title: Clinical effectiveness of stress-reduction techniques in patients with hypertension: systematic review and meta-analysis.
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.
authors.affiliation: aDepartment of Medical Psychology and Psychotherapy, Medical University of Graz bEBM Review Center, Department of Internal Medicine, Medical University of Graz cInstitute for Medical Informatics, Statistics and Documentation, Medical University of Graz dHEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research, Graz, Austria eInstitute for Quality and Efficiency in Healthcare (IQWiG), Cologne fBristol-Meyers Squibb GmbH&Co, KGaA, Munich gHannover Medical School, Hannover, Germany hBasel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland iInstitute of General Practice, Goethe University Frankfurt, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Nagele
authors.forename: Klaus
authors.initials: K
authors.lastname: Jeitler
authors.forename: Karl
authors.initials: K
authors.lastname: Horvath
authors.forename: Thomas
authors.initials: T
authors.lastname: Semlitsch
authors.forename: Nicole
authors.initials: N
authors.lastname: Posch
authors.forename: Kirsten H
authors.initials: KH
authors.lastname: Herrmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grouven
authors.forename: Tatjana
authors.initials: T
authors.lastname: Hermanns
authors.forename: Lars G
authors.initials: LG
authors.lastname: Hemkens
authors.forename: Andrea
authors.initials: A
authors.lastname: Siebenhofer
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D000075222:Essential Hypertension; D040261:Harm Reduction; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality; D011788:Quality of Life; D013315:Stress, Psychological / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents