INTRODUCTION: Hypertension is a common cardiovascular disease, which can lead to severe outcomes without sufficient treatment. Lifestyle modification and exercise have been recommended in the management of hypertension. AIM: In this meta-analysis, we aimed to determine to what extent resistance training can alter blood pressure and identify factors modulating the potential benefits of resistance training. METHODS: We systematically searched PubMed, the Cochrane Library, Scopus, and Web of Science from inception to December 18, 2024, to identify randomized controlled trials comparing the effect of resistance exercise with control intervention on systolic and diastolic blood pressure. A random-effects model (DerSimonian-Laird) was employed to pool data. RESULTS: Fourteen randomized controlled trials with 676 patients with hypertension were included in this meta-analysis. We found that compared to the control intervention, resistance training significantly decreased both systolic blood pressure (weighted mean difference (WMD) -8.61 mm Hg, 95% confidence interval (CI) -13.95 to -3.27, I2 98.74%) and diastolic blood pressure (WMD -4.57 mm Hg, 95% CI -7.26 to -1.89, I2 97.37%). In subgroup analysis, the beneficial effects of resistance training remained statistically significant in all subgroups of age, gender, length of training, and body mass index (BMI). In addition, the beneficial effects of resistance training on blood pressure were much greater in men, those aged more than 60 years, those with BMI > 28 kg/m2, and those undergoing more than 10 weeks of exercise. CONCLUSIONS: These findings support the beneficial effects of resistance training for the management of hypertension, particularly in a selected subgroup of patients.

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