According to the US Centers for Disease Control and Prevention (CDC), one in three American adults has hypertension (commonly known as high blood pressure), yet only about half of affected people have their condition under control.1 This is concerning because hypertension can lead to dangerous health conditions including chronic heart failure, heart attack, kidney disease, and stroke. In fact, high blood pressure and its associated conditions lead to approximately 1,000 deaths each day in the United States.
A recent review article, “Massage Therapy for Essential Hypertension: A Systematic Review,”2 searched seven research databases for randomized controlled trials on massage therapy for improvement of hypertension. Twenty-four clinical trials were included in the review, for a total of 1,962 hypertensive subjects.
Nine of the clinical trials compared two groups: a group that received massage versus a group that received antihypertensive medication. The review’s authors performed a meta-analysis to combine all of the data from these nine studies. They found that massage was better than medication for lowering systolic blood pressure, but they did not find any significant differences in diastolic blood pressure between the two groups.
Eleven of the clinical trials compared two other groups: a group that received massage plus antihypertensive medication versus a group that received medication alone. Meta-analysis of these studies was even more exciting: massage combined with antihypertensive medication was significantly more effective at reducing both systolic and diastolic blood pressure than medication alone. In other words, people who take antihypertensive medication have better results if they also receive massage therapy.
Looking at the actual numeric results of this review, the overall decrease in systolic and diastolic blood pressure due to massage therapy was approximately 6.9 and 3.6 millimeters of mercury (mmHg) respectively. To put this in context, the CDC reports that a 12–13 mmHg reduction in average systolic blood pressure over four years can reduce heart disease risk by 21 percent, stroke risk by 37 percent, and total risk of cardiovascular-related death by 25 percent. Massage therapy plus antihypertensive medication may give your clients the blood pressure reduction they need in order to avoid the perilous conditions associated with hypertension.
A point of interest in this review article was that massage was shown to be significantly safer than antihypertensive medications based on the number of side effects reported. No serious adverse events occurred in either group, but there were significantly fewer minor adverse events with massage therapy than with medication.
A similar review article, “Chinese Massage (Tui Na) for the Treatment of Essential Hypertension: A Systematic Review and Meta-Analysis,”3 demonstrated the benefit of tui na compared to antihypertensive medications for hypertension. In this review, a meta-analysis of seven articles showed that tui na and antihypertensive medications were significantly more effective at lowering blood pressure in people with hypertension than medication alone. Again, adding a form of massage therapy as an adjunctive treatment was significantly beneficial for reducing blood pressure. Even though this review included fewer primary articles, the results were the same.
Still, there were many undetermined factors in these review articles that may affect blood pressure outcomes. For example, the articles reviewed did not indicate a consistent amount of massage that was most beneficial for the client. The timing of the massage ranged from 10 minutes to one hour over a course of four weeks to one year. We cannot determine if more treatment leads to better outcomes, or if there is a threshold of timing past which there is no further treatment benefit. Also, there were no consistent descriptions of the clients that benefitted from massage. Improvement of blood pressure outcomes may be based on patient characteristics such as age, comorbidities, gender, stress levels, or other factors. More research is needed to help determine which patients are most likely to benefit from massage.

Conclusion
So, what do the results in these studies mean for you?
1. Massage therapy in conjunction with antihypertensive medication is more beneficial for reduction in blood pressure than medication alone. Therefore, encourage your client to continue taking antihypertensive medication in accordance with her physician’s instructions and to rebook her next appointment for a massage.
2. Data does not exist about the amount of massage needed to show a reduction in blood pressure. Therefore, work with your client and her primary care provider to determine the right amount of massage for her.
3. Severe adverse events due to massage therapy were not shown in any of the clinical trials reviewed, and massage is expected to be safe for people with hypertension. However, be sure to screen all clients for other potential contraindications to massage.

Notes
1.    US Centers for Disease Control and Prevention, “High Blood Pressure,” accessed November 2014, www.cdc.gov/bloodpressure.
2. X. J. Xiong, S. J. Li, and Y. Q. Zhang, “Massage Therapy for Essential Hypertension: A Systematic Review,” Journal of Human Hypertension (July 3, 2014).
3.    X. Yang, H. Zhao, and J. Wang, “Chinese Massage (Tuina) for the Treatment of Essential Hypertension: A Systematic Review and Meta-Analysis,” Complementary Therapies in Medicine 22, no. 3 (June 2014): 541–8.

Jerrilyn Cambron, LMT, DC, MPH, PhD, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at jcambron@nuhs.edu.