Therapeutic Potential and Mechanistic Pathways of Plant-Based Supplements and Exercise Training in Blood Pressure Management: An Evidence-Based Review and Research Agenda

Hypertension (HTN) remains a leading modifiable risk factor for cardiovascular disease, and non-pharmacological strategies combining exercise training with plant-derived bioactive supplementation are increasingly recognized as promising adjuncts for blood pressure (BP) management. This evidence-based review synthesizes findings from 31 clinical studies investigating selected plant-based supplements with the strongest available clinical evidence, namely beetroot juice (BRJ), green tea (GT), curcumin (CN), resveratrol (RSV), and garlic, administered alone or in combination with different exercise modalities across acute, short-term, and long-term interventions. Collectively, the evidence indicates that BRJ exerts the most consistent BP-lowering effects, particularly during aerobic training performed at ~50% heart rate reserve (HRR), or ~60% peak oxygen consumption (VO_2peak) in individuals with early-stage vascular dysfunction. CN and garlic also enhance exercise-induced BP reductions, especially in older or metabolically compromised populations. GT shows variable outcomes depending on caffeine content, exercise modality, and participant health status, while RSV provides modest vascular support, often contingent on concurrent training. Mechanistically, these botanicals and exercise converge on key vascular-regulatory pathways, including enhanced nitric oxide (NO) bioavailability, reduced oxidative stress and inflammation, attenuated renin-angiotensin-aldosterone system (RAAS) and sympathetic activity, and improved mitochondrial function through Sirtuin 1 (SIRT1)/AMP-activated protein kinase (AMPK) signaling. Together, these integrated mechanisms improve endothelial function, lower vascular resistance, and ultimately reduce BP. From a translational standpoint, combining exercise with targeted plant-based supplementation offers a safe, accessible, and physiologically synergistic strategy for BP control in clinical populations. Future research should define optimal dosing, timing relative to exercise, and population-specific efficacy to inform precision-based, integrative interventions for HTN management.