Annals of Medicine

2024, VOL. 56, NO. 1, 2320863

https://doi.org/10.1080/07853890.2024.2320863

Comment

Tai Chi training as a primary care plan for the prevention and
management of hypertension: an opinion and positioning article
Ting Zhanga,b, Shuman Yanga, Wei Liuc, Qingping Baic and Song Gaoa
College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China; bUniversity Hospital, Zhejiang Normal
a

University, Jinhua, China; cPhysical Education College, Guangxi University of Science and Technology, Liuzhou, China

ABSTRACT ARTICLE HISTORY

Hypertension is a prevalent chronic condition worldwide that can impact patients’ quality of life. Received 19 October 2023
Oral antihypertensive drugs are widely used to manage high blood pressure, primarily by Revised 13 February 2024
regulating the renin-angiotensin-aldosterone system. Nevertheless, limited efficacy and low Accepted 14 February 2024
compliance represent significant obstacles, arising primarily from dose, duration, and medication
KEYWORDS
type restrictions. Furthermore, the prolonged use of antihypertensive medication may result in
Hypertension; exercise
dependence and adverse effects, without any substantial improvement in achieving targeted therapy; Tai Chi;
blood pressure leves. As a result, research has focused on using exercise therapy to treat prevention and
hypertension. Tai Chi, a widely-practiced Chinese health exercise, has evolved into a form of management; limitations
exercise therapy that might help alleviate the risk associated with hypertension. Therefore, this
article aims to outline the role of Tai Chi in preventing and managing hypertension.

Introduction hypertension aged 45–65 years, and more women than

men having hypertension aged 65 ≥ years [7].
Hypertension, defined as a clinical blood pressure
Oral antihypertensive medications are the most
≥140/90 mmHg, is a common chronic disease with the
common treatment for high blood pressure. Medicines
highest prevalence worldwide [1]. Hypertension causes
are mainly used to treat hypertension by regulating
headaches, dizziness, palpitations, numbness in the
the dysfunction of the renin-angiotensin-aldosterone
limbs and can even cause cerebral hemorrhage [2]. Its
system [8]. However, compliance and effective control
pathological basis is water and sodium retention or
of hypertension are not high due to limitations in the
endothelial damage caused by various factors, and it is
a risk factor for obesity, metabolic syndrome, dyslipid- dose, duration, and type of medication taken. In addi-
emia, and stroke [3,4]. Globally, 31.1% of adults (1.39 tion, long-term use of antihypertensive drugs can lead
billion people) have hypertension [5]. However, changes to dependence and other side effects, with no signifi-
in the prevalence of hypertension have not been uni- cant effect on associated symptoms such as chest
form throughout the world. Over the past two decades, tightness and palpitations [9,10]. Therefore, studies
the prevalence of hypertension has declined slightly in have attempted to improve hypertension with exercise
high-income countries, while it has increased substan- therapy [11,12]. Exercise therapy has significant advan-
tially in low- and middle-income countries [5]. The tages in this regard, with significant efficacy and low
China Hypertension Survey (CHS) showed that in 2015, drug dependence. In the early twentieth century, the
the crude prevalence of hypertension among adults WHO and the International Society of Hypertension
aged ≥18 years in China was 27.9%, with a total preva- revised the guidelines for the treatment of hyperten-
lence of approximately 244.5 million [6]. Epidemiology sion to include exercise as one of the forms of antihy-
shows that there are 80million hypertensive patients pertensive therapy [13]. Long-term cardiorespiratory
aged ≥ 20 years in the U.S. Hypertension is also associ- endurance training is characterized by low intensity, long
ated with gender, with more men than women having duration, and high rhythm, which may be effective in

CONTACT Song Gao [email protected] College of Physical Education and Health Sciences, Zhejiang Normal University, No. 688, Yingbin
Avenue, Wucheng District, Jinhua 321004, China
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the
Accepted Manuscript in a repository by the author(s) or with their consent.
2 T. ZHANG ET AL.

controlling hypertension [14]. Studies have shown that conditions can easily perform Tai Chi training, and only
resistance training lowers blood pressure as much or a common place is needed. Compared with conven-
more than aerobic training [15,16]. However, resistance tional aerobic exercise, Tai Chi training does not require
training involves more forceful movements and special equipment and venues, and the intensity and
patients may experience reactions such as dizziness, difficulty of the exercise are not too high, which makes
nausea and stomach upset, so a pre-assessment of the it easy for patients with hypertensive to practice.
participant’s physical condition is required [17]. The quality of life of patients with hypertension is
The ACSM statement notes that complementary or threatened, and there is an urgent need to find safe
alternative types of neurological exercise, such as yoga, and effective complementary and alternative therapies.
Pilates and Tai Chi, have been shown to lower blood Tai Chi plays an important role in the daily manage-
pressure [18]. Some studies have concluded that ment of chronic diseases, and its value in the preven-
moderate-intensity aerobic exercise is superior to tion and treatment of hypertension deserves further
low-intensity and sustained high-intensity exercise in investigation. Therefore, this paper aims to summarise
preventing and reducing blood pressure [19]. It is the clinical research results of Tai Chi in improving
important to note that the classification of exercise hypertension, analyse the limitations and challenges of
intensity is an artificially defined range, and there are current research, and propose a new direction.
individual differences. Aerobic exercise has been found
to produce more endogenous β-endorphins, which in
Tai Chi for persons with hypertension
turn reduces the hyperexcitability of the sympathetic
nervous system [20,21]. Long-term exercise improves High blood pressure can lead to cardiovascular diseases
vascular endothelial function and reduces plasma such as cerebral hemorrhage, stroke, and heart attack
endothelin levels to relieve the highly constricted state [31]. If a patient is diagnosed with hypertension, he or
of blood vessels [22,23]. Exercise can block the she needs to adhere to antihypertensive medication
over-activation of the renin-angiotensin-aldosterone and good lifestyle habits, such as a low-salt, low-fat diet
system, reduce plasma renin activity, angiotensin II, [32]. In addition, the search for active and effective
and aldosterone plasma levels, and improve vasodila- exercise to complement the treatment of hypertension
tation [24]. is particularly important to improve the quality of life
Tai Chi is a light-to-moderate intensity mind-body of patients with hypertension. At present, most studies
exercise worthy of long-term practice, and its safe and have confirmed the clear effect of Tai Chi on lowering
effective features have attracted the attention of the blood pressure, improving blood lipids and quality of
public and researchers [25]. A single session of aerobic life in hypertensive patients [33–35]. The characteristics
exercise can produce a short-term antihypertensive of the included studies are shown in Table 1.
effect (i.e. lasting from a few hours to 1 d) in both nor- Persons with hypertension can not only lower their
mal subjects and hypertensive patients, a phenome- blood pressure during Tai Chi training, but also
non known as exercise hypotension [26]. A study by improve their quality of life by promoting general
Bersaoui et al. showed that long-term moderate-intensity health [35,36]. An 8-week Yang-style Tai Chi training
aerobic exercise improved blood pressure levels in an by Lo et al. confirmed that Tai Chi can improve exer-
Asian population, with mean systolic and diastolic cise performance and time in patients with hyperten-
blood pressure decreasing by 7.2 and 4.7 mmHg, sion [37]. A study by Ma et al. [36] reported that
respectively [27]. Another study found that after 24 weeks of group-based Tai chi was effective for
10 weeks of regular exercise in elderly hypertensive elderly patients with hypertension. Sun et al. [38] con-
patients, systolic and diastolic blood pressure levels ducted a long-term Tai Chi intervention, and they ran-
were reduced by 13 mmHg (1 mmHg = 0.133 kPa) and domly divided community-dwelling older adults with
18 mmHg, respectively, but the antihypertensive effect hypertension into the Mind-Body Meditative Tai Chi
was not enhanced when the frequency of exercise was Program group and the control group (such as read-
greater than three times a week [28]. A meta-analysis ing and learning software applications). It was found
concluded that swimming training at moderate inten- that after a long period, the Tai Chi group markedly
sity, 3 times/week for 8–11 weeks had the most signif- improved SBP, DBP, BMI, epithelial growth factor
icant effect on systolic blood pressure reduction receptor (eGFR), physical health scales (including role
among all exercise types, frequencies and duration of physical health, bodily pain, and total physical
groups [29]. The cost of Tai Chi training is about $3.50 health of HRQoL), and the vitality scale of mental
per class, which is not a financial burden for partici- health HRQoL. However, there were no significant
pants [30]. People of different ages and physical changes in any of the outcome measures in the
 Annals of Medicine 3

Table 1. Characteristics of the included studies.

Frequency (per
Author Sample (mean age) Gender(M/F) Intervention week) and duration Control group Measured outcomes
Ma C 2018 TC: 79 TC: 54/25 C: 55/24 24-style Tai 1h, 3–5x, 24w Usual care SBP*, DBP*, BMI*,
(China) (70.24 ± 10.25) Chi + usual care Waist girth
[36] C:79
(69.71 ± 10.84)
Sun J 2015 TC: 136 TC: 19/117 Tai Chi 3 h/w and 2h None exercise-related SBP*, DBP*, BMI*,
(AUS) C: 130 C: 29/101 practice by activities such as HRQoL
[38] themselves at reading and learning
home,1year computer software
applications
Lo HM 2012 TC: 27 / Yang-style Tai Chi 1h, 3x, 8w Usual care Routine Health Care
(China) C: 31 Behaviour scal;
[37] BP
Shou XL 2019 TC:104 / 24-Style Simplified 20–30min, 2x /day, General daily lifestyle SBP*, DBP*, BMI*,
(China) C: 104 Tai Chi 3 months intervention PP, TC, TG, and
[39] LDL-C
McDermott K Chi-Running: CR: 5/5 Chi-Running 4h at week 0, and Active control/ SBP, DBP, BMI*; injure
2015 (USA) 10 (56.4 ± 8.2) C: 6/6 three more times self-directed control
[40] C:12 (54.1 ± 4.5) for 2h training at
weeks 2, 4, and 8.
Tsai JC 2003 TC: TC: 19/18 Tai Chi 30min, 3x, 12w; / BP*, lipid profile* and
(China) 37 (51.6 ± 16.3) C: 19/20 64% of maximal anxiety status*
[34] C:39 (50.5 ± 9.8) heart rate
Pan X 2015 TC: 24 (51.6 ± 16.3) / Tai Chi 1h, 6x, 12w Usual care blood glucose,
(China) [43] HP: 16 (50.5 ± 9.8) cholesterol, NO*,
CO*, H2S* and BP*
Abbreviations: SBP, Systolic blood pressure; DBP, Diastolic blood pressure; BMI, Body Mass Index; HRQoL, Health-related quality of life; BP, Blood pressure;
PP, Pulse pressure; TC, Total cholesterol; TG, Triglyceride; LDL-C, Low-density lipoprotein cholesterol. *indicates statistically significant differences between
the intervention group and the control group (p < 0.05).

control group. This provides evidence for the commu- lowers C-reactive protein (CRP) and other inflamma-
nity application of Tai Chi to improve blood pressure tory factor concentrations, and is useful in protecting
and quality of life in patients with hypertension. vascular endothelial function and delaying the onset
Focusing on patients with hypertension among of hypertension. More research is needed on the
young and middle-aged adults, Shou et al. [39] con- mechanism of blood pressure lowering by Tai Chi.
ducted a 3-month Tai Chi intervention and compared
the effectiveness of Tai Chi training for 1 month and
Limitations of current Tai Chi research
3 months. The study showed that SBP, heart rate (HR),
triglycerides (TG), total cholesterol (TC), and low-density Although traditional Chinese exercise therapy, as repre-
lipoprotein cholesterol (LDL-C) all changed significantly sented by Tai Chi, has shown good effects in improving
after 1 month, while BMI, blood glucose (Glu), DBP and hypertension, there are some limitations to the studies.
pulse pressure (PP) did not change significantly. After At present, the vast majority current controlled clinical
3 months of Tai Chi training, BMI, HR, SBP, DBP, PP, TG, trials have recruited subjects without any basic Tai Chi
TC, LDL-C, and Glu all changed significantly. This is training; Tai Chi training has generally not exceeded
consistent with a study of the effects of Tai Chi on 6 months to assess differences from the control group
blood lipid changes in patients with hypertension [34]. [44,45]. Thus, this may result in different research find-
Furthermore, there is a pre-experimental study on Tai ings. There is a lack of large, multicenter trials of Tai Chi
Chi running, which shows that Tai Chi running is an for hypertension. At present, many studies have only
acceptable exercise for patients with hypertension and examined its effects on blood glucose and lipid metab-
has a lowering effect on BMI [40]. olism and blood pressure, ignoring the damage to the
At present, most studies have confirmed that Tai vascular endothelium by the inflammatory response,
Chi has good effects on reducing blood pressure, and relevant effect indicators should be added in future
improving blood lipids and quality of life in patients studies to improve the strength of the evidence.
with hypertension, but the mechanism is unclear Nocturnal blood pressure and circadian rhythms are
[41,42]. The research by Pan et al. [43] found that the important factors in good blood pressure control.
vasodilatory endogenous gas signalling molecules However, current studies have only confirmed that Tai
such as NO, CO and H2S were altered in patients with Chi improves circadian rhythms in patients with insom-
hypertension. Tai Chi, as a traditional Chinese exercise, nia [46]. In addition, Tai Chi protocols for improving
has fewer side effects, lowers lipids, lowers glucose, hypertension are not standardized, and the duration
4 T. ZHANG ET AL.

and frequency used in different studies are inconsis- Disclosure statement

tent. It is recommended that standard exercise proto-
No potential conflict of interest was reported by the
cols that are consistent with disease progression be author(s).
explored to improve the reproducibility and generaliz-
ability of study results. Hypertension occurs at different
ages and in different conditions [47], and there are Funding
fewer trials of traditional exercise therapy across age This work was supported by the Scientific Research Fund of
groups and conditions (e.g. prehypertension, H-type Zhejiang Provincial Education Department [No. Y202249390].
hypertension), which is an important area for future
research.
Tai Chi, as a light-to-moderate intensity aerobic exer- ORCID
cise, can be practiced three times a week to meet the Song Gao http://orcid.org/0000-0002-0747-9611
standards recommended by the European Society of
Cardiology (ESC) guidelines for physical activity in
patients with sports cardiology and cardiovascular dis- Data availability statement
ease [48,49]. Patients with hypertension are recom-
mended to do at least 30 min/day of moderate-intensity Data sharing is not applicable to this article, given that no
new data were created or analysed in this study.
aerobic exercise (walking, jogging, cycling, or swimming)
for 5–7 days/week [50]. Despite the above relevant
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