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Relaxation techniques may help lower high blood pressure-at least in the short term-but the longer term effects are unclear, finds a pooled data analysis of the existing research published in the open access journal BMJ Medicine.

And the risk of bias in the existing body of research means that further, more rigorously designed and longer studies are needed to confirm whether these techniques have a constructive role in the treatment of high blood pressure, conclude the researchers.

High blood pressure affects around a third of 30-79 year olds and is one of the leading attributable causes of deaths in both men and women, note the researchers.

While drugs are available to treat the condition, adherence to them is poor, generating interest in alternative approaches, such as relaxation techniques, to reduce one of the major risk factors for high blood pressure-high stress levels.

But it’s far from clear which of these methods, which can include breath control, mindfulness, yoga, Tai Chi, and biofeedback, among others, might be most effective.

To build on the evidence base, the researchers scoured research databases for studies, published in English up to February 2024 that looked at the potential impact of relaxation techniques on high blood pressure (140/90 mm Hg and above) and elevated blood pressure (120/80 mm Hg and above).

They included 182 studies, 166 of which looked at high blood pressure, and 16 of which looked at elevated blood pressure (pre-hypertension).

Where possible, the researchers deployed network meta analysis, a statistical technique used to simultaneously compare the effects of several different ‘treatments’.

The pooled results of 54 studies showed that most relaxation techniques seemed to lower both systolic and diastolic blood pressure for people with high blood pressure after 3 or fewer months. The most commonly included interventions were breath control (13 studies), yoga/tai chi (11), biofeedback (8), progressive muscle relaxation (7), and music (7).

Compared with no intervention, breath control achieved a reduction of 6.65 mm Hg in systolic blood pressure (the first and higher number in a blood pressure reading), meditation a drop of 7.71 mm Hg, meditative movement, such as tai chi and yoga, a drop of 9.58 mm Hg, and mindfulness a drop of 9.90 mm Hg.

Music was also associated with a fall of 6.61 mm Hg, progressive muscle relaxation with a fall of 7.46 mm Hg, and psychotherapy with a reduction of 9.83 mm Hg. Combined techniques were associated with a drop of 6.78 mm Hg in blood pressure.

There was no statistical evidence of effectiveness for any technique after 3 to 12 months and the certainty of the evidence was very low. The most commonly included techniques at this timepoint were biofeedback (7 studies), yoga/tai chi (4), and progressive muscle relaxation (4).

Very few studies included long term follow up of 12 months or more, and of the 3 included in the network analysis, the results showed that compared with no treatment autogenic (self directed) training might lower both systolic and diastolic blood pressure, but the certainty of the evidence was low.

There was no statistical evidence of effectiveness for other treatments assessed at this time point, including biofeedback, progressive muscle relaxation, and techniques involving a combined approach.

Limited data were available for elevated blood pressure: only two studies compared relaxation techniques with no treatment/usual care and the effects on systolic blood pressure were small.

The researchers note that the descriptions of relaxation interventions were sometimes incomplete or sparse, there were few data on costs and cost effectiveness, and most of the included studies didn’t report information on the risk of cardiovascular disease/events/deaths.

But they suggest: “The results of our systematic review and network meta-analysis indicate that relaxation or stress management techniques might result in meaningful reductions in blood pressure at up to three months of follow-up.”

But they caution: “Uncertainty exists about this effect, however, because of the risk of bias in the primary studies, the potential for publication bias in this area, and imprecision in the effect estimates, meaning that the observed changes in blood pressure might be too small to affect cardiovascular or cerebrovascular outcomes.”

And they add: “Hypertension is a chronic condition, likely to require long term drug treatments or behavioural changes. As such, interventions that are used for a brief period, or provide only short term benefits, are unlikely to be clinically useful.

“Too few studies exist, however, to assess whether the beneficial effects of relaxation are maintained when the techniques are practised for longer than three months. Future studies must clearly report whether participants were still using relaxation methods at the time of the outcome assessment, with details on adherence to the relaxation schedule. These factors might strongly influence the effectiveness of the different relaxation and stress management techniques.” 

Reference:

Katie E Webster, Monika Halicka, Russell J Bowater, Thomas Parkhouse, Effectiveness of stress management and relaxation interventions for management of hypertension and prehypertension: systematic review and network meta-analysis, BMJ Medicine, DOI:10.1136/bmjmed-2024-001098 

An Amsterdam UMC-led study has found that migrants, this case from West Africa to Europe, experience a ‘clear change’ in their microbiome composition as compared to their non-migrant peers in West Africa, which expose them to an increase of cardiovascular disease. These peer-reviewed findings are published today in the journal Gut Microbes demonstrating that participants who lost specific groups of microbes or acquired specific new groups of microbes had higher rates of cardiovascular risk factors such as hypertension, diabetes, obesity, and poor kidney function.

“The results clearly demonstrate the importance of our findings in the relation to migration-related health outcomes,” explains postdoctoral researcher at Amsterdam UMC and first author of the study, Barbara Verhaar, who carried out the research together with colleagues at the University of Ghana, and Kwame Nkrumah University of Science & Technology (KNUST).

“It was already thought that migration had an effect on an individual’s microbiome, but previous studies have either lacked in the number of individuals included, didn’t control for variations in diet or only compared first- and second-generation migrants. Our study makes use of our own RODAM study cohort to definitively demonstrate this change,” says Verhaar.

The Amsterdam UMC led study included more than 1100 individuals from two separate continents and three locations: rural Ghana, urban Ghana or Netherlands. Respondents completed identical dietary questionnaires and provided both fecal and blood samples to determine the composition of their gut microbiomes. Analyses revealed the presence of different microbes across the three groups, in line with the hypothesis that migration would affect microbiome composition. The findings show that some groups of microbes disappear, and new ones emerge along the migration axis.

Health Outcomes

Previous studies, as well as the World Health Organisation, note that migrants frequently experience poorer health outcomes than native residents and research from Amsterdam UMC has found this also to be the case in the Netherlands.

“This research underscores the relevance of gut health and how we look at the adverse health outcomes that are often associated with migration. It is fascinating to learn that when we migrate, we lose some relevant microbes we acquired in our home countries and pick up new microbes in the new countries, and this can influence our health very importantly. We found that macronutrient groups such as protein, fat and salt in food were strongest associated with gut microbiota composition and these were higher in migrants, which might have contributed to the shift in gut microbiota composition. Future longitudinal studies are needed to verify these findings,” adds Charles Agyemang, Professor of Global Migration, Ethnicity & Health at Amsterdam UMC and senior author of the study.

Cardiometabolic risk is a growing concern for researchers across the globe and Agyemang is currently leading a host of projects, both in the Netherlands and several African countries, that aim to develop better interventions to lower the risk of developing cardiometabolic diseases, such as diabetes and hypertension; and to improve management of cardiometabolic diseases.

As part of these efforts, as in this study, he works with the several institutions across the globe especially in the African region to ensure that research in Amsterdam is strengthened with international data and, also, that research findings are translated into concrete policy.

“The findings of this study provide important insights into how migration can reshape our gut microbiota and subsequent health outcomes and emphasizes the needs for north-south collaborations,” adds Ellis Owusu-Dabo, Professor of Epidemiology and Global Health, KNUST.  

Reference:

Barbara J. H. Verhaar, Eva L. van der Linden, Gut microbiota shift in Ghanaian individuals along the migration axis: the RODAM-Pros cohort, Gut Microbes, https://doi.org/10.1080/19490976.2025.2471960.

The list of treatments for low back pain is endless, but few offer relief for the one in four Americans who suffer from this persistent pain and leading cause of disability globally. More than 80% of those with chronic low back pain wished there were better treatment options. Yet, without sufficient pain relief, many people need to take opioids, which can be addictive.

The good news? A multi-institutional team, led by researchers from the Penn State College of Medicine and the University of Wisconsin-Madison, found that eight weeks of either mindfulness or cognitive behavioral therapy (CBT) training led to meaningful improvements among adults with chronic low back pain that’s currently treated with opioids and had not responded to prior treatments. These behavioral therapies helped improve physical function and quality of life and reduce pain and opioid dose in a randomized clinical trial. The benefits persisted for up to 12 months.

The findings were published today (April 7) in JAMA Network Open. This is the largest trial to date comparing mindfulness with CBT as treatments for opioid-treated chronic pain and the research team followed up with participants over a longer time period than many previous trials of mindfulness.

“Both mindfulness and cognitive behavioral therapy were shown to be safe, effective treatments, providing lasting benefits for people with opioid-treated chronic back pain,” said Aleksandra Zgierska, Jeanne L. and Thomas L. Leaman, MD, endowed professor and vice chair of research of family and community medicine and professor of anesthesiology and perioperative medicine and of public health sciences at the Penn State College of Medicine, who led the study. “These evidence-based behavioral therapies should be standard of care available to our patients.”

Pain is multifaceted, especially chronic pain that can last for months or years. Chronic low back pain is the most common form of chronic non-cancer pain that’s treated with opioids. Previous research has shown that adults with chronic pain may benefit from behavioral therapies, which can help people change their thoughts about and relationship to pain, but it’s been understudied, the researchers explained. Studies on behavioral therapies were generally small in size and evaluated benefits over the short-term.

“People think of chronic pain as a physical condition that requires a physical intervention,” said Eric Garland, endowed professor in health sciences and professor of psychology at the University of California, San Diego and senior author of the study.

The research team set out to evaluate the effectiveness of mindfulness compared to CBT as treatments for chronic opioid-treated low back pain and their long-term effects. CBT is considered the standard psychotherapy for chronic pain, but its long-term benefits haven’t been well studied. To date, only 17 studies have evaluated mindfulness for chronic low-back pain and three studies have compared mindfulness and CBT.

This study was planned in partnership with an advisory panel composed of clinicians and representatives of community and advocacy organizations that work with people with chronic pain as well as adults with opioid-treated chronic low back pain and their caregivers. The panel’s feedback, included throughout the study, helped the researchers design and implement the study and better translate the study’s results to be meaningful and useful to patients and clinicians.

The team enrolled 770 adults to participate in a randomized clinical trial conducted in three sites — Madison, Wisconsin; Boston, Massachusetts; and Salt Lake City, Utah. Participants, on average, experienced moderate-to-severe pain, functional limitations, compromised quality of life and numerous prior treatments for their chronic low-back pain and were treated with daily opioid medications for at least three months.

“The people in this study had quite severe back pain that interfered with their life and was bad enough to need opioid medication. Usually, in that condition, people don’t really get better over time on their own,” said Bruce Barrett, professor of family medicine and community health at the University of Wisconsin-Madison and co-lead of the study.

Participants were then assigned to either receive mindfulness-based therapy or CBT, which were conducted in therapist-led, two-hour group sessions for eight weeks. The mindfulness group learned to notice the sensations they experienced, giving them more control over how they related and respond to the pain and other symptoms. The CBT group learned coping skills and strategies to change their negative thought patterns. Participants were instructed to practice on their own for 30 minutes a day, six days a week during the 12-month study and to continue with their routine care. They were not instructed to reduce their opioid dosage. They reported on their pain level, ability to do daily activities, mental and physical health-related quality of life and daily opioid medication use at the start of the study and after three, six, nine and 12 months.

At the end of the study, participants in both groups reported significant and long-lasting benefits including reductions in pain and daily opioid dose. They also reported increased function and health-related quality of life through 12 months. Both mindfulness and CBT tools were shown that they could be effective and used safely over the long-term, the researchers said.

“The goal of pain management is to improve quality of life, increase function and reduce the sense of suffering. The study’s interventions likely helped reduce the participants’ sense of suffering, which probably allowed them to function a whole lot better,” said Penney Cowan, founder of the American Chronic Pain Association and co-author and advisor on the study. “People can live with pain, but they need to know how to do it. This study provides a sense of hope. It says you can do this and help yourself to a better quality of life.”

The research team explained that people living with chronic pain assemble a toolkit filled with different self-coping and self-care methods to manage their pain. They can use these tools at different times and in different ways.

“Mindfulness and CBT are other tools that you can add to your toolbox to increase your capacity to cope and live a meaningful life,” said Christin Veasley, founder of the Chronic Pain Research Alliance and co-author and advisor on the study. “What’s important about the types of therapies, like the ones evaluated in this study, is that they can be used broadly across all pain conditions and all pain severities.”

For example, while participants were told to continue their usual treatment, including pain medication as advised by their usual clinicians, opioid dosage decreased in both groups through 12 months following the intervention. Zgierska explained that participants learned skills, like taking a mindful breath before taking medication. The improvements, the research team said, were the byproduct of people implementing these tools, learning to better cope with pain and deciding to decrease their opioid use on their own.

“These therapies aren’t a total cure, but they teach people how to develop the inner resources they need to cope with chronic pain and to live a better life,” Garland said. “Mindfulness is a self-regulated tool that comes from within, unlike surgery or medication where something is being done to you from the outside. By learning these techniques, patients continue to experience lasting benefit.”

Reference:

Zgierska AE, Edwards RR, Barrett B, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e253204. doi:10.1001/jamanetworkopen.2025.3204.

A study published in JAMA Otolaryngology-Head & Neck Surgery has revealed that women who consumed sugary drinks daily had a 4 to 5 times higher risk of oral cavity cancer (OCC). However, the overall risk remained low, with three cases per 100,000 people.

Researchers have found in a new cohort study that initiating hormonal contraceptives postpartum is linked to an increased immediate risk of developing depression. The risk was higher when contraceptives, particularly combined oral contraceptives, were started earlier postpartum. Hormonal contraceptive (HC) use is associated with depression. It is, however, unknown whether this is also true in the postpartum period when women have a heightened depression risk and are routinely offered HC treatment. A study was done to examine whether HC initiation post partum is associated with the development of depression within 12 months post partum. A population-based cohort study based on nationwide Danish register data was conducted including all primiparous women who gave birth from January 1, 1997, through December 31, 2022. Women were excluded if they had depression within 24 months before delivery, multiple births or stillbirth, or a diagnosis of breast cancer or liver tumor. Data analysis was conducted between March 20, 2023, and January 17, 2025. Hormonal contraceptive initiation within 12 months post partum was treated as a time-varying exposure. Hormonal contraceptive types were categorized as combined oral contraceptives (COCs), combined nonoral contraceptives (CNOCs), progestogen-only pills (POPs), and progestogen-only nonoral contraceptives (PNOCs). Depression within 12 months post partum, defined as filling an antidepressant prescription or receiving a hospital diagnosis of depression, was the main outcome. Adjusted hazard ratios (AHRs) and average absolute risks of depression within 12 months post partum were estimated using Cox proportional hazards regression and a G-formula estimator. Results Of 610 038 first-time mothers, 248 274 (40.7%) initiated HCs within 12 months post partum (mean [SD] age, 27.6 [4.3] years for HC users vs 29.6 [4.8] years for nonusers). Hormonal contraceptive initiation was associated with subsequent depression, with an AHR of 1.49 (95% CI, 1.42-1.56) compared with no use, resulting in an increase in the 12-month absolute risk from 1.36% (95% CI, 1.32%-1.39%) to 1.54% (95% CI, 1.50%-1.57%). The AHR for COC was 1.72 (95% CI, 1.63-1.82); CNOC, 1.97 (95% CI, 1.64-2.36); and PNOC, 1.40 (95% CI, 1.25-1.56). Progestogen-only pill exposure was associated with an instantaneously reduced risk in the early study period, but it was increased late post partum. The earlier COCs were initiated post partum the higher the associated rate ratio of depression. In this cohort study, HC initiation post partum was associated with an instantaneous increased risk of developing depression. The associated risk was higher the earlier it was initiated post partum, at least for COC. This finding raises the issue of whether the incidence of depression post partum is increased by routine HC initiation after childbirth.