Clinical effectiveness of stress-reduction techniques in patients with hypertension: systematic review and meta-analysis

J Hypertens. 2014 Oct;32(10):1936-44; discussion 1944. doi: 10.1097/HJH.0000000000000298.


Objective: A systematic review and meta-analysis focusing on patient-relevant outcomes and blood pressure was conducted to assess the clinical effectiveness of stress-reduction techniques in adults with essential hypertension.

Methods: Systematic reviews and randomized controlled trials (RCTs) were identified as part of a systematic search in six electronic databases ending September 2012. RCTs comparing stress-reduction techniques versus no such techniques with a follow-up of at least 24 weeks and published in English or German were included. Outcomes of interest were death, cardiovascular morbidity/mortality, end-stage renal disease, health-related quality of life, adverse events, changes in blood pressure, and changes in antihypertensive medication. When appropriate, meta-analyses were used to combine data.

Results: Seventeen RCTs analyzing different stress-reduction techniques such as biofeedback, relaxation or combined interventions were identified. Data were not reported for most of the patient-relevant outcomes, and meta-analyses could only be used to evaluate effects on blood pressure. The data indicated a blood pressure-lowering effect, but the studies had methodological shortcomings and heterogeneity between them was high. Mean group differences for DBP ranged from -10 to 1 mmHg and for SBP from -12 to 10 mmHg. In terms of antihypertensive medication, no favorable effects of stress-reduction techniques could be identified.

Conclusions: The available RCTs on stress-reduction techniques used for at least 24 weeks appeared to indicate a blood pressure-lowering effect in patients with essential hypertension, but this should be interpreted with caution because of major methodological limitations. A benefit of specific stress-reduction techniques in hypertensive patients remains unproven.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / drug effects
  • Essential Hypertension
  • Harm Reduction*
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy
  • Hypertension / therapy*
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / mortality
  • Quality of Life
  • Stress, Psychological / therapy*
  • Treatment Outcome


  • Antihypertensive Agents