Abstract
Background: Stretching exercises are strongly recommended as part of exercise training programs; however, their effects on blood pressure (BP) and other related cardiovascular parameters in adult individuals with elevated BP (pre-hypertension) or hypertension remain unclear. Methods: A systematic search was conducted in PubMed and databases accessed via the EBSCO platform up to 30 September 2025, following the PRISMA guidelines. An additional search of Scopus was performed on 8 April 2026. Studies eligible for inclusion were randomized controlled trials, randomized crossover trials, non-randomized clinical trials and single-arm trials investigating stretching interventions in adults with pre-hypertension and or hypertension. Risk of bias assessment was performed using RoB 2 for randomized trials and ROBINS-I for the non-randomized trials. A random-effect meta-analysis was performed when at least two studies reported sufficiently comparable BP outcomes. The quantitative synthesis was considered exploratory. Results: Eleven records published between 2014 and 2025 met the eligibility criteria and were included. All protocols used static stretching, although only a small number were clearly described as active stretching. The results were heterogeneous across the design, duration of intervention and outcomes. Chronic interventions more often reported favorable changes in indices of arterial stiffness, whereas acute interventions demonstrated more variable immediate BP responses. In the exploratory meta-analysis, the pooled estimate suggested a reduction in systolic blood pressure (SBP) in favor of stretching; however, this effect did not reach statistical significance (mean difference (MD) = -5.39 mmHg, 95% confidence interval (CI): -11.32 to 0.53; I(2) = 0%). For diastolic blood pressure (DBP), the pooled estimate favored stretching and reached statistical significance (MD = -3.93 mmHg, 95% CI: -7.25 to -0.60; I(2) = 0%). In sensitivity analyses including a third study, the pooled effects remained in favor of stretching for systolic BP (MD = -6.6 mmHg, 95% CI: -12.2 to -1.0; I(2) = 56%) and diastolic BP (MD = -5.4 mmHg, 95% CI: -7.1 to -3.7; I(2) = 8%). These pooled estimates should be interpreted with caution due to the small number of studies, heterogeneity in study design and participant characteristics, and overall limitations in methodological quality. Secondary findings suggested possible improvements in selected vascular parameters, including brachial-ankle pulse wave velocity, augmentation index, and cardio-ankle vascular index, whereas acute responses were more variable and protocol-dependent. Overall, the level of evidence was limited, with most randomized trials judged as having some concerns and non-randomized studies judged as having a critical risk of bias. Conclusions: Stretching interventions may improve BP and selected vascular parameters in adults with pre-hypertension and hypertension and may represent a practical adjunct within the non-pharmacological management of BP. However, the current evidence is limited by methodological heterogeneity, risk of bias, and the small number of studies available for quantitative synthesis. Therefore, the pooled findings should be considered exploratory and hypothesis-generating rather than definitive. Further high-quality randomized controlled trials are required to determine the optimal type, dose, and long-term clinical relevance of stretching interventions in this population.