Massage therapy for essential hypertension: a systematic review

Utilization of massage chairs for promoting overall health and wellness: A rapid scoping review

OBJECTIVE

To investigate the potential benefits of using massage chairs for improving health.

DATA SOURCES

A rapid scoping review was conducted using PubMed, Embase, Cochrane Library, and Google Scholar from inception to November 1, 2022.

STUDY SELECTION

Using the keyword strategy ("massage chair*" OR "massage-chair*"), only studies in English were selected. Two reviewers independently screened the studies, and conflicts were resolved by consensus. Studies involving physical massage therapy were excluded.

DATA EXTRACTION

A total of 59 articles were identified, and 18 were included in the final analysis. Quality assessment was performed, following STROBE, CONSORT and CASP guidelines. The following data were extracted: authors, year, country, study design, study objective, age, gender, participants, measures, and main findings.

DATA SYNTHESIS

The results of the present review indication that the utilization of massage chairs may positively affect both physical and mental health concerns. This review especially found a more significant number of studies showing benefits in mental health. However, two case reports indicated complications when using massage chairs.

CONCLUSIONS

The use of massage chairs could have benefits on cognitive function improvement, stress reduction and mental fatigue decline, muscle stiffness improvement, pain reduction, and potential benefits for quality of life.

Effect of massage on blood pressure in patients with hypertension: A meta-analysis

BACKGROUND

Hypertension (HTN) is a chronic medical condition that affects 1.13 billion people globally. Successful management of HTN is accomplished through both pharmacological and non-pharmacological interventions. Massage therapy, a widely practiced complementary and alternative medicine therapy that alleviates physical discomfort and promotes overall well-being. The current meta-analysis aims to evaluate the effect of massage on blood pressure in patients with HTN.

METHODS

Electronic databases, including PubMed, Prospero, Scopus, ClinicalTrials.gov, Embase, and the Cochrane Library, were searched from their inception up to March 2021. All experimental trials that met the (PICO) criteria were included. The primary outcome of the study was blood pressure. A meta-analysis was conducted using a random-effects model to generate a summary of treatment effects, expressed as the effect size (Standardized Mean Difference - SMD), along with a 95% Confidence Interval (CI).

RESULTS

Six studies were included in the review, in which 290 patients participated, 148 were in the experimental group and 142 in the control group. Meta-analysis showed a minimal reduction of systolic blood pressure (SMD: -0.65 mmHg, 95% CI: -4.75, 3.55) and diastolic blood pressure (SMD: -0.68 mmHg, 95% CI: -2.43, 1.06) with considerable heterogeneity (I2> 94%).

CONCLUSION

The findings demonstrated that massage therapy resulted in a minimal reduction in blood pressure among patients with hypertension. To suggest massage as an effective intervention to reduce blood pressure further randomized control trials are recommended. Additionally, the literature is limited and still emerging, further large prospective studies with long follow-ups are warranted to verify the findings from this meta-analysis.

Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines

BACKGROUND

Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines.

METHODS

We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension from low-income rural and urban communities in Malaysia (n = 495) and the Philippines (n = 451). We compared the prevalence, characteristics and household expenditure on TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, and five hypertension management outcomes and wellbeing.

RESULTS

The prevalence of TCAM use to manage hypertension was higher in the Philippines than in Malaysia (18.8% vs 8.8%, p < 0.001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries, mainly as a complement, rather than an alternative to conventional treatment. Households allocated around 10% of health spending to TCAM in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use, while belief in conventional medicine was a negative predictor. TCAM use was not strongly associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country.

CONCLUSIONS

A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension, despite a general lack of evidence on efficacy and safety of commonly used TCAM modalities. Recognising that their patients may be using TCAM to manage hypertension will enable health care providers to deliver safer, more patient-centred care.

Use of massage therapy by mid-aged and older Australian women

BACKGROUND

Massage is a widely acceptable and popular form of complementary medicine (CM) among Australian women. While there is some research that reports on massage use in younger women, there is minimal research exploring massage use in the treatment of chronic illness in older women. This study provides an estimate of the prevalence of massage use, as well as identifying the characteristics significantly associated with consultation with a massage therapist, for mid-age and older Australian women.

METHODS

A cross-sectional sub-study was conducted on a sample of women drawn from the 45 and Up Study; a large cohort study of adults aged 45 years and over. Data from 1795 women were included in the analyses and massage use was compared against measures of demographics, health status and health care utilisation.

RESULTS

A total of 174 (7.7%) women consulted with a massage therapist in the previous 12 months. Women were more likely to consult a massage therapist if they have tertiary level education (O.R. = 1.67; 95% C.I.: 1.04, 2.65; p = 0.031), private health insurance (O.R. = 6.37; 95% C.I.: 4.41, 9.19; p < 0.001) and/or osteoarthritis (O.R. = 1.72; 95% C.I.: 1.19, 2.48; p = 0.004). They were also more likely to consult a massage therapist if they have a poorer health-related quality of life (HRQoL) (O.R. = 1.14; 95% C.I.: 1.04, 1.27; p = 0.007).

CONCLUSION

Older, tertiary-level educated Australian women with private health insurance were more likely to use massage therapy, as were women with osteoarthritis specifically. Women with lower HRQoL were found to be more likely to use massage therapy in the treatment of their chronic illness. This research provides insight into the determinants of massage use among ageing women and is useful for governments in consideration of accessibility to holistic healthcare when developing public policy for healthcare in Australia.

Chinese herbal medicine formula combined with calcium antagonist in the treatment of hypertension: a systematic review and meta-analysis

OBJECTIVE

Chinese herbal medicine formula and calcium antagonist are commonly used medicines for hypertension in China. This study aims to examine the efficacy and safety of for the treatment of Chinese herbal medicine formula combined calcium antagonist hypertension.

METHODS

PubMed, the Cochrane library, CNKI, VIP, Sinomed, and Wanfang Database were searched up to January 31, 2021. Data analysis was performed using the Recman 5.3. The source of clinical heterogeneity used stata16.0 for sensitivity analysis.

RESULTS

17 RCTs and 1587 cases were finally included. The results shows that the traditional Chinese medicine decoction combined with calcium antagonists is better than calcium antagonists alone in the treatment of hypertension. In addition, it can effectively alleviate the adverse reactions caused by calcium antagonists. However, due to the low quality of methodology and the small-scale research, more high-quality clinical trials are still needed for verification.

The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies

Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.

Acute Effects of Connective Tissue Manipulation on Autonomic Function in Healthy Young Women

Background: Connective tissue manipulation (CTM) has therapeutic effects on diseases with autonomic imbalance, yet its mechanisms of action are not clearly identified. Objective: The aim of this study was to investigate acute autonomic responses to CTM in healthy young women with various physical activity levels. Method: The study was designed as a nonrandomized, controlled single-center study. Healthy women aged between 18 and 25 years were assigned to a connective tissue manipulation group (CTMG) (n = 150) or a control group (CG) (n = 60). CTM was applied to the CTMG while the CG did not receive any intervention. Respiratory rate (RR), heart rate, systolic/diastolic blood pressures (SP/DP), oxygen saturation (OS) and body temperature were measured. The International Physical Activity Questionnaire short form was used to determine physical activity levels. ­Results: Analysis revealed significant reduction in SP and DP and an increment in RR in the CTMG (p < 0.05). RR increased and SP decreased among inactive, SP decreased among moderately active, and SP and OS decreased among highly active participants in the CTMG (p < 0.05). There were no significant alterations in the CG (p > 0.05). Conclusions: CTM has an immediate reducing effect on sympathetic activity in healthy young women independently from the physical activity level. Future studies are needed to clarify long-term effects of CTM on autonomic functions in healthy individuals.

Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure?: Recommendations based on high-quality systematic reviews

BACKGROUND

This review aims to rate the quality of evidence and the strength of recommendations in high-quality systematic reviews of non-drug therapies. Hypertensive patients who are resistant or non-adherent to antihypertensive drugs may be easier to manage if they choose alternative non-drug therapies for hypertension, based on this review.

METHODS

P: Adults (>18 years), except pregnant women, with essential hypertension. I: Cupping, moxibustion, acupuncture, acupoint stimulation, yoga, meditation, tai chi, Qi gong, Chinese massage, massage, spinal manipulation, biofeedback, device-guided breathing therapy, aromatherapy, music therapy, and relaxation approaches. C: 1. No treatment. 2. Sham therapy. 3. Conventional treatment, including antihypertensive drugs and lifestyle modification (e.g., exercise). O: 1. Change in the incidence of cardiovascular death. 2. Change in the incidence of myocardial infarction. 3. Change in the incidence of stroke. 4. Change in blood pressure (BP). 5. Efficacy rate of BP lowering. 6. Adverse effects (review specific). S: Systematic reviews of randomized controlled trials, including meta-analyses and assessments of the methodological quality/risk of bias.

INFORMATION SOURCES

Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane library, PubMed, Web of Science, China National Knowledge Infrastructure, and Chinese Scientific Journal Database were searched. The bibliographies of the included articles were also searched for relevant systematic reviews. GRADE criteria were used to rate the quality of evidence in systematic reviews considering 6 factors, including risk of bias.

RESULTS

This review ultimately included 13 systematic reviews of 14 non-drug therapies (acupuncture, wet cupping, Baduanjin, blood letting, auricular acupuncture, music, massage, Qi gong, moxibustion, relaxation therapies, biofeedback, device-guided breathing, yoga and tai chi) based on the inclusion criteria. The quality of evidence was generally low, and weak recommendations were given for most therapies except massage and acupuncture plus antihypertensive drug. Based on the analyzed evidence, massage and acupuncture plus antihypertensive drug could benefit people who want to lower their BP and do not have contraindications for massage and acupuncture plus antihypertensive drug.

DISCUSSION/STRENGTH

The GRADE approach makes this review a unique reference for people who are considering the grade of quality of evidence in systematic reviews, the balance of desirable and undesirable consequences and the strength of recommendations to decide which intervention should be used to reduce BP.

LIMITATIONS

Many non-drug therapies were excluded due to the low methodological quality of their systematic reviews, and only 14 therapies were evaluated in this review. As no patient-important outcomes were reviewed, surrogate outcomes were used to rate the strength of recommendations. This approach may cause a decrease in evidence quality according to GRADE, but we argue that this is appropriate in the context of this review.

Blood-Letting Therapy for Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the efficacy and safety of blood-letting therapy (BLT) in treatment of hypertension.

METHODS

A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials, Excerpt Medica Database (EMBASE), PubMed, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and Wanfang Database to identify randomized controlled trials (RCTs) in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs (BPAD) against placebo, no treatment or antihypertensive drugs. The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials. The Review Manager 5.3 software was used for meta-analysis.

RESULTS

A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified. Compared with antihypertensive drugs, blood pressure was significantly reduced by BLT (RR=1.21, 95% CI: 1.01 to 1.44, P=0.03; heterogeneity: P=0.06, I²=60%) and BPAD (RR=1.25, 95% CI, 1.02 to 1.53, P=0.03; heterogeneity: P= 0.01, I²=71%). Moreover, a significant improvement in Chinese medicine syndrome by BLT (RR=1.32; 95% CI: 1.14 to 1.53, P=0.0002; heterogeneity: P=0.53, I²=0%) and BPAD (RR=1.47; 95% CI: 1.06 to 2.04, P=0.02; heterogeneity: P=0.13, I²=56%) was identified. The reported adverse effects were well tolerated.

CONCLUSION

Although some positive findings were identified, no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. Further rigorously designed trials are warranted to confirm the results.

Evaluation of changes in left ventricular structure and function in hypertensive patients with coronary artery disease after PCI using real-time three-dimensional echocardiography

We aimed to evaluate the changes in left ventricular structure and function in hypertensive patients with coronary artery disease before and after percutaneous coronary intervention (PCI) using real-time three-dimensional echocardiography. Two hundred and eighty hypertensive patients with coronary artery disease undergoing PCI and 120 cases who did not receive PCI in our hospital were selected as the subjects of our study. All patients were administered with routine antiplatelet, anticoagulant, lipid-lowering, antihypertensive, dilating coronary artery and other medications. The left ventricular systolic function and systolic synchrony index changes before and after subjects were treated by PCI were analyzed using three-dimensional echocardiography. At 2 days before surgery, there were no significant differences in the left ventricular end-diastolic volume, left ventricular end-systolic volume (LVESV) and ejection fraction (EF) between the two patient groups (P>0.05). At 3 months and 9 months, the two key time points after PCI, the LVESV level in the PCI group was distinctly decreased, while EF was significantly increased (P<0.05). In addition, before treatment, there were no significant differences in the parameters of time from the corresponding segment of the myocardium to the minimal systolic volume in two patient groups, such as Tmsv-16SD, Tmsv-16Dif, Tmsv-12SD, Tmsv-12Dif, Tmsv-6SD and Tmsv-6Dif (P>0.05); however, the parameters of time from the corresponding segment of the myocardium to the minimal systolic volume in patients in the PCI group were significantly reduced at 3 and 9 months after surgery (P<0.05). Three-dimensional echocardiography can evaluate the critical parameters in the prognosis of hypertensive patients with coronary artery disease after PCI accurately and in real-time, which may play a significant role.

Prevalence, patterns, and predictors of massage practitioner utilization: Results of a US nationally representative survey

BACKGROUND

The use of massage therapy is common, especially in patients with musculoskeletal pain. The purpose of this study was to examine the prevalence, utilization, socio-demographic and health-related predictors of massage practitioner consultations in the US population.

METHODS

Cross-sectional data from the 2012 National Health Interview Survey for adults (n = 34,525).

RESULTS

Prevalence of massage practitioner utilization were 12.8% (lifetime) and 6.8% (last 12 months). Compared to non-users, those who used massage in the last year were more likely: female, at least high school educated, annual income ≥ US$ 15,000, diagnosed with spinal pain or arthritis, report moderate physical activity level as compared to low level, and consume alcohol as compared to being abstinent. Massage was mainly used for general wellness or disease prevention (56.3%), but also for specific, typically musculoskeletal, health problems (41.9%) for which 85.2% reported massage helped to some or a great deal. Most (59.1%) did not disclose massage use to their health care provider, despite 69.4% reporting massage therapy combined with medical treatment would be helpful.

CONCLUSIONS

Approximately 7% (15.4 million) of US adults used massage therapy in the past year, mainly for general disease prevention, wellness or musculoskeletal pain. The majority of respondents reported positive outcomes of massage on specific health problems and overall well-being. Massage utilization was rarely covered by health insurance. Despite the majority of massage users considered massage therapy combined with medical care helpful, most did not disclose massage therapy use to their health care provider.

Reducing effect of aerobic exercise on blood pressure of essential hypertensive patients: A meta-analysis

BACKGROUND

The comprehensive meta-analysis aimed to explore the reductive effect of aerobic exercise on blood pressure of hypertensive patients.

METHODS

The related researches were selected from PubMed and Embase databases up to June 2016. Based on specific inclusive criteria, the eligible studies were selected, and the heterogeneities in their results were estimated by χ-based Q-test and I statistics. Quantitative meta-analysis was assessed by R 3.12 software, and results were presented by standardized mean difference (SMD) and their 95% confidence intervals (CIs). Outcome indicators were systolic blood pressure (SBP) and diastolic blood pressure (DBP). The publication biases were estimated by Egger test. Besides, the "leave one out" method was used for sensitivity evaluations.

RESULTS

As a result, a total of 13 papers with 802 samples were included. Based on the meta-analysis results, there were no significant differences in SBP and DBP between aerobic and control groups before exercise (SMD = 0.15, 95%CI: -0.16-0.46; SMD = 0.16, 95% CI: -0.23-0.55). However, significant reductions were obviously in aerobic group after aerobics, compared with control (SMD = -0.79, 95% CI: -1.29 to -0.28; SMD = -0.63, 95% CI: -1.14 to -0.12). A significant publication bias was detected in SBP (t = -2.2314, P = 0.04549) but not in DBP (t = -1.4962, P = 0.1604). Additionally, the DBP result would be altered after the exclusion of 2 individual papers.

CONCLUSION

Aerobic exercise may be a potential nonpharmacological treatment for blood pressure improvement in essential hypertensive patients.

Massage therapy research review

In this review, massage therapy has been shown to have beneficial effects on varying conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons between massage therapy and standard treatment control groups, several have compared different forms of massage (e.g. Swedish versus Thai massage), and different active therapies such as massage versus exercise. Typically, the massage therapy groups have experienced more positive effects than the control or comparison groups. This may relate to the massage therapy providing more stimulation of pressure receptors, in turn enhancing vagal activity and reducing cortisol levels. Some of the researchers have assessed physical, physiological and biochemical effects, although most have relied exclusively on self-report measures. Despite these methodological problems and the dearth of research from the U.S., the massage therapy profession has grown significantly and massage therapy is increasingly practiced in traditional medical settings, highlighting the need for more rigorous research.

Update in Hypertension Therapy

Hypertension is the leading cause of early mortality in the world, and reduction of blood pressure can help to reduce that burden. There is an enormous and ever-expanding body of literature on hypertension, with a 2016 Medline search for hypertension retrieving more than 113,000 publications. Recent guidelines from major societies have been published, and often present conflicting recommendations based on the same data. Using a question-and-answer format, this article reviews some of the recent developments and opinions on management of blood pressure and provides practical suggestions for management in the clinical arena.

Meta-analysis of the effectiveness of traditional Chinese herbal formula Zhen Wu Decoction for the treatment of hypertension

OBJECTIVES

Zhen Wu Decoction (ZWD), a famous classic herbal formula documented in traditional Chinese medicine (TCM), is widely available in China for treating hypertensive patients with kidney yang deficiency and fluid retention syndrome. This systematic review aims to evaluate the effectiveness and safety of ZWD for hypertension.

METHODS

Cochrane Central Register of Controlled Trials, PubMed, Embase, the Chinese National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Chinese Biomedical Literature Database, and the Wanfang Database were searched from their inception to November 2014. Randomised controlled trials of ZWD used alone or in combination with antihypertensive drugs against placebo, no intervention or antihypertensive drugs in hypertensive patients were identified. Two assessors independently reviewed each trial. The Cochrane risk of bias assessment tool was used for quality assessment.

RESULTS

Seven trials involving 472 hypertensive patients were identified. Compared with antihypertensive drugs, ZWD showed no significant effects in lowering blood pressure (BP) (n=177; risk ratio (RR) 1.06; 95% CI 0.87 to 1.28; p=0.58); however, ZWD plus antihypertensive drugs (ZPAD) significantly lowered systolic BP (n=80; weighted mean difference (WMD) -14.00 mm Hg, 95% CI -18.84 to -9.16 mm Hg; p<0.00001), diastolic BP (n=80; WMD -8.00 mm Hg, 95% CI -11.35 to -4.65 mm Hg; p<0.00001), and BP (n=215; RR 1.21, 95% CI 1.08 to 1.37; p=0.001). TCM symptoms and syndromes were significantly improved by either ZWD (n=177; RR 1.58, 95% CI 1.28 to 1.95; p<0.0001) or ZPAD (n=215; RR 1.30, 95% CI 1.14 to 1.49; p=0.0001). Adverse effects were not reported.

CONCLUSIONS

This systematic review revealed no definite conclusion about the application of ZWD for hypertension due to the poor methodological quality, high risk of bias, and inadequate reporting on clinical data. More rigorously designed trials, especially addressing continuous BP and adverse effects, are warranted.

Efficacy and Safety of a Traditional Chinese Herbal Formula Xuefu Zhuyu Decoction for Hypertension: A Systematic Review and Meta-Analysis

The cardioprotective role of xuefu zhuyu decoction (XZD), a well-known classical herbal formula, has been documented for hypertension treatment recently. This study aims to summarize the efficacy and safety of XZD in treating hypertension.Seven databases were searched to identify randomized controlled trials evaluating the efficacy of XZD in hypertensive patients. Fifteen studies involving 1364 hypertensive patients were included. All studies compared XZD and antihypertensive drugs with antihypertensive drugs used alone.In all, 15 studies reported significant effects of XZD for lowering blood pressure compared with the control group (P < 0.05), and 7 studies reported significant effects of XZD for improving symptoms compared with the control group (P < 0.00001). Meanwhile, studies reported XZD was more efficacious than antihypertensive drugs in improving total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, hemorheology, carotid intima-media thickness, and left ventricular mass index (P < 0.05). No severe adverse event was reported.This meta-analysis provides evidence that XZD is beneficial for hypertension. Although concerns regarding selective bias and methodologic flaws were raised, our findings suggests XZD as a new candidate cardioprotective drug for hypertension, which should be given priority for future preclinical and clinical studies.

Massage therapy: understanding the mechanisms of action on blood pressure. A scoping review

Massage therapy (MT) has shown potential in reducing blood pressure (BP); however, the psychophysiological pathways and structures involved in this outcome are unclear. The aims of this scoping review were twofold. (1) To summarize the current knowledge of the mechanisms of action of MT on BP. (2) To highlight the research gaps and challenges that researchers must overcome to further elucidate how MT attenuates BP. A scoping review was conducted to examine the evidence regarding the mechanisms of action of MT on BP. This review included the thematic analysis of 27 publications that considered the influence of MT on BP. Based on this analysis, six potential BP mediating pathways were identified Current theories suggest that MT exerts sympatholytic effects through physiologic and psychological mechanisms, improves hypothalamus-pituitary-adrenocortical axis function, and increases in blood flow, which, in turn, may improve endothelial function. Future study is needed, using more scientifically rigorous methodology, to fully elucidate the mechanism of action of MT.

Chinese herbal medicine for resistant hypertension: a systematic review

OBJECTIVES

This study aimed to summarise the current evidence from randomised control trials (RCTs) concerning treatment of patients with resistant hypertension with Chinese herbal medicine (CHM).

DESIGN

Seven databases, including the Cochrane Library, PubMed, EMBASE, CNKI, VIP, CBM and Wanfang, were systematically searched from their inception to March 2014 for RCTs investigating treatment of resistant hypertension in which CHM was used either as a monotherapy or in combination with conventional medicine versus placebo, no intervention or conventional medicine.

RESULTS

Five trials containing 446 hypertensive patients were identified. The methodological quality of most trials was evaluated as generally low. All included trials compared CHM plus antihypertensive drugs with antihypertensive drugs alone for resistant hypertension. Formulations of CHM included tablet, decoction and injection. It was found that, compared with antihypertensive drugs alone, CHM (tablet) plus antihypertensive drugs resulted in clinically, but not statistically, significant reductions in systolic blood pressure (SBP; weighted mean difference (WMD)=-10.32 mm Hg; 95% CI -21.10 to 0.46; p=0.06) and diastolic blood pressure (DBP; WMD=-3.30 mm Hg; 95% CI -7.66 to 1.06; p=0.14). CHM (decoction) plus antihypertensive drugs also produced a clinically meaningful, but not statistically significant, reduction in SBP (WMD=-12.56 mm Hg; 95% CI -26.83 to 1.71; p=0.08), and did significantly decrease DBP (WMD=-7.89 mm Hg; 95% CI -11.74 to -4.04; p<0.0001). There were no significant differences in SBP (WMD=-3.50 mm Hg; 95% CI -8.95 to 1.95; p=0.21) and DBP (WMD=1.00 mm Hg; 95% CI -1.39 to 3.39; p=0.41) between CHM (injection) plus the antihypertensive drugs group and antihypertensive drugs alone. The safety of CHM remained uncertain.

CONCLUSIONS

No definite conclusions about the effectiveness and safety of CHM for resistant hypertension could be drawn. More rigorously designed trials are warranted.

Qigong for hypertension: a systematic review

The purpose of this review was to evaluate the efficacy and safety of qigong for hypertension.A systematic literature search was performed in 7 databases from their respective inceptions until April 2014, including the Cochrane Library, EMBASE, PubMed, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, Wanfang database, and Chinese National Knowledge Infrastructure. Randomized controlled trials of qigong as either monotherapy or adjunctive therapy with antihypertensive drugs versus no intervention, exercise, or antihypertensive drugs for hypertension were identified. The risk of bias was assessed using the tool described in Cochrane Handbook for Systematic Review of Interventions, version 5.1.0.Twenty trials containing 2349 hypertensive patients were included in the meta-analysis. The risk of bias was generally high. Compared with no intervention, qigong significantly reduced systolic blood pressure (SBP) (weighted mean difference [WMD] = -17.40 mm Hg, 95% confidence interval [CI] -21.06 to -13.74, P < 0.00001) and diastolic blood pressure (DBP) (WMD = -10.15 mm Hg, 95% CI -13.99 to -6.30, P < 0.00001). Qigong was inferior to exercise in decreasing SBP (WMD = 6.51 mm Hg, 95% CI 2.81 to 10.21, P = 0.0006), but no significant difference between the effects of qigong and exercise on DBP (WMD = 0.67 mm Hg, 95% CI -1.39 to 2.73, P = 0.52) was identified. Compared with antihypertensive drugs, qigong produced a clinically meaningful but not statistically significant reduction in SBP (WMD = -7.91 mm Hg, 95% CI -16.81 to 1.00, P = 0.08), but appeared to be more effective in lowering DBP (WMD = -6.08 mm Hg, 95% CI -9.58 to -2.58, P = 0.0007). Qigong plus antihypertensive drugs significantly lowered both SBP (WMD = -11.99 mm Hg, 95% CI -15.59 to -8.39, P < 0.00001) and DBP (WMD = -5.28 mm Hg, 95% CI, -8.13 to -2.42, P = 0.0003) compared with antihypertensive drugs alone. No serious adverse events were reported.The meta-analysis suggests that qigong is an effective therapy for hypertension. However, more rigorously designed randomized controlled trials with long-term follow-up focusing on hard clinical outcomes are required to confirm the results.