Abstract
Background: Hypertension is highly prevalent globally but controlling hypertension with medication alone is challenging. Resistant hypertension, a special hypertension phenotype, is even more challenging to manage. Use of aerobic exercise is supported by high grade evidence as a therapeutic modality to reduce blood pressure in hypertension thereby reducing cardiovascular risk. Further, the new hypertension guidelines strongly recommend exercise to reduce blood pressure. However publications of trials investigating effectiveness of exercise in resistant hypertension are limited and no systematic review has been published to date. Objectives: To identify the level of evidence for the effectiveness of exercise and physical activity in managing blood pressure in adults with resistant hypertension. Methods: Studies published in Scopus, MEDLINE, CINHAL, Web of Science, Embase and SPORTDiscus databases; and unpublished studies in Open Grey, Current Control Trials, ClinicalTrials.gov, Cos Conference Papers Index and the WHO International Clinical Trials Registry Platform will be searched. Two reviewers will independently review the studies. Results: The following will be reported: methodological quality of the selected full texts assessed using Cochrane risk of bias tools (RoB-2 and ROBINS-I) for randomised and non-randomised trials; clinical heterogeneity and sensitivity analysed using Review Manager (RevMan) software; outcomes of detected and/orAQ2 correct reporting and publication bias described in Funnel plots and Begg's rank correlation/Edgar's regression tests; and results of quality of the evidence described using the Recommendation Assessment, Development and Evaluation (GRADE) tool. Types of exercise will be described in sub-groupings. Conclusions: Strength of the literature for exercise therapy for resistant hypertension will be identified.