How effective are stress management and relaxation interventions for the management of hypertension and pre-hypertension? A systematic review and network meta-analysis.

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

2E.2

Presenter:

Katie Webster

Twitter:

@BristolESG

Co-authors:

Dr. Katie Webster, Dr. Monika Halicka, Dr Russell Bowater, Dr. Jelena Savović, Dr. Alyson Huntley, Ms. Sarah Dawson, Dr. Christopher Clark, Dr. Rachel Johnson, Professor Julian Higgins, Professor Deborah Caldwell.  

Author institutions:

NIHR Bristol Evidence Synthesis Group, Population Health Sciences, Bristol Medical School, University of Bristol. University of Exeter Medical School, University of Exeter.

Problem

Worldwide, hypertension affects more than 30% of people aged 30-79 years, and is a major risk factor for cardiovascular, cerebrovascular and peripheral arterial disease. However, relatively small changes in blood pressure are associated with better health outcomes. As such, hypertension is an important target for interventions to prevent cardiovascular morbidity and mortality. Although medication is a mainstay of treatment, non-pharmacological interventions such as lifestyle and behavioural changes, have long been recognized as an important adjunct in blood pressure control and are first-line recommendations for treatment by many international guidelines. A priority setting exercise including patients, researchers and healthcare professionals, identified stress management interventions as a top ten research priority for hypertension. In the UK, NICE has also recommended future research into relaxation therapies for hypertension.

Approach

We report a systematic review and network meta-analysis of stress management and relaxation interventions for hypertension and pre-hypertension. Eligible randomised controlled trials included adults (≥18 years) with hypertension (BP ≥140/90mmHg) or pre-hypertension (BP ≥120/80mmHg). Interventions include yoga, tai chi, mindfulness-based stress reduction, meditation and other stress-management interventions. The primary outcomes are systolic and diastolic blood pressure. No restrictions on blood pressure measurement protocol were imposed. Studies at low risk of bias (assessed using the RoB2 tool) will be quantitatively synthesised using a random effects network meta-analysis (NMA). NMA allows the comparative effectiveness of active interventions to be estimated relative to every other intervention in the network, even in the absence of direct head-to-head studies. The development of this review was informed by consultation with public contributors with lived experience of hypertension. Input was sought to identify specific relaxation and stress management interventions to include, and to select important outcomes for managing hypertension.

Findings

To date, we have extracted data from 182 included studies published between 1975 and 2023. Studies were conducted in 31 different countries, lasted from 1 to 36 months, and randomised almost 15,000 people. Common interventions were yoga, progressive muscle relaxation, biofeedback, device-guided breathing, music therapy, mindfulness and tai chi. Results from network meta-analysis of these studies will be presented at the conference.

Consequences

Identification of effective non-pharmacological interventions for blood pressure control has the potential to improve blood pressure management – and consequently cardiovascular outcomes – for millions of people worldwide. The use of effective stress management techniques as an alternative or adjunct to conventional pharmacological treatments may empower people to manage their own blood pressure, and provide a novel, evidence-based approach for the management of hypertension in primary care. The results of this work may also inform future hypertension guidelines.

Submitted by:

Katie Webster

Funding acknowledgement:

This work was funded by NIHR.