Abstract
INTRODUCTION: Hypertension is a major public health concern, prevalent among aging populations. We aimed to compare the cardiovascular metabolic effects of four traditional Chinese exercises (Tai Chi, Baduanjin, Wuqinxi, and Yijinjing) in middle-aged and older adults hypertensive patients through network meta-analysis, and provide exercise recommendations for this population. METHODS: Randomized controlled trials of traditional Chinese exercises on cardiovascular health in middle-aged and older adults hypertensive patients were systematically searched in China National Knowledge Infrastructure (CNKI), Wanfang data, Cqvip, Web of Science, PubMed, and Cochrane Library databases from January 2010 to July 2025. 19 studies with 1,501 individuals were selected and analyzed with RevMan 5.3 and Stata 15.1. The primary outcomes were blood pressure measures, lipid profiles (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol), and endothelial function indicators (nitric oxide, endothelin). Surface Under the Cumulative Ranking Area (SUCRA) probability rankings were determined to select best interventions. RESULTS: The SUCRA probability ranking results show that in terms of improving the blood pressure of middle-aged and elderly hypertensive patients, Tai Chi demonstrated the highest probability of being the best intervention for reducing systolic and diastolic blood pressure, with SUCRA values of 86.7% and 79.3% respectively probability (63.6%). DISCUSSION: Tai Chi and BaduanJin demonstrated a relatively high probability of superiority in improving multiple cardiovascular and metabolic indicators of middle-aged and older adults patients with hypertension. These findings support the practical application of traditional Chinese exercise regimens, Tai Chi and Baduanjin, in cardiovascular disease care strategies for middle-aged and older adults hypertensive patients. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD420251141539.