The optimal dose of brisk walking for improving blood pressure in hypertensive patients: a systematic review and bayesian meta-analysis of randomized controlled trials

Background Hypertension is one of the most common chronic diseases worldwide. Brisk walking is regarded as a safe and effective exercise modality for blood pressure reduction; however, its optimal exercise dose remains unclear. This study aims to systematically evaluate the effects of brisk walking on blood pressure in patients with hypertension using a Bayesian meta-analysis, and to determine the dose-response relationship and the optimal exercise dose range. Methods Randomized controlled trials (RCTs) were systematically searched in China National Knowledge Infrastructure (CNKI), VIP Information (VIP), Wanfang Data, CBM, PubMed, EBSCO (MEDLINE), Embase, the Cochrane Library, and Web of Science from database inception to December 30, 2025. Bayesian hierarchical random-effects models were constructed using the brms, metafor, and dosresmeta packages in R software (version 4.4.3) to perform pairwise comparisons and dose-response meta-analyses. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Results A total of 17 RCTs involving 1,493 patients with hypertension were included. Brisk walking significantly reduced systolic blood pressure (Hedges’ g = − 0.48, 95% CrI [−0.54 to −0.43]) and diastolic blood pressure (Hedges’ g = − 0.51, 95% CrI [−0.58 to −0.44]), both representing moderate effect sizes. A “U” shaped dose-response relationship was observed for systolic blood pressure, with the optimal dose at approximately 460 MET (Metabolic Equivalent) ⋅ min/week (Hedges’ g = − 1.00, 95% CrI [−1.54 ∼−0.46]), indicating a large effect size. Diastolic blood pressure exhibited a negative dose–response relationship, with the most significant improvement also observed at approximately 620 MET min/week (Hedges ’ g = − 0.55, 95% CrI [−1.06 ∼−0.03]), corresponding to a substantial effect. Conclusion Brisk walking significantly improves blood pressure in patients with hypertension and demonstrates a precise dose-response relationship. A brisk walking regimen of four sessions per week, ≤ 40 minutes per session, lasting at least 12 weeks, with a total weekly dose of 460–620 MET min/week, is recommended to achieve the most pronounced blood pressure-lowering effects.