The objective of this review was to evaluate the effectiveness of relaxation to lower high blood pressure. We searched electronic bibliographic databases and grey literature to identify randomized controlled trials comparing relaxation therapies with no active treatment or sham therapy, enrolling adult participants with raised systolic blood pressure (SBP) ⩾140 mm Hg or diastolic blood pressure (DBP) ⩾85 mm Hg and follow-up ⩾8 weeks. Twenty-five trials with up to 5 years follow-up, assessing 1198 participants, met our inclusion criteria and were meta-analysed. Overall, relaxation resulted in small, statistically significant reductions in SBP (mean difference: −5.5 mm Hg, 95% CI: −8.2 to −2.8) and DBP (mean difference: −3.5 mm Hg, 95% CI: −5.3 to −1.6) compared to the control. Substantial heterogeneity between trials (I2>70%) was not explained by duration of follow-up, type of control, type of relaxation therapy or baseline blood pressure. The 9 trials that reported blinding of outcome assessors found a non-significant net reduction in blood pressure (SBP mean difference: −3.2 mm Hg, 95% CI: −7.7 to 1.4) associated with relaxation, as did the 15 trials comparing relaxation with sham therapy (SBP mean difference: −3.5 mm Hg, 95% CI: −7.1 to 0.2). Adequate randomization was confirmed in only seven trials and concealment of allocation in only one. In view of the poor quality of the included trials and unexplained variation between trials, the evidence in favour of a causal association between relaxation and blood pressure reduction is weak. Some of the apparent benefit of relaxation was probably due to aspects of treatment unrelated to relaxation.
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We thank Professor E Canino of Universidad Simon Bolivar, Professor TK Bera of Scientific Research Department, Kaivalyadhama SMYM Samiti and Dr. MH Shein of Hadassah University for supplying unpublished data; Dr Sat Bir S Khalsa of Harvard Medical School for supplying unpublished information about studies of yoga; Dr Benjamin Gavish of Intercure Inc. for helpful suggestions and Sheila Dickinson for helpful discussions on statistical aspects of the review.
This work was undertaken with funding from the National Institute for Clinical Excellence; preliminary work was reported in a national clinical guideline (http://www.nice.org.uk/page.aspx?o=217976).
This paper is based on a Cochrane review first published in The Cochrane Library 2008, Issue 1 (www.thecochranelibrary.com for information). Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of review authors, and are not necessarily shared by The Cochrane Collaboration.
Conflict of interest
GAF has received honoraria from a number of pharmaceutical companies for lectures and consultancy, and grant support for clinical trials from medical charities and the pharmaceutical industry. HOD, JMM, DJN, FC, JVC and FRB have no conflicts of interest. The funding body was not involved in any aspect of the design or conduct of the review or interpretation of findings and was not in a position to benefit financially from the results of the review. The views expressed are those of the authors and not necessarily those of the funding body.
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Dickinson, H., Campbell, F., Beyer, F. et al. Relaxation therapies for the management of primary hypertension in adults: a Cochrane review. J Hum Hypertens 22, 809–820 (2008). https://doi.org/10.1038/jhh.2008.65
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