Blood pressure synchronizes to predictable phrase structures in music and demonstrates stronger entrainment to loudness variations than tempo changes, according to new research that could inform personalized music-based cardiovascular therapies.
The study of 92 patients (60 women and 32 men, mean age 42 years) found that music with more predictable phrase structures produced significantly greater blood pressure-music synchronization, with Harold Bauer's performance of Franz Liszt's transcription of Franz Schubert's Serenade demonstrating the most pronounced cardiovascular effects among the classical piano recordings tested.
Key Findings
Researchers continuously monitored blood pressure while patients listened to nine out of 30 piano music tracks. Blood pressure entrained more to loudness than tempo in 25 out of 30 tracks. Increased predictability of phrase structures enabled listeners to anticipate phrase changes, leading to higher blood pressure-music synchronization that may strengthen the body's baroreflex sensitivity—its ability to regulate blood pressure.
The research employed a Bayesian algorithm developed by study lead Professor Elaine Chew's team to automatically detect music tempo and loudness phrase arc boundaries. Music was played back to patients on a reproducing piano for consistency and to approximate a live performance experience in a controlled experimental setting.
Clinical Implications & Therapeutic Potential
Professor Chew, a pianist by training and Professor of Engineering at King's College London, explained the research's broader significance: "Like language, music has patterns and phrases which form expressive structures, and this is often what strikes a chord with listeners. This research tells us that more predictable music phrase structures have a bigger impact in regulating the cardiovascular system."
The findings build on previous research demonstrating that respiration and heart rate are similarly influenced by phrase structures. "Stronger synchronisation was observed for predictable phrases, which are more regular, of duration similar to slow-paced breathing, and in longer tracks therefore having more phrase instances," Professor Chew noted.
"This research raises the intriguing possibility that we could design music therapies to elicit specific biological responses in the future. This could be tailored specifically to individuals, bringing us closer to music as precision medicine. In the longer term, one day we may be able to use music to prevent heart disease or slow, arrest, or reverse its progression," Professor Chew concluded.
Physiological Mechanisms
Professor Chew provided context for the underlying mechanisms: "Throughout time and across cultures, humans have moved and grooved to music. There are likely to be biological and social advantages to being able to coordinate our actions to an external rhythm, such as people on a boat synchronising their rowing."
She continued: "To coordinate our actions in this way, we need to be able to anticipate the beginnings and ends of rhythm cycles. It is this anticipation that likely influences our cardiorespiratory cycles. It feels good to synchronise to musical structures – research has found that music uses the same reward system as food, sex and drugs."
Methodological Approach
The tracks used in the study consisted of original recordings of legendary performances by master pianists, with researchers systematically altering their expressivity to observe cardiovascular variable effects. Researchers measured entrainment—the synchronization of physiological rhythms with external stimuli—quantified using Earth Mover's Distance to produce similarity measures between music and physiology.
Blood pressure measurements for each track were shuffled with responses to other tracks to determine statistical significance and establish whether blood pressure responses were influenced by the music being heard rather than random physiological variation.
The study used classical piano music because researchers could vary the music and simulate a live experience in a research setting. However, the investigators argue that their methods and strategies are transferrable to any music with phrase indications.
Research Context
The research team notes that music is increasingly recognized as a potential nonpharmacological intervention to regulate the cardiovascular system, with this study contributing to the growing evidence base for music-based therapeutic approaches.
Research was supported by the European Research Council as part of the Computational Shaping and Modeling of Musical Structures project. The abstract "Cardiovascular synchronisation to music: blood pressure entrainment to expressive musical structures" will be presented at the European Society of Cardiology Congress 2025 in the Digital innovations in clinical practice session on August 31, 2025.