Health

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

Publikation aus Health

Nagele E, Jeitler K, Horvath K, Semlitsch T, Posch N, Herrmann KH, Grouven U, Hermanns T, Hemkens LG, Siebenhofer A.

Journal of Hypertension: October 2014 - Volume 32 - Issue 10 - p 1936–1944 doi: 10.1097/HJH.0000000000000298, 10/2014

Abstract:

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.