Abstract Objective The purpose of this study was to determine the effects of mat Pilates (MP) versus MP plus aerobic exercise (AE) compared with the effects of no intervention on ambulatory blood pressure (BP) in women with hypertension. Methods This 3-arm, parallel-group randomized clinical trial assessed 60 women who had hypertension and were 30 to 59 years old. The intervention lasted 16 weeks, and the participants were allocated into 3 groups: MP only (MP group), MP with alternating bouts of AE on a treadmill (MP + AE group), and control group (CG) with no exercises. Primary outcomes were the effects of the interventions on ambulatory BP assessed in the 24-hour, awake, and asleep periods of analysis. Results A 2-way analysis of variance did not reveal statistically significant differences in between-group comparisons in the 24-hour period of analysis for systolic BP (CG vs MP = 3.3 [95% CI = −7.1 to 13.8]; MP vs MP + AE = 0.7 [95% CI = −4 to 5.4]; CG vs MP + AE = 4.0 [95% CI = −5.2 to 13.4]), diastolic BP (CG vs MP = 2.2 [95% CI = −5.6 to 10.0]; MP vs MP + AE = 1.1 [95% CI = −4.3 to 6.5]; CG vs MP + AE = 3.3 [95% CI = −3.8 to 10.4]), and heart rate (CG vs MP = 3.4 [95% CI = −2 to 8.8]; MP vs MP + AE = 2.0 [95% CI = −3.4 to 7.5]; CG vs MP + AE = 5.4 [95% CI = −0.8 to 11.8]). The awake and asleep periods of analyses also showed similar behavior and did not reveal statistically significant between-group differences. Furthermore, in the responsiveness analysis based on the minimal clinically important difference, no differences were observed between groups. Conclusion The magnitudes of the decrease in systolic BP during the 24-hour period of analysis were −3 and −5.48 mm Hg for the MP and MP + AE groups, without differences for responsiveness between groups. The results suggest that MP supplemented with AE or not may be an alternative adjuvant treatment for women who have hypertension and are using antihypertension medication. Impact Sixteen weeks of MP training reduced ambulatory BP in women who had hypertension. The MP + AE group displayed a BP reduction similar to that of the MP group. A reduction in ambulatory BP can decrease the risk of cardiovascular disease.