Intervention Review

Relaxation therapies for the management of primary hypertension in adults

  1. Heather O Dickinson1,*,
  2. Fiona R Beyer2,
  3. Gary A Ford3,
  4. Donald Nicolson4,
  5. Fiona Campbell5,
  6. Julia V Cook6,
  7. James Mason7

Editorial Group: Cochrane Hypertension Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 6 NOV 2007

DOI: 10.1002/14651858.CD004935.pub2


How to Cite

Dickinson HO, Beyer FR, Ford GA, Nicolson D, Campbell F, Cook JV, Mason J. Relaxation therapies for the management of primary hypertension in adults. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004935. DOI: 10.1002/14651858.CD004935.pub2.

Author Information

  1. 1

    Newcastle University, Institute of Health and Society, Newcastle upon Tyne, Tyne & Wear, UK

  2. 2

    University of Newcastle, Institute for Health and Society, Newcastle upon Tyne, Tyne & Wear, UK

  3. 3

    Royal Victoria Infirmary, Clinical Research Facility, Newcastle upon Tyne, UK

  4. 4

    University of Leeds, School of Healthcare, Leeds, UK

  5. 5

    University of Sheffield, School of Health and Related Research, Sheffield, UK

  6. 6

    Newcastle University , Institute of Health and Society, Newcastle upon Tyne, UK

  7. 7

    Durham University, Queen's Campus, School of Medicine and Health, Stockton-on-Tees, UK

*Heather O Dickinson, Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, Tyne & Wear, NE2 4AA, UK. heather.dickinson@newcastle.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Background

Lifestyle interventions are often recommended as initial treatment for mild hypertension, but the efficacy of relaxation therapies is unclear.

Objectives

To evaluate the effects of relaxation therapies on cardiovascular outcomes and blood pressure in people with elevated blood pressure.

Search methods

We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review.

Selection criteria

Inclusion criteria: RCTs of a parallel design comparing relaxation therapies with no active treatment, or sham therapy; follow-up ≥8 weeks; participants over 18 years, with raised systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥85 mmHg); SBP and DBP reported at end of follow-up. Exclusion criteria: participants were pregnant; participants received antihypertensive medication which changed during the trial.

Data collection and analysis

Two reviewers independently extracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted.

Main results

29 RCTs, with eight weeks to five years follow-up, met our inclusion criteria; four were excluded from the primary meta-analysis because of inadequate outcome data. The remaining 25 trials assessed 1,198 participants, but adequate randomisation was confirmed in only seven trials and concealment of allocation in only one. Only one trial reported deaths, heart attacks and strokes (one of each). Meta-analysis indicated that relaxation resulted in small, statistically significant reductions in SBP (mean difference: -5.5 mmHg, 95% CI: -8.2 to -2.8, I2 =72%) and DBP (mean difference: -3.5 mmHg, 95% CI: -5.3 to -1.6, I2 =75%) compared to control. The substantial heterogeneity between trials was not explained by duration of follow-up, type of control, type of relaxation therapy or baseline blood pressure.

The nine trials that reported blinding of outcome assessors found a non-significant net reduction in blood pressure (SBP mean difference: -3.2 mmHg, 95% CI: -7.7 to 1.4, I2 =69%) associated with relaxation. The 15 trials comparing relaxation with sham therapy likewise found a non-significant reduction in blood pressure (SBP mean difference: -3.5 mmHg, 95% CI: -7.1 to 0.2, I2 =63%).

Authors' conclusions

In view of the poor quality of included trials and unexplained variation between trials, the evidence in favour of 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Relaxation for high blood pressure in adults which has no clearly identified cause

The World Health Organisation estimates that high blood pressure leads to over 7 million deaths each year, about 13% of the total deaths worldwide. If people lower their blood pressure, they are less likely to die or to have heart attacks and strokes. If someone's blood pressure is only slightly too high, they may prefer trying to lower it by changing their lifestyle rather than starting on drugs. Although we know that relaxing can counteract the short-term increases in blood pressure that are caused by stress, we don't know if a sustained programme of relaxation can produce long-term reductions in blood pressure or decrease the risk of death, heart attack and stroke.

Our review pooled findings from 1,198 people with blood pressure over 140/85 mmHg who were enrolled in 25 randomised controlled trials. These trials compared the effect of relaxation either with no treatment or with a dummy treatment which wasn't expected to reduce blood pressure. Overall, relaxation reduced blood pressure by a small amount: the average reduction was 5/3 mmHg, but might be anywhere between 8/5 mmHg and 3/2 mmHg. Different trials gave different − sometimes inconsistent − results. Many of the trials were not well designed or conducted. In the good quality trials, relaxation resulted in smaller average reductions in blood pressure and the results could even be consistent with an average increase in blood pressure. Even when all the trials were put together, the combined group of all the people in all the trials wasn't large enough and the trials didn't run for long enough to tell us whether relaxation could reduce the risk of death, heart attack or stroke. Few people reported side-effects of relaxation and, on average, people were just as likely to report side-effects of the comparison treatment.

Different types of relaxation were taught in different trials. It was difficult to disentangle their effects, especially as many trials used a combination of methods. Overall, we found no evidence that autogenic training was effective. Progressive muscle relaxation, cognitive/behavioural therapies and biofeedback seemed to be more likely to reduce blood pressure. However, some of the reduction in blood pressure was almost certainly due to aspects of treatment that were not related to relaxation, such as frequent contact with professionals who were trying to help.

 

アブストラクト

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

成人の原発性高血圧症管理のためのリラクゼーション療法

背景

軽度の高血圧の初期治療としてしばしば生活習慣の介入が推奨されているが、リラクゼーション療法の有効性は不明である。

目的

血圧が上昇した人を対象にリラクゼーション療法が心血管アウトカムおよび血圧に及ぼす効果を評価する。

検索戦略

コクラン・ライブラリ、MEDLINE, EMBASE、Science Citation Index、ISI Proceedings、ClinicalTrials.gov、Current Controlled Trials、ならびにシステマティック・レビュー、メタアナリシスおよび本レビューに含めたランダム化比較試験(RCT)の参照文献リストを検索した。

選択基準

選択基準:リラクゼーション療法を無実薬治療または偽治療と比較した並行デザインのRCT。追跡期間8週間以上。参加者は18歳を超えており、収縮期血圧(SBP)140mmHg以上または拡張期血圧(DBP)85mmHg以上。追跡終了時にSBPおよびDBPの報告がある。除外基準:妊娠している。試験期間中に変更した降圧薬が投与されていた。

データ収集と分析

2名のレビューアが独自にデータを抽出し、試験の質を評価した。不一致は議論または第3者のレビューアによって解決した。ランダム効果モデルのメタアナリシスおよび感度解析を行った。

主な結果

8週間~5年間の追跡期間のある29件のRCTが、今回の選択基準に合致した。そのうち、アウトカムのデータが不適切であった4件は、主要なメタアナリシスから除外した。残り25件の試験で参加者1,198例が評価されていたが、適切なランダム化が確認されたのは7件の試験であったにすぎず、適切な割付けの隠蔽化については1件で確認されただけであった。1件の試験でのみ、死亡、心臓発作、脳卒中(各1例)が報告されていた。メタアナリシスから、リラクゼーション療法はコントロールと比較して、SBP(平均差:-5.5mmHg、95%CI:-8.2~-2.8、I2=72%)およびDBP(平均差:-3.5mmHg、95%CI:-5.3~-1.6、I2=75%)がわずかであるが、統計学的に有意な低下が示された。試験間でみられたかなりの異質性は、追跡期間の長さ、コントロールの種類、リラクゼーション療法の種類、ベースライン時の血圧で説明できなかった。アウトカムの査定者を盲検化した試験9件の報告から、リラクゼーション療法に伴う正味の血圧低下は有意でないことが見出された(SBPの平均差:-3.2mmHg、95%CI:-7.7~1.4、I2=69%)。リラクゼーション療法と偽治療を比較した15件の試験でも同様に、有意ではない血圧低下が見出された(SBPの平均差:-3.5mmHg、95%CI:-7.1~0.2、I2=63%)

著者の結論

選択された試験の質が不良であり、試験間での説明のつかないバラツキを考慮すると、リラクゼーション療法と血圧低下との因果関係を支持するエビデンスは弱い。リラクゼーション療法の見かけの利益は、リラクゼーションとは無関係の治療の側面におそらく一部起因していたと思われる。

訳注

監  訳: 曽根 正好,2008.4.1

実施組織: 厚生労働省委託事業によりMindsが実施した。

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