Key takeaways:

• Compared with aerobic exercise, tai chi was better for reducing office systolic blood pressure.
• Participants with prehypertension also had greater drops in 24-hour ambulatory and nighttime BP with tai chi.

Among adults with prehypertension, 12 months of tai chi significantly decreased office systolic BP by a mean of 2.4 mm Hg more than aerobic exercise, along with greater reductions in 24-hour and nighttime ambulatory systolic BP, data show.

“As a safe, moderate-intensity, multimodal mind-body exercise, tai chi uses a progressive approach that guides individuals to concentrate on slow and fluid movements,” Yanwei Xing, MD, of the China Academy of Chinese Medical Sciences and Guang’anmen Hospital, Beijing, and colleagues wrote in JAMA Network Open. “Tai chi is suitable for people of all ages and physical conditions to practice. From the perspective of implementation, a tai chi program is easy to introduce and practice in community settings, thereby providing primary care for populations with prehypertension.”

In a prospective, randomized trial, Xing and colleagues analyzed data from 342 adults with prehypertension, defined as a systolic BP of 120 mm Hg to 139 mm Hg and/or a diastolic BP of 80 mm Hg to 89 mm Hg. The mean age of patients was 49 years; 48.5% were men. Researchers randomly assigned participants to a tai chi group (n = 173) or an aerobic exercise group (n = 169). Participants in both groups performed four 60-minute supervised sessions per week for 12 months.

“In both groups, each session consisted of a 10-minute warm-up, 40 minutes of core exercises, and a 10-minute cool-down activity,” the researchers wrote. “The 24-form Yang-style tai chi, consisting of 24 standard movements, was adopted for the tai chi intervention. Aerobic exercise interventions included climbing stairs, jogging, brisk walking and cycling.”

The primary outcome was office systolic BP at 12 months; secondary outcomes included office and ambulatory systolic BP at 6 and 12 months.

At 12 months, systolic BP decreased by a mean of –7.01 mm Hg for participants in the tai chi group and by a mean of –4.61 mm Hg for participants in the aerobic exercise group, for a difference of –2.4 mm Hg (95% CI, –4.39 to –0.41; P = .02).

The between-group difference was similar at 6 months, also favoring tai chi (–2.31; 95% CI, –3.94 to –0.67; P = .006). The mean reduction in 24-hour ambulatory systolic BP at 12 months was greater for the tai chi group vs. the aerobic exercise group (–2.16; 95% CI, –3.84 to –0.47; P = .01), as was nighttime ambulatory systolic BP (4.08; 95% CI, 6.59 to 1.57; P = .002).

The overall mean attendance rates of the tai chi and aerobic exercise groups during the 12 months of intervention were 87.3% and 85.7%, respectively.

“Our study provides additional important findings,” the researchers wrote. “First, the 24-hour ambulatory and nighttime ambulatory systolic BP of the tai chi group were significantly reduced. Second, a significant decrease in nighttime ambulatory pulse rate was observed in the tai chi group in our study. One potential explanation is that tai chi may play an important role in reducing sympathetic excitability. A previous study showed that tai chi exercise might produce a relaxing effect, enhance vagal modulation and decrease sympathetic modulation. Third, the systolic BP load of the tai chi group was significantly reduced.”