Contents lists available at ScienceDirect Life Sciences journal homepage: www.elsevier.com/locate/lifescie Blood pressure response between resistance exercise with and without blood flow restriction: A systematic review and meta-analysis Everton Domingos, Marcos D. Polito ⁎ Research Group of Cardiovascular Response and Exercise, Londrina State University, Londrina, Paraná, PR, Brazil ARTICLE INFO Keywords: Cardiovascular Strength Exercise Meta-analysis ABSTRACT Aim: The aim of this study was to compare, by means of a systematic review and meta-analysis, the effects of resistance training with and without blood flow restriction (BFR) on blood pressure (BP). Materials and methods: This review was composed according to the preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. Searches were carried out in the databases PubMed, SPORTDiscus, and Web of Science. BP was the main outcome for the analysis of the acute, post-exercise, and chronic effect of resistance exercise with and without BFR. Search results were limited to studies investigating the effect of resistance training with and without BFR on acute or chronic BP, published in a scientific peer-reviewed journal in English. Key findings: Seventeen references were eligible. During exercise, the diastolic BP (DBP) was higher in exercise with BFR (ES = 17.84) in comparison to traditional exercise with loads ≥60% 1RM (ES = 5.53; P < 0.01); and the systolic BP (SBP) and DBP were higher during exercise with BFR in hypertensive individuals (ES = 69.83 and 43.66) in comparison to traditional exercise with loads < 60% 1RM (ES = 48.05 and 28.37; P < 0.05). In the post-exercise analysis, exercise with BFR presented lower values for SBP (ES = −5.13; P = 0.02) and DBP (ES = −4.70; P < 0.01). Significance: Although resistance exercise with BFR resulted in greater post-exercise hypotension than traditional exercise, higher SBP and/or DBP values were observed during exercise with BFR compared to traditional ex- ercise, especially in hypertensive individuals. Thus, exercise with BFR should be prescribed with caution when BP control is necessary during exercise. 1. Introduction Resistance training with blood flow restriction (BFR) is indicated to improve both strength and muscle mass [1]. This model of exercise, by using a relatively light load, is recommended for people with limita- tions to perform traditional exercise with moderate/high load (> 60% 1RM), such as hypertensive patients [2]. In this context, in addition to the results on strength and muscle mass, it is important to analyze other physiological variables, such as blood pressure (BP). During traditional exercise with moderate/high load, BP tends to increase according to the load and/or volume of exercise (repetitions or sets) [3]. This is explained by two reasons; the increased load causes increased compression of the muscles on the blood vessels, increasing vascular resistance and BP; and the prolonged time of execution of the exercise, which, although not necessarily causing great vascular com- pression, causes the accumulation of metabolites to activate the che- moreceptor mechanism, causing an increase in BP [4]. In relation to exercise with BFR, the main characteristic is to reduce or interrupt the flow of blood to a particular muscle group. Muscle contraction per- formed with low blood flow elevates metabolic stress and may increase the muscle pressure or reflex to the cardiovascular control center, causing exaggerated sympathetic nervous activity [5]. The increase in sympathetic activity may influence the increase in peripheral vascular resistance and, consequently, increase BP during exercise [3–5]. In this context, the relatively low exercise load with BFR may not be the only variable that influences BP during execution. On the other hand, studies that analyzed BP behavior during exercise with BFR compared with traditional exercise present different methodological designs (training and clinical status of the sample, BFR value, BFR duration, and exercise volume), hindering a conclusion about this issue [6–9]. In addition, other studies have investigated the behavior of BP after exercise with BFR (with the goal of monitoring post-exercise hypoten- sion) [6,10] or in a chronic way (after weeks of training) [11]. https://doi.org/10.1016/j.lfs.2018.08.006 Received 11 June 2018; Received in revised form 31 July 2018; Accepted 3 August 2018 ⁎ Corresponding author at: Universidade Estadual de Londrina, Rod. Celso Garcia Cid, km 380, Londrina, PR Zip code: 86050-520, Brazil. E-mail address: marcospolito@uel.br (M.D. Polito). Life Sciences 209 (2018) 122–131 Available online 04 August 2018 0024-3205/ © 2018 Published by Elsevier Inc. T