Morning Versus Evening Exercise for Blood Pressure Control in Hypertension: A Systematic Review of Randomized Controlled Trials

Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. While clinical guidelines strongly recommend lifestyle modifications, including exercise, as a core treatment, they currently lack specific recommendations regarding the optimal timing of its administration. Given the circadian regulation of blood pressure (BP), autonomic tone, and vascular function, the timing of exercise may impact BP control. This systematic review aims to synthesize evidence from randomized clinical trials (RCTs) to compare the effects of morning and evening exercise on BP control in hypertensive patients. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Embase from inception to January 2026. We included RCTs involving adult hypertensive patients that compared morning and evening exercise interventions. Outcomes of interest included systolic BP (SBP), diastolic BP (DBP), mean arterial pressure, 24-hour ambulatory BP, nocturnal BP, and post-exercise hypotension (PEH). Five studies, comprising four trials (two long-term parallel RCTs and two short-term crossover RCTs), were included. Long-term interventions indicated that evening exercise was superior to morning exercise in reducing SBP and mean arterial pressure (MAP) in hypertensive men. Short-term interventions yielded conflicting results. However, limited data suggest that morning exercise may be more beneficial for women in reducing SBP and attenuating stress reactivity. The timing of exercise may influence BP control in hypertensive patients. Evening exercise appears to be the optimal strategy for long-term BP reduction in hypertensive men. Conversely, morning exercise may be preferable for women. These findings suggest that exercise recommendations should be tailored individually to each patient. Future efforts should be directed towards long-term studies to better elucidate the effects of morning and evening exercise on BP control.