Biofeedback for hypertension: a systematic review

Abstract

To assess the evidence for the long-term effectiveness of biofeedback for the treatment of essential hypertension in adults. A systematic review following accepted international guidelines was conducted. Randomized controlled trials that compared biofeedback procedures with antihypertensive medication, placebo (sham biofeedback treatment), no intervention or other behavioural treatments were included. The outcome measure was change in blood pressure. The inclusion criteria were fulfilled by 36 trials. Twenty-one trials employed biofeedback treatment with no adjunctive therapy, whereas 15 others used biofeedback treatment alongside another treatment. The majority of trials were small with no posttreatment follow-up or follow-up of less than 6 months. Qualitative heterogeneity of the included studies (e.g. poor quality of the trials, differences in interventions and inconsistencies in the measurement of outcomes) meant that it was inappropriate to pool data in the form of a meta-analysis. A narrative summary of the data based on trial authors' conclusions is presented. No studies reported long-term (>12 months) follow-up of patients. Data were grouped first by treatment type and then by comparator. Trial results were variable and conflicting, demonstrating no clear benefits of biofeedback in relation to moderation of hypertension. Although there may be other reported life benefits to its use, we found no convincing evidence that consistently demonstrates the effectiveness of the use of any particular biofeedback treatment in the control of essential hypertension when compared with pharmacotherapy, placebo, no intervention or other behavioural therapies. Any future research needs to be conducted using accepted quality standards and given current guidelines for the treatment of hypertension is likely to be considered only as an adjunct to pharmacological treatment.