Mind-body therapies intervention for essential hypertension: network meta-analysis based on the antihypertensive effect

TL;DR

This study compares mind-body therapies for lowering blood pressure in essential hypertension patients using a network meta-analysis of 15 trials.

Contribution

A network meta-analysis ranks specific mind-body therapies for their effectiveness in reducing blood pressure in essential hypertension.

Findings

Bhramari Pranayama and Specific Qigong ranked highest for systolic blood pressure reduction.

Sound Relax Meditation, Specific Qigong, and Bhramari Pranayama showed top rankings for diastolic blood pressure reduction.

Findings suggest the need for larger, high-quality trials to confirm these effects.

Abstract

Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases and may lead to serious health outcomes such as stroke, myocardial infarction, heart failure, and renal failure. Essential hypertension (EH) accounts for approximately 90% of all hypertension cases. In this study, we applied a network meta-analysis (NMA) to quantitatively synthesize evidence from randomized controlled trials (RCTs) and to compare and rank the effects of mind–body therapies (MBTs) on systolic and diastolic blood pressure in patients with EH, with the aim of providing evidence to support informed selection of MBT interventions.

A comprehensive search strategy restricted to English-language RCTs was developed and applied across multiple biomedical databases, including PubMed, Embase, the Cochrane Library, Web of Science, CBM, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP, from database inception to March 2, 2025. (The literature found in the Chinese database did not meet the requirements.) Two authors independently screened studies, extracted data, and performed a frequentist network meta-analysis using STATA version 18.0 to compare and rank MBTs with respect to their effects on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Additional analyses were conducted to evaluate network consistency and robustness of the findings.

A total of 15 RCTs involving 949 participants were included, comprising 18 intervention arms and 11 distinct MBT interventions. While most MBTs demonstrated some degree of blood pressure–lowering effect, SUCRA values indicated that Bhramari Pranayama (BP; SUCRA = 75.3%) and Specific Qigong (SQ; SUCRA = 73.7%) had the highest probabilities of ranking among the more effective interventions for reducing SBP. For DBP reduction, Sound Relax Meditation (SRM; SUCRA = 83.0%), Specific Qigong (SQ; SUCRA = 80.2%), and Bhramari Pranayama (BP; SUCRA = 78.1%) showed relatively favorable rankings. These rankings represent relative probabilities and should be interpreted in conjunction with effect sizes and the overall certainty of evidence.

Compared with other MBTs, Bhramari Pranayama and Specific Qigong demonstrated more favorable relative effects on systolic blood pressure in patients with essential hypertension. Sound Relax Meditation, Specific Qigong, and Bhramari Pranayama showed comparatively better performance in reducing diastolic blood pressure. Given the limited number of studies and modest sample sizes, these findings should be interpreted cautiously, and further large-scale, high-quality RCTs are needed to confirm these comparative effects.

Figures