Is adding massage therapy on top of antihypertensive drugs more effective in reducing blood pressure among patients with essential hypertension?
Date of publication of the systematic review: March 2015
Design
Systematic review of 24 randomized control trials (RCTs).
Participants
1962 patients diagnosed with essential hypertension (age range: not reported, male % range: not reported). There was no restriction in the diagnostic standard of essential hypertension.
Intervention
Intervention 1: Massage therapy alone was applied. The massage therapy lasted from 10 to 60 minutes per session and the number of sessions ranged from 1 to 7 per week. The duration of intervention ranged from 10 days to 6 months.
Intervention 2: Massage therapy plus antihypertensive drugs was applied. The massage therapy lasted from 10 to 60 minutes per session and the number of sessions ranged from 1 to 7 per week. Several types of antihypertensive drugs were used. The duration of intervention ranged from 10 days to 12 months.
Comparator
Comparison 1: Massage therapy alone versus antihypertensive drugs;
Comparison 2: Massage therapy plus antihypertensive drugs versus antihypertensive drugs.
Major Outcomes
Outcome 1: Change in systolic blood pressure (SBP)at the end of the intervention;
Outcome 2: Change in diastolic blood pressure (DBP) at the end of the intervention.
Comparison    Massage therapy alone versus antihypertensive drugs
Main Results
Compared to antihypertensive drugs, massage therapy alone significantly lowered SBP (pooled mean difference (MD): -3.47, 95% CI: -5.39 to -1.56) among patients with essential hypertension. There was no statistically significant difference in DBP (pooled MD: -0.98, 95% CI: -2.28 to 0.32) between the two groups.
Comparison 1: Massage therapy alone versus antihypertensive drugs among patients with essential hypertension
Outcomes No. of studies (Total no. of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) Pooled MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (mmHg) 6 (410) Not reported/207 Not reported/203 35% -3.47 (-5.39 to -1.56) 0.0004 Very high
2 (mmHg) 6 (410) Not reported/207 Not reported/203 17% -0.98 (-2.28 to 0.32) 0.14 Very high
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Massage therapy plus antihypertensive drugs versus antihypertensive drugs
Main Results
Compared to antihypertensive drugs, massage therapy plus antihypertensive drugs significantly lowered SBP (pooled mean difference (MD): -6.92, 95% CI: -10.05 to -3.80) and DBP (pooled MD: -3.63, 95% CI: -6.18 to -1.09) among patients with essential hypertension.
Comparison 2: Massage therapy plus antihypertensive drugs versus antihypertensive drugs among patients with essential hypertension
Outcomes No. of studies (Total no. of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) Pooled MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (mmHg) 4 (634) Not reported/328 Not reported/306 63% -6.92 (-10.05 to -3.80) < 0.0001 Very high
2 (mmHg) 4 (634) Not reported/328 Not reported/306 80% -3.63 (-6.18 to -1.09) 0.0005 Very high
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Massage therapy alone versus antihypertensive drugs
Main Results
Compared to antihypertensive drugs, massage therapy alone significantly lowered SBP (pooled mean difference (MD): -3.47, 95% CI: -5.39 to -1.56) among patients with essential hypertension. There was no statistically significant difference in DBP (pooled MD: -0.98, 95% CI: -2.28 to 0.32) between the two groups.
Comparison 1: Massage therapy alone versus antihypertensive drugs among patients with essential hypertension
Outcomes 1 (mmHg) 2 (mmHg)
No. of studies (Total no. of participants) 6 (410) 6 (410)
Mean (SD)/ No. of participants Intervention Not reported/207 Not reported/207
Comparator Not reported/203 Not reported/203
Pooled MD (95% CI) -3.47 (-5.39 to -1.56) -0.98 (-2.28 to 0.32)
p value 0.0004 0.14
Overall quality of evidence* Very high Very high
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Massage therapy plus antihypertensive drugs versus antihypertensive drugs
Main Results
Compared to antihypertensive drugs, massage therapy plus antihypertensive drugs significantly lowered SBP (pooled mean difference (MD): -6.92, 95% CI: -10.05 to -3.80) and DBP (pooled MD: -3.63, 95% CI: -6.18 to -1.09) among patients with essential hypertension.
Comparison 2: Massage therapy plus antihypertensive drugs versus antihypertensive drugs among patients with essential hypertension
Outcomes 1 (mmHg) 2 (mmHg)
No. of studies (Total no. of participants) 4 (634) 4 (634)
Mean (SD)/ No. of participants Intervention Not reported/328 Not reported/328
Comparator Not reported/306 Not reported/306
Pooled MD (95% CI) -6.92 (-10.05 to -3.80) -3.63 (-6.18 to -1.09)
p value < 0.0001 0.0005
Overall quality of evidence* Very high Very high
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
Compared to antihypertensive drugs, massage therapy alone significantly lowered SBP among patients with essential hypertension. However, there was no statistically significant difference in DBP between two groups. Compared to antihypertensive drugs, massage therapy plus antihypertensive drugs significantly lowered SBP and DBP among patients with essential hypertension. For all outcomes, the overall quality of evidence is very high. Further research is most unlikely to have an important impact on our confidence in this estimate of effect.
Harms
Among 24 included trials, only five trials reported adverse events. Three trials reported flushing, fatigue, headache, dizziness, palpitations and ankle edema in antihypertensive drugs group while one trial reported flushing, headache and palpitations in both massage therapy group and antihypertensive drugs group. There was no occurrence of adverse events in the remaining one trial. All adverse effects were not serious and relieved without special treatment.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/24990417
The synopsis is based on the following article:
Xiong XJ, Li SJ, Zhang YQ. Massage therapy for essential hypertension: a systematic review. Journal of human hypertension. 2015 Mar 1;29(3):143-51.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.