A network meta-analysis of 182 randomized controlled trials (166 for hypertension and 16 for prehypertension) found that relaxation and stress management interventions were associated with short-term reductions in blood pressure in adults with hypertension.

The systematic review, published in BMJ Medicine, included 202 reports assessing nonpharmacologic interventions for individuals with hypertension or prehypertension. Pharmacologic interventions were also included in the network for comparative connectivity but were not the primary focus of the analysis.

At short-term follow-up, defined as 3 months or less, several interventions—including mindfulness (−9.90 mm Hg), meditative movement (−9.58 mm Hg), psychotherapy (−9.83 mm Hg), multicomponent interventions (−6.78 mm Hg), and music (−6.61 mm Hg)—were associated with reductions in systolic blood pressure compared with passive comparators. Progressive muscle relaxation, meditation, and breathing control were also associated with beneficial effects. Diastolic blood pressure reductions were observed across multiple interventions. These reductions exceeded the minimally important differences of 5 mm Hg for systolic pressure and 3 mm Hg for diastolic pressure. Between-study heterogeneity was moderate (τ=2.62-4.73).

Short-term results were derived from 54 trials rated as low or moderate risk of bias. The median intervention duration was 2 months. Overall, 99 of the 182 included trials were rated at high risk of bias, contributing to very low certainty of evidence according to the CINeMA framework.

At medium-term follow-up, defined as more than 3 months and up to 12 months, relaxation interventions were ongoing in 4 trials (19%) but had been discontinued in 14 trials (67%). The effects of these interventions beyond 12 months were uncertain, as few studies reported long-term outcomes. In one trial, autogenic training was associated with a systolic blood pressure reduction of −6.95 mm Hg, although the sample size was small. A total of 16 trials involving participants with prehypertension reported findings; 2 showed small reductions in blood pressure with meditative movement, but the certainty of this evidence was low.

The authors noted the need for longer-term data, standardized intervention protocols, and trials that include cardiovascular outcomes. They specifically called for rigorous methods in future studies to minimize bias. The protocol was registered in PROSPERO and the review followed PRISMA-NMA guidelines.

No conflicts of interest were reported.