Effects of aerobic exercise on blood pressure and lipid profiles in postmenopausal women with hypertension: a systematic review and meta-analysis

Abstract Background Postmenopausal women experience a decline in estrogen levels, which weakens vascular protection, reduces arterial elasticity, and predisposes them to lipid metabolism disorders. Consequently, this population faces an increased risk of hypertension, frequently accompanied by dyslipidemia. Although aerobic exercise is widely recommended as a lifestyle intervention, quantitative evidence regarding its effects in postmenopausal women with hypertension remains inconsistent. This study aimed to systematically evaluate the effects of aerobic exercise on blood pressure and lipid profiles in postmenopausal women with hypertension and to explore potential sources of heterogeneity. Methods This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD420251251858). PubMed, the Cochrane Library, Web of Science, and Embase were searched from inception to January 2, 2026. Randomized controlled trials (RCTs) with an intervention duration of at least 8 weeks were included if participants were postmenopausal women meeting the diagnostic criteria for hypertension (SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg). Eligible interventions consisted of aerobic exercise or exercise programs predominantly based on aerobic training, while control groups received no exercise intervention. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Prespecified subgroup analyses, meta-regression, sensitivity analyses, and assessments of publication bias were performed. Results A total of 23 RCTs encompassing 25 comparisons and 1,135 postmenopausal women with hypertension were included. Compared with control conditions, aerobic exercise significantly reduced systolic blood pressure (MD = − 8.98 mmHg, 95% CI − 11.83 to − 6.12; I ² = 80.9%) and diastolic blood pressure (MD = − 4.64 mmHg, 95% CI − 6.31 to − 2.97; I² = 74.8%), although heterogeneity was substantial. Regarding lipid outcomes, aerobic exercise was associated with an increase in high-density lipoprotein cholesterol (MD = 0.10 mmol/L, 95% CI 0.04 to 0.17; I² = 50.3%), whereas the pooled effect on low-density lipoprotein cholesterol was inconclusive (MD = − 0.11 mmol/L, 95% CI − 0.30 to 0.07; I² = 46.2%). Subgroup analyses indicated that exercise modality was associated with differences in blood pressure responses (between-group P < 0.0001). Meta-regression revealed that higher baseline diastolic blood pressure was associated with greater reductions in diastolic blood pressure (β = −0.31, P = 0.004). Sensitivity analyses confirmed the robustness of the findings, and no significant publication bias was detected (Begg’s and Egger’s tests, both P > 0.05). Overall, the risk of bias was rated as moderate. GRADE assessments indicated that the overall certainty of evidence for the primary outcomes was moderate, with downgrading mainly due to between-study heterogeneity (SBP/DBP/HDL-C) and imprecision (LDL-C). Conclusions In postmenopausal women with hypertension, aerobic exercise confers clinically meaningful reductions in blood pressure and modest improvements in high-density lipoprotein cholesterol, whereas evidence for low-density lipoprotein cholesterol reduction remains inconclusive. Future trials employing more standardized exercise prescriptions and better control of co-interventions are warranted to clarify the magnitude and stability of lipid-related outcomes.