Tai chi more effective than aerobic exercise for BP lowering in prehypertension


In a Chinese prospective RCT, 12 months of tai chi decreased systolic blood pressure (BP), but not diastolic BP, in individuals with prehypertension compared with aerobic exercise.

This summary is based on the publication of Li X, Chang P, Wu M, et al. - Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension: A Randomized Clinical Trial. JAMA Netw Open. 2024 Feb 5;7(2):e2354937. doi: 10.1001/jamanetworkopen.2023.5493

Introduction and methods


Recent studies have suggested exercise interventions can reduce blood pressure (BP) in individuals with hypertension or prehypertension [1-3]. Although the American College of Sports Medicine and the American Heart Association recommend aerobic exercise for BP reduction [4], it has its drawbacks, such as the need for sufficient space and the risk of joint damage. Tai chi is a Chinese mind–body exercise that reduces BP and improves balance and cardiopulmonary function [2,5-9].

Aim of the study

The study aim was to assess the efficacy of tai chi versus aerobic exercise for BP lowering in individuals with prehypertension.


In a prospective, single-blinded RCT conducted at 2 tertiary public hospitals in China, 342 treatment-naïve adults (aged 18–65 years) with prehypertension, defined as systolic BP (SBP) 120–139 mmHg and/or diastolic BP (DBP) 80–89 mmHg, were randomized to a tai chi training program or moderate-intensity aerobic exercise training program. Both groups participated in 60-minute supervised training sessions 4 times per week for 12 months. Exclusion criteria were, among others, TD1, TD2, coronary heart disease, and CKD (eGFR <60 mL/min).


The primary endpoint was the change in SBP in the office setting from baseline to 12 months. Secondary endpoints included changes in office SBP at 6 months, office DBP at 6 and 12 months, 24-hour ambulatory BP at 12 months, lipid profile, and metabolic parameters.

Other assessments included the mean daily caloric intake over the last 7 days, 1-week total physical activity, and safety evaluations.

Main results

  • At 12 months, the mean change in office SBP from baseline (i.e., primary endpoint) was –7.01 mmHg (SD: 10.12) in the tai chi group (n=173) and –4.61 mmHg (SD: 8.47) in the aerobic exercise group (n=169) (mean difference: –2.40 mmHg; 95%CI: –4.39 to –0.41; P=0.02).
  • The mean change in office SBP at 6 months was −6.18 mmHg (SD: 8.00) in the tai chi group and −3.88 mmHg (SD: 7.30) in the aerobic exercise group (mean difference: –2.31 mmHg; 95%CI:–3.94 to –0.67; P=0.006).
  • There were no significant differences between the groups in the mean change in office DBP at 6 months (mean difference: −0.92 mmHg; 95%CI: −1.86 to 0.01; P=0.052) and 12 months (mean difference: −1.17 mmHg; 95%CI: −2.53 to 0.19; P=0.09).
  • The mean reduction in 24-hour ambulatory SBP at 12 months was greater in the tai chi group compared with the aerobic exercise group (mean difference: –2.16 mmHg; 95%CI: –3.84 to –0.47; P=0.01), as was the mean change in nighttime ambulatory SBP at 12 months (mean difference: –4.08 mmHg; 95%CI: –6.59 to –1.57; P=0.002).
  • There were no significant between-group differences in the mean changes in 24-hour ambulatory DBP, daytime ambulatory SBP, and daytime or nighttime ambulatory DBP, nor in the lipid profile, metabolic parameters, mean daily caloric intake and total physical activity.
  • During the study, no serious adverse events or complications were reported.


In this Chinese, prospective, bicenter RCT, 12 months of tai chi decreased office SBP, as well as 24-hour and nighttime ambulatory SBP, in individuals with prehypertension compared with aerobic exercise. However, there were no differences in DBP (measured either in the office or ambulatory). The authors conclude their “findings support the important public health value of tai chi to promote the prevention of cardiovascular disease in populations with prehypertension.”

Find this article online at JAMA Netw Open.


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  2. Chan AWK, Chair SY, Lee DTF, et al. Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: a randomised controlled trial. Int J Nurs Stud. 2018;88:44-52. doi:10.1016/j.ijnurstu.2018.08.009
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