Skip to main content


Log in

Effectiveness of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in Hypertensive Patients: a Systematic Review and Meta-Analysis

  • Guidelines / Clinical Trials/Meta-Analysis (WJ Kostis, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript


Purpose of Review

The purpose of this meta-analysis is to compare the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on blood pressure of hypertensive individuals.

Recent Findings

Continuous aerobic training programs are successful in health promotion and are effective in systolic blood pressure (SBP) and diastolic blood pressure (DBP) modulation. However, HIIT seems to be superior to MICT to improvement of cardiorespiratory fitness.


PubMed, ScienceDirect, and Google Scholar were searched for randomized clinical trials that compared chronic effects of HIIT and MICT on BP in hypertensive subjects. Pre- and post-intervention changes in maximal oxygen uptake (VO2max) between MICT and HIIT were analyzed. Both interventions presented significant differences in SBP (MICT: mean difference (MD), 3.7 mmHg [95% CI = 2.57, 4.82], p < 0.00001; and HIIT: MD, 5.64 mmHg [95% CI = 1.69, 9.52], p = 0.005) and in DBP (MICT: MD, 2.41 mmHg [95% CI = 1.09, 3.72], p = 0.0003; and HIIT: MD, 4.8 mmHg [95% CI = 2.9, 6.7], p < 0.00001) compared with the control group. No differences were found in the SBP values (MD, 1.13 mmHg [95% CI = − 0.01, 2.27], p = 0.05); however, differences were found between groups in DBP (MD, 1.63 mmHg [95% CI = 0.83, 2.44], p = 0.0001). In the secondary outcome, both interventions increased VO2max in comparison with control groups (MICT: MD, 1.30 ml/kg/min [95% CI = 0.92, 1.68], p < 0.00001; and HIIT: MD, 4.90 ml/kg/min [95% CI = 3.77, 6.04], p < 0.00001), and HIIT promoted greater improvement than MICT (MD, 2.52 ml/kg/min [95% CI = 1.90, 3.13], p < 0.0001). In conclusion, HIIT and MICT promote reduction in SBP in adults with hypertension, and HIIT showed a greater magnitude in DBP reduction. For hypertensive patients, HIIT may be associated with a greater improvement in VO2max than MICT might.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Molmen-Hansen HE, Stolen T, Tjonna AE, Aamot IL, Ekeberg IS, Tyldum GA, et al. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. Eur J Prev Cardiol. 2012;19:151–60.

  2. Costa EC, Hay JL, Kehler DS, Boreskie KF, Arora RC, Umpierre D, et al. Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in adults with pre- to established hypertension: a systematic review and meta-analysis of randomized trials. Sport Med [Internet] Springer International Publishing. 2018;48:2127–42. recently published and very useful metaanalysis is one of the pioneers in comparing the efficiency between high-intensity interval training and moderate-intensity continuous training in dropping blood pressure.

  3. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004 - BHS IV. J Hum Hypertens. 2004;18:139–85.

  4. Bakker EA, Sui X, Brellenthin AG, Lee DC. Physical activity and fitness for the prevention of hypertension. Curr Opin Cardiol. 2018;33:394–401.

    Article  Google Scholar 

  5. Huang G, Shi X, Gibson CA, Huang SC, Coudret NA, Ehlman MC. Controlled aerobic exercise training reduces resting blood pressure in sedentary older adults. Blood Press. 2013;22:386–94.

    Article  Google Scholar 

  6. Kokkinos P, Manolis A, Pittaras A, Doumas M, Giannelou A, Panagiotakos DB, et al. Exercise capacity and mortality in hypertensive men with and without additional risk factors. Hypertension. 2009;53:494–9.

  7. Ismail H, McFarlane JR, Nojoumian AH, Dieberg G, Smart NA. Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure. A systematic review and meta-analysis. JACC Hear Fail. 2013;1:514–22.

  8. Adams SC, DeLorey DS, Davenport MH, Stickland MK, Fairey AS, North S, et al. Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: a phase 2 randomized controlled trial. Cancer. 2017;123:4057–65.

  9. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: a meta- analysis of randomized controlled trials. Hypertension. 2000;35:838–43.

  10. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46:667–75.

    Article  CAS  Google Scholar 

  11. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2. Available from:

  12. Rognmo Ø, Hetland E, Helgerud J, Hoff J, Slørdahl SA. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil. 2004;11:216–22 This original scientific paper suggests that highintensity aerobic interval exercise is superior to moderate exercise for increasing VO2 peak in stable coronary artery disease patients.

  13. Jung ME, Bourne JE, Beauchamp MR, Robinson E, Little JP. High-intensity interval training as an efficacious alternative to moderate-intensity continuous training for adults with prediabetes. J Diabetes Res [Internet]. 2015;2015 Available from:

  14. dos Santos RZ, Bundchen DC, Amboni R, dos Santos MB, Ghisi GL d M, Herdy AH, et al. Treinamento aeróbio intenso promove redução da pressão arterial em hipertensos. Rev Bras Med Esporte. 2015;21:292–6.

    Article  Google Scholar 

  15. Cook, Nancy R.; Cohen, Jerome; Hebert, Patricia R.; Taylor, James; Hennekens CH. Implications of small reductions in diastolic blood pressure for Primary Prevention. Arch Intern Med.1995;155:701–9. Available from:

  16. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.

  17. Pagonas N, Vlatsas S, Bauer F, Seibert FS, Zidek W, Babel N, et al. Aerobic versus isometric handgrip exercise in hypertension: a randomized controlled trial. J Hypertens. 2017;35:2199–2206.

  18. Sikiru L, Okoye GC. Effect of interval training programme on pulse pressure in the management of hypertension: a randomized controlled trial. Afr Health Sci. 2013;13:571–578.

  19. Ciolac EG, Bocchi EA, Bortolotto LA, Carvalho VO, Greve JMD, Guimarães GV. Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertens Res. 2010;33:836–43.

    Article  CAS  Google Scholar 

  20. Mitranun W, Deerochanawong C, Tanaka H, Suksom D. Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sport. 2014;24. Available from:

  21. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement (Reprinted from Annals of Internal Medicine). Ann Intern Med. 2009;151:264–9.

    Article  Google Scholar 

  22. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–1324. Available from: guideline statement emphasizes the classification of blood pressure and non-farmacological interventions, behind the importance of out-of-office blood pressure measurement in establishing the diagnosis of hypertension and in assessing the effects of therapy.

  23. Santos C, Pimenta C, Nobre M. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-am Enferm. 2007;15:508–11. Available from:

  24. Tjønna AE, Lee SJ, Rognmo Ø, Stølen TO, Bye A, Haram PM, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118:346–54. Available from:

  25. Ramos JS, Dalleck LC, Borrani F, Beetham KS, Mielke GI, Dias KA, et al. High-intensity interval training and cardiac autonomic control in individuals with metabolic syndrome: a randomised trial. Int J Cardiol [internet] Elsevier Ireland Ltd. 2017;245:245–52. This was a substudy of the Exercise in prevention of Metabolic Syndrome (EX-MET) multicenter trial, reporting data collected at the Brisbane site, which investigated many different HIIT volumes to reduce the severity of the metabolic syndrome.

  26. Smart NA, Waldron M, Ismail H, Giallauria F, Vigorito C, Cornelissen V, et al. Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Healthc. 2015;13:9–18.

  27. Cheema BS, Davies TB, Stewart M, Papalia S, Atlantis E. The feasibility and effectiveness of high-intensity boxing training versus moderate-intensity brisk walking in adults with abdominal obesity: a pilot study. BMC Sports Sci Med Rehabil. 2015;7. Available from:

  28. Fu TC, Wang CH, Lin PS, Hsu CC, Cherng WJ, Huang SC, et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol [Internet] Elsevier Ireland Ltd. 2013;167:41–50.

  29. Iellamo F, Caminiti G, Sposato B, Vitale C, Massaro M, Rosano G, et al. Effect of high-intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure. Intern Emerg Med. 2014;9:547–52 This study had a high evaltuation on TESTEX scale, which gives the assessment of study quality and reporting of included studies and evaluated the effect of different intensities exercise training on 24-h ambulatory blood pressure profile in patients with chronic heart failure.

  30. Guimarães GV, Ciolac EG, Carvalho VO, D’Avila VM, Bortolotto LA, Bocchi EA. Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertens Res. 2010;33:627–32. Available from: This original article presents a high evaluation on TESTEX scale, which gives the assessment of study quality and reporting of included studies, and used the ambulatory blood pressure monitoring.

  31. Gorostegi-Anduaga I, Corres P, MartinezAguirre-Betolaza A, Pérez-Asenjo J, Aispuru GR, Fryer SM, et al. Effects of different aerobic exercise programmes with nutritional intervention in sedentary adults with overweight/obesity and hypertension: EXERDIET-HTA study. Eur J Prev Cardiol. 2018;25:343–53 This EXERDIET-HTA study had a large sample size and changes in blood pressure as a primary outcome.

  32. Nemoto, Ken-Ichi; Hirokazu, Gen-No; Shizue, Masuki; Kazunobu O, Hiroshi N. Effects of high-intensity interval walking training on physical fitness. Mayo Clin Proc. 2007;82:803–11.

  33. Tashiro E, Miura S-I, Koga M, Sasaguri M, Ideishi M, Ikeda M, et al. Crossover comparison between the depressor effects of low and high work-rate exercise in mild hypertension. Clin Exp Pharmacol Physiol. 1993;20:689–96.

    Article  CAS  Google Scholar 

  34. Angadi SS, Mookadam F, Lee CD, Tucker WJ, Haykowsky MJ, Gaesser GA. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study. J Appl Physiol [Internet]. 2015;119:753–8 Available from: original article presents a high evaluation on TESTEX scale, which gives the assessment of study quality and reporting of included studies.

  35. Mohr M, Nordsborg NB, Lindenskov A, Steinholm H, Nielsen HP, Mortensen J, et al. High-intensity intermittent swimming improves cardiovascular health status for women with mild hypertension. Biomed Res Int Hindawi Publishing Corporation. 2014;2014. Available from:

  36. Larsen MK, Matchkov VV. Hypertension and physical exercise: the role of oxidative stress. Med [Internet] The Lithuanian University of Health Sciences. 2016;52:19–27. Available from:.

    Article  Google Scholar 

  37. Borjesson M, Onerup A, Lundqvist S, Dahlof B. Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs. Br J Sports Med. 2016;50:356–61.

    Article  Google Scholar 

  38. Schultz MG, Sharman JE. Exercise hypertension. Pulse [Internet]. 2013;1:161–76 Available from:

    Article  Google Scholar 

  39. Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sport Med. 2015;45:679–92.

  40. Ostman C, Smart NA, Morcos D, Duller A, Ridley W, Jewiss D. The effect of exercise training on clinical outcomes in patients with the metabolic syndrome: a systematic review and meta-analysis. Cardiovasc Diabetol BioMed Central. 2017;16:1–11.

    Article  Google Scholar 

  41. Schjerve IE, Tyldum GA, Tjønna AE, Stølen T, Loennechen JP, Hansen HEM, et al. Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults. Clin Sci (Lond). 2008;115:283–93.

  42. Currie KD, Dubberley JB, McKelvie RS, Macdonald MJ. Low-volume, high-intensity interval training in patients with CAD. Med Sci Sports Exerc. 2013;45:1436–42.

    Article  Google Scholar 

  43. Lee DC, Sui X, Artero EG, Lee IM, Church TS, PA MA, et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men the Aerobics Center Longitudinal Study. Circulation. 2011;124:2483–90. Available from:

  44. Musameh MD, Nelson CP, Gracey J, Tobin M, Tomaszewski M, Samani NJ. Determinants of day-night difference in blood pressure, a comparison with determinants of daytime and night-time blood pressure. J Hum Hypertens. 2017;31:43–48. Available from:

  45. Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G, et al. Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension. 2007;50:325–32. Available from:

  46. Way KL, Sultana RN, Sabag A, Baker MK, Johnson NA. The effect of high intensity interval training versus moderate intensity continuous training on arterial stiffness and 24 h blood pressure responses: a systematic review and meta-analysis. J Sci Med Sport. 2019;22:385–391 This very recently published meta-analysis describes the comparison between high-intensity interval training and moderateintensity continuous training in dropping blood pressure, and emphasizes the 24h blood pressure responses.

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Juliana Moraes Leal.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Guidelines / Clinical Trials/Meta-Analysis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leal, J.M., Galliano, L.M. & Del Vecchio, F.B. Effectiveness of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in Hypertensive Patients: a Systematic Review and Meta-Analysis. Curr Hypertens Rep 22, 26 (2020).

Download citation

  • Published:

  • DOI: