Endothelial dysfunction is an early marker of cardiovascular risk in individuals with prehypertension and hypertension. Flow-mediated dilation (FMD) is a widely used, non-invasive method to assess endothelial function. While exercise can improve FMD the optimal modality, intensity, and volume remain unclear. This network meta-analysis (NMA) compared the effects of different exercise interventions on FMD in this population. An NMA of randomised controlled trials (RCTs) published up to June 2024 was conducted using six databases. Two reviewers independently screened and extracted data. Analysis was performed using Stata 16.0. Twenty-two RCTs (n = 1,353) were included. High-intensity interval training (HIIT), aerobic training (AT), and resistance training (RT) significantly improved FMD. Based on surface under the cumulative ranking (SUCRA), HIIT ranked highest (72.2%), followed by AT (66.1%) and RT (53.5%). Exercise intensity >= 6.0 METs and 3.0 to 5.9 METs showed significant effects, with SUCRA rankings of 92.5% and 68.9%. Weekly volumes of 500 to 1,000 and > 1,000 METs-min were most effective (84.6% and 71.2%, respectively). HIIT, moderate-to-vigorous intensity exercise (>= 3.0 METs), and weekly volumes > 500 METs-min are effective strategies to improve endothelial function in prehypertensive and hypertensive individuals.

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