The Effectiveness of Respiratory Muscle Training on Blood Pressure and Arterial Function in Individuals With High Blood Pressure: A Systematic Review and Meta-Analysis

Background and Purpose: High blood pressure (BP) remains a major contributor to global cardiovascular morbidity, and there is increasing interest in low-cost, home-based interventions to support BP management. Respiratory muscle training, particularly inspiratory muscle training (IMT), may positively influence hemodynamic and vascular function. This systematic review and meta-analysis evaluated the effects of respiratory muscle training on BP, vascular function, and respiratory muscle strength in adults with elevated or high BP. Methods: Following PRISMA 2020 guidelines and a registered PROSPERO protocol (CRD420251025607), five databases were searched for randomized controlled trials examining respiratory or IMT in adults with prehypertension or hypertension. Trials were required to include a comparator group and report BP, vascular outcomes, or respiratory muscle strength. Two reviewers independently completed study selection, data extraction, and risk-of-bias assessment. Random-effects meta-analyses were conducted for systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), maximal inspiratory pressure, and maximal expiratory pressure. Results: Ten trials (n = 298) met the inclusion criteria. Pooled results demonstrated modest reductions in DBP (−4.95 mm Hg) and PP (−7.70 mm Hg), while reductions in SBP (−3.92 mm Hg) were more variable and not statistically significant. IMT produced significant improvements in maximal inspiratory pressure (+25.60 cm H 2 O), whereas maximal expiratory pressure changes were nonsignificant. Two studies demonstrated improvements in endothelial function or reductions in endothelial injury biomarkers. Adherence across studies exceeded 85%, and no serious adverse events were reported. Discussion and Conclusions: IMT seems to be a feasible, safe adjunct intervention that improves inspiratory muscle strength and modestly lowers DBP and PP in adults with elevated or high BP. Variability in SBP responses highlights the need for standardized protocols and larger, longer-term studies. Emerging evidence suggests potential vascular benefits, but methodological heterogeneity limits the ability to draw firm conclusions. Overall, IMT represents a practical option within cardiopulmonary rehabilitation that warrants further investigation to clarify its cardiovascular and vascular impact.