Is massage effective for lowering blood pressure in patients with hypertension?

Massage Therapy for Lowering Blood Pressure in Hypertension

Massage therapy has minimal effect on blood pressure reduction and is not recommended as a primary intervention for hypertension management. While massage may provide modest short-term reductions in blood pressure, evidence supporting its effectiveness is limited and of poor methodological quality 1, 2, 3.

Evidence on Massage for Blood Pressure Reduction

• Meta-analyses show massage therapy produces only minimal reductions in blood pressure, with the most recent meta-analysis (2024) demonstrating minimal changes in both systolic (-0.65 mmHg) and diastolic (-0.68 mmHg) blood pressure 3
• Earlier meta-analyses reported more significant reductions (systolic: -7.39 mmHg, diastolic: -5.04 mmHg), but noted poor methodological quality of included studies 1
• Small studies have shown some effect (e.g., a preliminary study with only 8 participants in the experimental group), but these findings require validation in larger, more rigorous trials 4, 5
• The safety profile of massage therapy for hypertension management remains unclear 2

Recommended Evidence-Based Interventions for Hypertension

Current hypertension guidelines recommend the following lifestyle modifications that have stronger evidence for blood pressure reduction:

Physical Activity

• Regular aerobic exercise (30 minutes on 5-7 days per week) can reduce systolic blood pressure by 5-8 mmHg 6
• Resistance/strength training 2-3 days per week can reduce blood pressure by 4-5 mmHg 7, 6
• Dynamic resistance training targeting major muscle groups is recommended over isometric exercises 7

Dietary Modifications

• DASH diet (rich in fruits, vegetables, whole grains, low-fat dairy) can reduce systolic blood pressure by 11 mmHg 6
• Sodium restriction (reducing intake by 1000 mg/day) can lower systolic blood pressure by 5-6 mmHg 6
• Increased potassium intake (3500-5000 mg/day) can reduce systolic blood pressure by 4-5 mmHg 6

Weight Management

• Weight loss of approximately 5 kg can reduce systolic blood pressure by 4.4 mmHg and diastolic blood pressure by 3.6 mmHg 6
• Even modest weight reduction provides significant blood pressure benefits 6

Alcohol Moderation

• Limiting alcohol consumption (≤2 drinks/day for men, ≤1 drink/day for women) can reduce systolic blood pressure by 4 mmHg 6

Implementation Algorithm for Blood Pressure Management

1. First-line approach: Implement evidence-based lifestyle modifications with proven efficacy:

   • DASH diet + sodium restriction 6
   • Regular aerobic and resistance exercise 6, 7
   • Weight management if overweight/obese 6
   • Alcohol moderation 6

2. Monitoring: Assess blood pressure response after 3-6 months of lifestyle modifications 6

3. Pharmacological intervention: Consider if:

   • Blood pressure remains ≥140/90 mmHg after 3-6 months of lifestyle modifications 6
   • Initial blood pressure is ≥160/100 mmHg 6
   • Patient has high cardiovascular risk, diabetes, or target organ damage 6

Conclusion on Massage Therapy

While massage may provide temporary relaxation and stress reduction benefits, current evidence does not support its use as an effective intervention for blood pressure management. Patients interested in complementary approaches should be directed toward evidence-based lifestyle modifications that have demonstrated significant and consistent blood pressure-lowering effects 6.