Effects of Mixed Aerobic, Resistance, and Combined Training on Blood Pressure in Elderly Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Aerobic (AT) and resistance training (RT) are well established as effective strategies for lowering blood pressure (BP) in patients with hypertension; however, evidence on the impact of combined training (CT; AT and RT) on BP remains limited. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of AT, RT, and CT for reducing BP in older adults with pre-existing or established hypertension. Five electronic databases (PubMed, CENTRAL, SPORTDiscus, Web of Science, and CINAHL) were systematically searched to identify RCTs reporting the effects of AT, RT, and CT on systolic blood pressure (SBP) and diastolic blood pressure (DBP). RCTs published in English, involving hypertensive older adults and available in peer-reviewed journals as of December 2024, were included. A random-effects model was used for the analysis, with 95% confidence intervals (CIs). Nineteen trials were included, totaling 1,253 participants. SBP was reduced following CT (-4.12 (-6.41 to -1.83; p = 0.0004; I² = 94%), AT (standardized mean difference (SMD) = -1.93 (-5.27 to 1.40); p = 0.06; I² = 96%), and RT (SMD = -2.39 (-2.85 to -1.92); p < 0.00001; I² = 27%). DBP was also reduced following CT (SMD = -4.53 (-6.67 to -2.39); p < 0.0001; I² = 95%), AT (SMD = -0.50 (-3.62 to 2.63); p = 0.04; I² = 8%), and RT (SMD = -0.48 (-1.56 to 0.61); p = 0.05; I² = 39%). Compared with AT and RT as standalone interventions, CT showed a greater BP-reducing effect (SMD = -0.98 (-4.76 to 2.81); p = 0.001; I² = 18%); however, this difference was not statistically robust, likely due to the small number of available trials. Although CT lowered BP in older adults with hypertension, very high between-study heterogeneity (I² > 90% in several analyses) limits confidence in these pooled estimates. The effects of AT on BP outcomes were not significantly different from those of RT.