Little evidence of blood pressure benefits from relaxation therapies for hypertension

Clinical question: 
How effective are relaxation therapies in the management of primary hypertension in adults?
Bottom line: 
The evidence in favour of a causal association between relaxation and blood pressure reduction is weak. The average reduction was 5/3 mm Hg, but varied between 8/5 and 3/2 mm Hg. The combined sample was too small and the trials too short to assess whether relaxation therapy could reduce the risks of death, heart attack or stroke. The median duration of treatment was 8 weeks (range 5 to 26 weeks). Progressive muscular relaxation, biofeedback and cognitive/behavioural therapies were most likely to be effective. There was little evidence that autogenic training was effective. Follow-up ranged from eight weeks to five years.
Caveat: 
Different trials gave different – sometimes inconsistent – results. Many of the trials were not well-designed or well-conducted. Some of the apparent benefit of relaxation therapy was possibly due to aspects of treatment unrelated to relaxation, such as frequent contact with treatment providers (which might reduce ‘white coat hypertension’).
Context: 
The World Health Organization estimates that high blood pressure leads to over 7 million deaths per year and about 13% of total deaths worldwide. Lifestyle interventions are often recommended as initial treatment for mild hypertension, but the efficacy of relaxation therapies (autogenic training, progressive muscular relaxation, cognitive/behavioural therapies, and biofeedback) is unclear. Autogenic training is a relaxation technique which focuses on physical sensations, such as breathing or the heartbeat, assisted by self-suggestion¹. 1. Stetter F, Kupper S. Applied Psychophysiology and Biofeedback. 2002;27:45-98.
Review CD#: 
CD004935
PEARLS No: 
88
Date: 
July, 2008
Authored by: 
Brian R McAvoy