BACKGROUND: Although exercise training reduces office blood pressure (BP), scarcer evidence is available on whether these benefits also apply to ambulatory blood pressure (ABP), which is a stronger predictor of cardiovascular disease and mortality. The present study aims to assess the effects of exercise training on ABP in patients with hypertension based on evidence from randomized controlled trials. METHODS AND RESULTS: A systematic search of randomized controlled trials on the aforementioned topic was conducted in PubMed and Scopus (since inception to April 1, 2020). The mean difference between interventions (along with 95% CI) for systolic BP and diastolic BP was assessed using a random-effects model. Sub-analyses were performed attending to (1) whether participants were taking antihypertensive drugs and (2) exercise modalities. Fifteen studies (including 910 participants with hypertension) met the inclusion criteria. Interventions lasted 8 to 24 weeks (3 to 5 sessions/week). Exercise significantly reduced 24-hour (systolic BP -5.4 mmHg; (95% CI -9.2 to -1.6); diastolic BP -3.0 mmHg (-5.4 to -0.6)), daytime (systolic BP -4.5 mmHg (-6.6 to -2.3); diastolic BP -3.2 mmHg (-4.8 to -1.5)), and nighttime ABP (systolic BP -4.7 mmHg (-8.4 to -1.0); diastolic BP -3.1 mmHg (-5.3 to -0.9)). In separate analyses, exercise benefits on all ABP measures were significant for patients taking medication (all p < 0.05) but not for untreated patients (although differences between medicated and non-medicated patients were not significant), and only aerobic exercise provided significant benefits (p < 0.05). CONCLUSIONS: Aerobic exercise is an effective coadjuvant treatment for reducing ABP in medicated patients with hypertension.

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