Objective To investigate the effect of aerobic exercise on blood pressure in patients with resistant hypertension through meta-analysis, aiming to identify more effective intervention strategies and provide reference for the control and treatment of resistant hypertension. Methods A systematic search was performed in CBM, CNKI, WANFANG, VIP, PubMed, OVID,Embase, and Web of Science for randomized controlled trials (RCTs) published in Chinese or English from inception to March 25, 2025. Two researchers independently conducted study selection and data extraction. Risk of bias was assessed using RoB 2,and statistical analyses were performed with RevMan 5.4. Results A total of 10 studies were included, comprising 532 cases.Meta-analysis showed that aerobic exercise significantly reduced systolic blood pressure (SBP) (SMD=0.77, 95% CI: 0.57-0.96, P<0.000 01), diastolic blood pressure (DBP) (SMD=0.83, 95% CI: 0.63-1.02, P<0.000 01), 24-hour SBP (SMD=0.48,95% CI: 0.23-0.73, P=0.000 2), and 24-hour DBP (SMD=0.43, 95% CI: 0.17-0.68, P=0.000 9). Subgroup analyses indicated greater SBP reductions among participants aged≤60 years, with BMI≤28 kg/m², exercise intensity >60% VO_2max, and intervention>12 weeks. DBP improvements were more evident in subgroups with age≤60 years, BMI≤28 kg/m², intensity ≤60% VO_2max, and duration >12 weeks. For 24-hour SBP, larger effects were found in subgroups with age>60 years, BMI≤28 kg/m², intensity≤60%VO_2max, and duration >12 weeks. In contrast, greater 24-hour DBP reductions occurred in participants aged≤60 years, with BMI≤28 kg/m², intensity >60% VO_2max, and duration≤12 weeks. Conclusion Aerobic exercise has a positive effect on reducing blood pressure in patients with resistant hypertension. Differences in participant characteristics and intervention protocols may affect the extent of this effect. The current relevant studies are limited in number and most have some risk of bias. However, the limited quantity and quality of existing studies highlight the need for further high-quality research to confirm and extend these findings.