authors.initials: H
authors.lastname: Boardman
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Nia
authors.initials: N
authors.lastname: Roberts
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: David
authors.initials: D
authors.lastname: McCartney
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Odaro
authors.initials: O
authors.lastname: Huckstep
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Julia
authors.initials: J
authors.lastname: Newton
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Helen
authors.initials: H
authors.lastname: Dawes
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Gerry
authors.affiliation: From the Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine (W.W., A.J.L., H.B., O.H., P.L.), British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health (C.F., H.R.), Bodleian Health Care Libraries (N.R.), Department of Primary Care Health Sciences (D.M.C.), Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (J.N.), and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, Oxford, United Kingdom; Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (P.K.); and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom (H.D.).
authors.forename: Paul
authors.initials: P
authors.lastname: Leeson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001795:Blood Pressure Determination / Q000379:methods*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D058246:Prehypertension / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
keywords: cardiovascular disease; exercise; hypertension; lifestyle; meta-analysis