Our study has limitations. We could not perform a
multivariate meta-regression analysis because data were
missing for important covariables, such as ethnicity (17
trials) and hypertensive status (7 trials). We did, however,
conduct subgroup analyses based on these important
covariables. Aerobic exercise had a slightly greater
effect on blood pressure in hypertensive participants
than in normotensive participants. The reduction was
greater for systolic blood pressure in black persons and
for diastolic blood pressure in Asian persons, but only a
relatively small number of trials were conducted in persons
of these ethnic backgrounds. In addition, all but
one trial included in our meta-analysis used an open
design. However, many trials masked observers who obtained
blood pressure measures. We identified a potential
publication bias by funnel-plot method. Several
large trials reported a moderate reduction in blood pressure.
However, blood pressure was not the primary outcome
of interest in most of these trials (23, 26, 30).
Furthermore, in a formal test using the “trim and fill”
method, reductions in systolic and diastolic blood pressure
remained unchanged.
The underlying mechanism or mechanisms responsible
for an exercise-induced reduction in blood pressure
remain unclear. Recent evidence shows that insulin resistance
and hyperinsulinemia may contribute to the
pathogenesis of hypertension (56, 57). Clinical trials
have shown that aerobic exercise reduces insulin resistance
and insulin levels in hypertensive patients (58,
59). Brett and associates (60) have reported that change
in blood pressure during exercise is strongly associated
with reduction in serum concentrations of to
Our study has limitations. We could not perform amultivariate meta-regression analysis because data weremissing for important covariables, such as ethnicity (17trials) and hypertensive status (7 trials). We did, however,conduct subgroup analyses based on these importantcovariables. Aerobic exercise had a slightly greatereffect on blood pressure in hypertensive participantsthan in normotensive participants. The reduction wasgreater for systolic blood pressure in black persons andfor diastolic blood pressure in Asian persons, but only arelatively small number of trials were conducted in personsof these ethnic backgrounds. In addition, all butone trial included in our meta-analysis used an opendesign. However, many trials masked observers who obtainedblood pressure measures. We identified a potentialpublication bias by funnel-plot method. Severallarge trials reported a moderate reduction in blood pressure.However, blood pressure was not the primary outcomeof interest in most of these trials (23, 26, 30).Furthermore, in a formal test using the “trim and fill”method, reductions in systolic and diastolic blood pressureremained unchanged.The underlying mechanism or mechanisms responsiblefor an exercise-induced reduction in blood pressureremain unclear. Recent evidence shows that insulin resistanceand hyperinsulinemia may contribute to thepathogenesis of hypertension (56, 57). Clinical trialsแสดงให้เห็นว่า ออกกำลังกายแอโรบิกช่วยลดความต้านทานต่ออินซูลินและระดับอินซูลินในผู้ป่วยความดันโลหิตสูง (5859) . Brett และบริษัทร่วม (60) ได้รายงานการเปลี่ยนแปลงในเลือด ความดันระหว่างออกกำลังกายจะขอเชื่อมโยงลดความเข้มข้นซีรั่มของการ
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