April 8, 2025

expert reaction to systematic review and network meta-analysis of relaxation techniques to manage high blood pressure

A systematic review and meta-analysis published in BMJ Medicine looks at stress management and relaxation techniques to manage high blood pressure.

Mr Les Rose, Former Clinical Science Consultant and Trustee of HealthSense, said:

“Firstly, I’m not an expert in the methods used, but it seems that the authors have been quite rigorous, their main constraint being the poor quality of so many of the source studies. I think the press release makes this clear. It’s much less a recommendation to use relaxation techniques, much more a call for better quality research.

Does the press release accurately reflect the science?

“Yes the science is accurately reflected.

Is this good quality research?  Are the conclusions backed up by solid data?

“The methodology of the meta-analysis looks sound, but it isn’t my specialism.

How does this work fit with the existing evidence?

“I can’t comment on the existing literature on the subject, as again it isn’t my specialism.

Have the authors accounted for confounders?  Are there important limitations to be aware of?

“The authors do seem to have addressed possible confounders, and they have discussed limitations.

What are the implications in the real world?  Is there any overspeculation?  

“Because of the lack of long-term studies, the generalisation of these findings to clinical practice doesn’t seem feasible. While it’s well known that adherence to drug treatment for hypertension is generally poor, there is no reason to believe that adherence to relaxation techniques is going to be any better. My guess is that, without the prompt of having a pack of pills at hand, compliance is going to be even worse.

“The paper obviously involved a huge amount of work, but sadly the outcome is not particularly groundbreaking.”

Prof Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter, said:

“This is a rigorous and important review. Its findings are eminently plausible: just like stress would increase blood pressure, so does relaxation decrease it. The problem, as I see it, might be compliance. Stressed people tend to be chronically pressed for time, and relaxation techniques take considerably more time than simply swallowing an antihypertensive pill.”

‘Effectiveness of stress management and relaxation interventions for management of hypertension and prehypertension: systematic review and network meta-analysis’ by Webster et al. was published in BMJ Medicine at 23:30 UK Time Tuesday 8 April 2025.

DOI: 10.1136/ bmjmed-2024-001098

Declared interests

Mr Les Rose “I have no conflicts of interest to declare. I am a retired clinical research scientist, a trustee of HealthSense, a Fellow of the Royal Society of Biology. and an honorary Fellow of the Institute of Clinical Research.”

For all other experts, no reply to our request for DOIs was received.