Abstract
Background
Relaxation and stress management techniques have been suggested to have beneficial impacts on blood pressure (BP). In this systematic review, we assessed whether these interventions may be useful for individuals with hypertension and pre-hypertension.
Methods
We included studies published in English, of adults with hypertension (BP >140/90mmHg) or pre-hypertension (BP>120/80mmHg). We included interventions such as yoga, breathing control and mindfulness. The primary outcomes were systolic and diastolic blood pressure. We searched MEDLINE, PsycINFO, CENTRAL and CINAHL (to February 2024). Where possible, we used network meta-analysis to compare the efficacy of the different interventions. Risk of bias was assessed using the RoB 2 tool; studies at high risk of bias were excluded from the primary analysis. CINeMA and GRADE were used to assess the certainty of the evidence.
Results
182 studies were included (166 in participants with hypertension, 16 in participants with pre-hypertension). At up to 3 months’ follow-up, most relaxation interventions appeared to have a beneficial effect on systolic and diastolic blood pressure for individuals with hypertension.
We report results from a random-effects network meta-analysis. Between study heterogeneity was moderate to substantial (tau from 2.62 to 5.18). When compared to a passive comparator (no intervention, wait-list or usual care), moderate reductions in systolic blood pressure were found for breathing control (mean difference [MD] -6.65 mmHg, 95% credible interval -10.39 to -2.93), meditation (MD -7.71mmHg, -14.07 to -1.29), meditative movement (including tai chi and yoga, MD -9.58mmHg, -12.95 to -6.17), mindfulness (MD -9.90mmHg, -16.44 to -3.53), music (MD -6.61mmHg, -11.62 to -1.56), progressive muscle relaxation (MD -7.46mmHg, -12.15 to -2.96), psychotherapy (MD -9.83mmHg, -16.24 to -3.43) and multicomponent interventions (MD -6.78mmHg, -11.59 to -1.99). Reductions were also seen in diastolic blood pressure. Few studies conducted follow-up for more than 3 months, but effects on blood pressure appeared to lessen over time.
Limited data were available regarding pre-hypertension. At up to 3 months, only two studies compared relaxation therapies to a passive comparator, and the effects on systolic blood pressure were small (meditative movement: MD -3.84mmHg, -6.25 to -1.43; multicomponent intervention: MD -0.53mmHg, -2.03 to 0.97).
All evidence was considered very-low certainty with the CINeMA framework, due to the risk of bias in the primary studies, potential publication bias and imprecision in the effect estimates.
Discussion
Relaxation and stress management techniques may have beneficial short-term effects on blood pressure for people with hypertension. However, the effectiveness of these interventions is still uncertain. Future studies should ensure rigorous methods to minimise the risk of bias, and a longer duration of follow-up to establish whether these effects persist.
Relaxation and stress management techniques have been suggested to have beneficial impacts on blood pressure (BP). In this systematic review, we assessed whether these interventions may be useful for individuals with hypertension and pre-hypertension.
Methods
We included studies published in English, of adults with hypertension (BP >140/90mmHg) or pre-hypertension (BP>120/80mmHg). We included interventions such as yoga, breathing control and mindfulness. The primary outcomes were systolic and diastolic blood pressure. We searched MEDLINE, PsycINFO, CENTRAL and CINAHL (to February 2024). Where possible, we used network meta-analysis to compare the efficacy of the different interventions. Risk of bias was assessed using the RoB 2 tool; studies at high risk of bias were excluded from the primary analysis. CINeMA and GRADE were used to assess the certainty of the evidence.
Results
182 studies were included (166 in participants with hypertension, 16 in participants with pre-hypertension). At up to 3 months’ follow-up, most relaxation interventions appeared to have a beneficial effect on systolic and diastolic blood pressure for individuals with hypertension.
We report results from a random-effects network meta-analysis. Between study heterogeneity was moderate to substantial (tau from 2.62 to 5.18). When compared to a passive comparator (no intervention, wait-list or usual care), moderate reductions in systolic blood pressure were found for breathing control (mean difference [MD] -6.65 mmHg, 95% credible interval -10.39 to -2.93), meditation (MD -7.71mmHg, -14.07 to -1.29), meditative movement (including tai chi and yoga, MD -9.58mmHg, -12.95 to -6.17), mindfulness (MD -9.90mmHg, -16.44 to -3.53), music (MD -6.61mmHg, -11.62 to -1.56), progressive muscle relaxation (MD -7.46mmHg, -12.15 to -2.96), psychotherapy (MD -9.83mmHg, -16.24 to -3.43) and multicomponent interventions (MD -6.78mmHg, -11.59 to -1.99). Reductions were also seen in diastolic blood pressure. Few studies conducted follow-up for more than 3 months, but effects on blood pressure appeared to lessen over time.
Limited data were available regarding pre-hypertension. At up to 3 months, only two studies compared relaxation therapies to a passive comparator, and the effects on systolic blood pressure were small (meditative movement: MD -3.84mmHg, -6.25 to -1.43; multicomponent intervention: MD -0.53mmHg, -2.03 to 0.97).
All evidence was considered very-low certainty with the CINeMA framework, due to the risk of bias in the primary studies, potential publication bias and imprecision in the effect estimates.
Discussion
Relaxation and stress management techniques may have beneficial short-term effects on blood pressure for people with hypertension. However, the effectiveness of these interventions is still uncertain. Future studies should ensure rigorous methods to minimise the risk of bias, and a longer duration of follow-up to establish whether these effects persist.
| Original language | English |
|---|---|
| Journal | BMJ Medicine |
| Publication status | Accepted/In press - 25 Feb 2025 |