Effect of music therapy on blood pressure and quality of life among individuals with essential hypertension: A systematic review and meta-analysis

Authors

  • Zewen Li 19560839168
  • Yi Zhang

DOI:

https://doi.org/10.54844/wsr.2025.1061

Keywords:

music therapy, hypertension, Chinese traditional medicine five-element music, anxiety, depression

Abstract

Essential hypertension requires lifelong treatment, which is ineffective and has many side effects with medications alone, thus, a non-invasive, low-cost non-pharmacological therapy to improve treatment rates and compliance is needed. To investigate the effects of music therapy on blood pressure levels, negative emotions, and quality of life in patients with essential hypertension, a systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses‌ (PRISMA) guidelines were performed in the present study. Randomized controlled trials about the effect of music therapy on essential hypertension were retrieved by a systematic search of PubMed, Embase, Scopus, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, VIP, and China Biology Medicine (CBM) databases from inception to February 2025. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias for inclusion in the study. Statistical analyses were performed using Cochrane software Revman 5.3 software and ADDIS 1.16.5 software. A total of 14 studies involving 1472 patients were included. Meta-analysis showed that music therapy reduced systolic blood pressure (mean difference [MD] = -11.18, 95% confidence interval [CI]: -13.17 to -9.20, P < 0.05) and diastolic blood pressure (MD = -7.06, 95% CI: -9.14 to-4.97, P < 0.05), and alleviated anxiety (MD = 2.15, 95% CI: -2.74 to-1.57, P < 0.05) and depression (MD = -3.66, 95% CI: -5.88 to -1.45, P < 0.05) in patients with essential hypertension. Network meta-analysis indicated that Chinese traditional medicine five-element music (59%) was more effective than other types of music (41%) in lowering systolic blood pressure, but less effective than other music (73%) in lowering diastolic blood pressure. No serious adverse events were reported in any trial. In conclusion, music therapy effectively lowered blood pressure levels, improved the quality of life in patients with hypertension, and had positive efficacy in relieving anxiety and depression.

References

Albanese, E., Bütikofer, L., Armijo-Olivo, S., Ha, C., & Egger, M. (2020). Construct validity of the Physiotherapy Evidence Database (PEDro) quality scale for randomized trials: Item response theory and factor analyses. Research Synthesis Methods, 11(2), 227-236. https://doi.org/10.1002/jrsm.1385

Bekiroğlu, T., Ovayolu, N., Ergün, Y., & Ekerbiçer, H. Ç. (2013). Effect of Turkish classical music on blood pressure: A randomized controlled trial in hypertensive elderly patients. Complementary Therapies in Medicine, 21(3), 147-154. https://doi.org/10.1016/j.ctim.2013.03.005

Carey, R. M., Whelton, P. K., & 2017 ACC/AHA Hypertension Guideline Writing Committee. (2018). Prevention, detection, evaluation, and management of high blood pressure in adults: Synopsis of the 2017 American college of cardiology/American heart association hypertension guideline. Annals of Internal Medicine, 168(5), 351-358. https://doi.org/10.7326/M17-3203

Carnovale, C., Perrotta, C., Baldelli, S., Cattaneo, D., Montrasio, C., Barbieri, S. S., Pompilio, G., Vantaggiato, C., Clementi, E., & Pozzi, M. (2023). Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects. Cardiovascular Research, 119(3), 647-667. https://doi.org/10.1093/cvr/cvac110

Chen, F., Jin, Y., Jiang, Q., & Chen, H. (2022). [Analysis of the effects of a five-tone therapeutic disease intervention on low- and intermediate-risk patients with essential hypertension]. Modern Practical Medicine, 34(3), 383, 420. https://doi.org/10.3969/j.issn.1671-0800.2022.03.045

Chow, C. K., Teo, K. K., Rangarajan, S., Islam, S., Gupta, R., Avezum, A., Bahonar, A., Chifamba, J., Dagenais, G., Diaz, R., Kazmi, K., Lanas, F., Li, W., Lopez-Jaramillo, P., Lu, F., Ismail, N. H., Puoane, T., Rosengren, A., Szuba, A., Temizhan, A., Wielgosz, A., Yusuf, R., Yusufali, A., McKee, M., Liu, L., Mony, P., Yusuf, S., & PURE Study investigators. (2013). Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA, 310(9), 959-968. https://doi.org/10.1001/jama.2013.184182

Cumpston, M., Li, T., Page, M. J., Chandler, J., Welch, V. A., Higgins, J. P., & Thomas, J. (2019). Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database of Systematic Reviews, 10(10), ED000142. https://doi.org/10.1002/14651858.ED000142

Daghbouche-Rubio, N., López-López, J. R., Pérez-García, M. T., & Cidad, P. (2022). Vascular smooth muscle ion channels in essential hypertension. Frontiers in Physiology, 13, 1016175. https://doi.org/10.3389/fphys.2022.1016175

do Amaral, M. A. S., Neto, M. G., de Queiroz, J. G., Martins-Filho, P. R. S., Saquetto, M. B., & Carvalho, V. O. (2016). Effect of music therapy on blood pressure of individuals with hypertension: A systematic review and meta-analysis. International Journal of Cardiology, 214, 461-464. https://doi.org/10.1016/j.ijcard.2016.03.197

Egan, B. M., Kjeldsen, S. E., Grassi, G., Esler, M., & Mancia, G. (2019). The global burden of hypertension exceeds 1.4 billion people: Should a systolic blood pressure target below 130 become the universal standard? Journal of Hypertension, 37(6), 1148-1153. https://doi.org/10.1097/HJH.0000000000002021

Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., Chalmers, J., Rodgers, A., & Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. The Lancet, 387(10022), 957-967. https://doi.org/10.1016/S0140-6736(15)01225-8

Fujita, M., & Fujita, T. (2016). The role of CNS in the effects of salt on blood pressure. Current Hypertension Reports, 18(2), 10. https://doi.org/10.1007/s11906-015-0620-7

Galińska, E. (2015). Music therapy in neurological rehabilitation settings. Psychiatria Polska, 49(4), 835-846. https://doi.org/10.12740/PP/25557

Hamam, M. S., Kunjummen, E., Hussain, M. S., Nasereldin, M., Bennett, S., & Miller, J. (2020). Anxiety, depression, and pain: Considerations in the treatment of patients with uncontrolled hypertension. Current Hypertension Reports, 22(12), 106. https://doi.org/10.1007/s11906-020-01117-2

Im-Oun, S., Kotruchin, P., Thinsug, P., Mitsungnern, T., Techa-Atik, P., & Pongchaiyakul, C. (2018). Effect of Thai instrumental folk music on blood pressure: a randomized controlled trial in stage-2 hypertensive patients. Complementary Therapies in Medicine, 39, 43-48. https://doi.org/10.1016/j.ctim.2018.05.014

Ji, M., Zhang, H., Xu, Z., & Zhang, W. (2018). [Effect of commercial music therapy on the regulation of blood pressure in hypertensive patients with hyperactive liver fire]. Journal of Clinic Nursing's Practicality, 3(45), 60-61. https://doi.org/10.3969/j.issn.2096-2479.2018.45.051

Jiang, Y., Xie, Y., & Zhao, M. (2022). [The association between cardiovascular disease and cognitive impairment based on the theory of "heart governing the spirit light" ]. Journal of Beijing University of Traditional Chinese Medicine, 45(4), 334-341. https://doi.org/10.3969/j.issn.1006-2157.2022.04.002

Johnson, A. K., & Xue, B. (2018). Central nervous system neuroplasticity and the sensitization of hypertension. Nature Reviews. Nephrology, 14(12), 750-766. https://doi.org/10.1038/s41581-018-0068-5

Kearney, P. M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P. K., & He, J. (2005). Global burden of hypertension: Analysis of worldwide data. The Lancet, 365(9455), 217-223. https://doi.org/10.1016/S0140-6736(05)17741-1

Koelsch, S., Fritz, T., Cramon, D. Y. V., Müller, K., & Friederici, A. D. (2006). Investigating emotion with music: An fMRI study. Human Brain Mapping, 27(3), 239-250. https://doi.org/10.1002/hbm.20180

Kühlmann, A. Y. R., de Rooij, A., Hunink, M. G. M., De Zeeuw, C. I., & Jeekel, J. (2018). Music affects rodents: A systematic review of experimental research. Frontiers in Behavioral Neuroscience, 12, 301. https://doi.org/10.3389/fnbeh.2018.00301

Kulinski, J., Ofori, E. K., Visotcky, A., Smith, A., Sparapani, R., & Fleg, J. L. (2022). Effects of music on the cardiovascular system. Trends in Cardiovascular Medicine, 32(6), 390-398. https://doi.org/10.1016/j.tcm.2021.06.004

Kunikullaya, K. U., Goturu, J., Muradi, V., Hukkeri, P. A., Kunnavil, R., Doreswamy, V., Prakash, V. S., & Murthy, N. S. (2016). Combination of music with lifestyle modification versus lifestyle modification alone on blood pressure reduction - a randomized controlled trial. Complementary Therapies in Clinical Practice, 23, 102-109. https://doi.org/10.1016/j.ctcp.2015.05.004

Lee, E. K. P., Poon, P., Yip, B. H. K., Bo, Y., Zhu, M. T., Yu, C. P., Ngai, A. C. H., Wong, M. C. S., & Wong, S. Y. S. (2022). Global burden, regional differences, trends, and health consequences of medication nonadherence for hypertension during 2010 to 2020: A meta-analysis involving 27 million patients. Journal of the American Heart Association, 11(17), e026582. https://doi.org/10.1161/JAHA.122.026582

Lei, X., Li, C., & Zhang, L. (2013). [Effect of music therapy on quality of life and blood pressure in hypertensive patients]. Shandong Medical Journal, 53(20), 90-91. https://doi.org/10.3969/j.issn.1002-266X.2013.20.035

Li, G., Chen, H., Xiao, W., Wang, S., & Hong, C. (2022). [Discussion on the mechanism of five elements music therapy with the two-way adjustment of intestinal flora-gut-brain axis in treating hypertension combined with anxiety]. China Journal of Traditional Chinese Medicine and Pharmacy, 37(6), 3136-3140.

Li, J., Yang, Z., Zhang, C., Hu, Y., Li, H., Zhang, M., Bu, P., Wang, S., Zhang, C., & Li, W. (2022). Chinese classical music lowers blood pressure and improves left ventricular hypertrophy in spontaneously hypertensive rats. Frontiers in Pharmacology, 13, 826669. https://doi.org/10.3389/fphar.2022.826669

Li, Y., Li, X., Lou, Z., & Chen, C. (2022). Long short-term memory-based music analysis system for music therapy. Frontiers in Psychology, 13, 928048. https://doi.org/10.3389/fpsyg.2022.928048

Liao, J., Papathanassoglou, E., Zhang, X., Li, Q., Gupta, A., Lu, F., Wu, Y., & Frishkopf, M. (2023). A cross-cultural randomized pilot trial of western-based and five elements music therapy for psychological well-being. Explore, 19(4), 571-577. https://doi.org/10.1016/j.explore.2022.11.001

Lin, F. (2017). [Exploring the application of five elements of music in the five states and five elements of people based on the somatic view]. China Journal of Traditional Chinese Medicine and Pharmacy, 32(11), 4940-4942.

Lin, F. (2019). [Mechanism of five notes of ancient China's pentatonic scale in disease treatment based on meridian and collateral theory]. Journal of Beijing University of Traditional Chinese Medicine, 42(6), 465-468. https://doi.org/10.3969/j.issn.1006-2157.2019.06.005

Liu, L., Wang, W., & Yao, C. (2010). [Guidelines for the prevention and treatment of hypertension in China (2009 Grassroots Edition) (II)]. Chinese Community Doctors, 26(26), 9.

Liu, M. Y., Li, N., Li, W. A., & Khan, H. (2017). Association between psychosocial stress and hypertension: A systematic review and meta-analysis. Neurological Research, 39(6), 573-580. https://doi.org/10.1080/01616412.2017.1317904

Loganathan, L., Gopinath, K., Sankaranarayanan, V. M., Kukreti, R., Rajendran, K., Lee, J. K., & Muthusamy, K. (2020). Computational and pharmacogenomic insights on hypertension treatment: Rational drug design and optimization strategies. Current Drug Targets, 21(1), 18-33. https://doi.org/10.2174/1389450120666190808101356

Lorber, M., & Divjak, S. (2022). Music therapy as an intervention to reduce blood pressure and anxiety levels in older adults with hypertension: A randomized controlled trial. Research in Gerontological Nursing, 15(2), 85-92. https://doi.org/10.3928/19404921-20220218-03

Ma, J., & Chen, X. (2022). Advances in pathogenesis and treatment of essential hypertension. Frontiers in Cardiovascular Medicine, 9, 1003852. https://doi.org/10.3389/fcvm.2022.1003852

Mahmood, S., Shah, K. U., Khan, T. M., Nawaz, S., Rashid, H., Baqar, S. W. A., & Kamran, S. (2019). Non-pharmacological management of hypertension: In the light of current research. Irish Journal of Medical Science, 188(2), 437-452. https://doi.org/10.1007/s11845-018-1889-8

Malakoutikhah, A., Dehghan, M., Ghonchehpoorc, A., Parandeh Afshar, P., & Honarmand, A. (2020). The effect of different genres of music and silence on relaxation and anxiety: A randomized controlled trial. Explore, 16(6), 376-381. https://doi.org/10.1016/j.explore.2020.02.005

Mavridis, I. N. (2015). Music and the nucleus accumbens. Surgical and Radiologic Anatomy, 37(2), 121-125. https://doi.org/10.1007/s00276-014-1360-0

Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J. (2016). Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation, 134(6), 441-450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews. Nephrology, 16(4), 223-237. https://doi.org/10.1038/s41581-019-0244-2

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151(4), 264-269, W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

Monteiro, J. L. G. C., da Silva Barbirato, D., Moraes, S. L. D., Pellizzer, E. P., & do Egito Vasconcelos, B. C. (2022). Does listening to music reduce anxiety and pain in third molar surgery? -a systematic review. Clinical Oral Investigations, 26(10), 6079-6086. https://doi.org/10.1007/s00784-022-04640-5

Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension. Nature Reviews Disease Primers, 4(1), 18014. https://doi.org/10.1038/nrdp.2018.14

Paine, N. J., Watkins, L. L., Blumenthal, J. A., Kuhn, C. M., & Sherwood, A. (2015). Association of depressive and anxiety symptoms with 24-hour urinary catecholamines in individuals with untreated high blood pressure. Psychosomatic Medicine, 77(2), 136-144. https://doi.org/10.1097/PSY.0000000000000144

Park, J. I., Lee, I. H., Lee, S. J., Kwon, R. W., Choo, E. A., Nam, H. W., & Lee, J. B. (2023). Effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability. BMC Complementary Medicine and Therapies, 23(1), 73. https://doi.org/10.1186/s12906-022-03832-6

Rennie, C., Irvine, D. S., Huang, E., & Huang, J. (2022). Music therapy as a form of nonpharmacologic pain modulation in patients with cancer: A systematic review of the current literature. Cancers, 14(18), 4416. https://doi.org/10.3390/cancers14184416

Shao, T., Liang, L., Zhou, C., Tang, Y., Gao, W., Tu, Y., Yin, Y., Malone, D. C., & Tang, W. (2023). Short-term efficacy of non-pharmacological interventions for global population with elevated blood pressure: A network meta-analysis. Frontiers in Public Health, 10, 1051581. https://doi.org/10.3389/fpubh.2022.1051581

Song, Y., & Li, K. (2015). [Effects of music therapy on anxiety, blood pressure and sleep status in elderly patients with hypertension]. Chinese Journal of Gerontology, 35(7), 1967-1968. https://doi.org/10.3969/j.issn.1005-9202.2015. 07.107

Su, M. (2007). [Effect of music therapy on blood pressure in patients with hypertension]. Modern Clinical Nursing, 2007(6), 8-9. https://doi.org/10.3969/j.issn.1671-8283.2007.06.004

Su, X. (2016). [Effect of music therapy on the regulation of blood pressure and mental status in elderly patients with hypertension]. Chinese Journal of Convalescent Medicine, 25(3), 253-254. https://doi.org/10.13517/j.cnki.ccm.2016.03.012

Teng, X. F., Wong, M. Y. M., & Zhang, Y. T. (2007). The effect of music on hypertensive patients. 2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2007, 4649-4651. https://doi.org/10.1109/IEMBS.2007.4353376

Tong, A., Flemming, K., McInnes, E., Oliver, S., & Craig, J. (2012). Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Medical Research Methodology, 12, 181. https://doi.org/10.1186/1471-2288-12-181

Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 international society of hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334-1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026

Verdecchia, P., Reboldi, G., & Angeli, F. (2020). The 2020 International Society of Hypertension global hypertension practice guidelines - key messages and clinical considerations. European Journal of Internal Medicine, 82, 1-6. https://doi.org/10.1016/j.ejim.2020.09.001

Wang, J., Yang, H., Li, N., & Zhang, C. (2018). [Treating hypertension based on syndrome differentiation of Sanjiao theory]. China Journal of Traditional Chinese Medicine and Pharmacy, 33(2), 469-472.

Xiao, X., Chen, W., & Zhang, X. (2023). The effect and mechanisms of music therapy on the autonomic nervous system and brain networks of patients of minimal conscious states: A randomized controlled trial. Frontiers in Neuroscience, 17, 1182181. https://doi.org/10.3389/fnins.2023.1182181

Zanini, C. R., Jardim, P. C. B. V., Salgado, C. M., Nunes, M. C., Urzêda, F. L., Carvalho, M. V. C., Pereira, D. A., deS Jardim, T., & Souza, W. K. (2009). [Music therapy effects on the quality of life and the blood pressure of hypertensive patients]. Arquivos Brasileiros de Cardiologia, 93(5), 534-540. https://doi.org/10.1590/s0066-782x2009001100015

Zhang, M., & Luan, M. (2018). Effects of Chinese medicine five elements music therapy on blood pressure and anxiety in hypertensive patients. The Journal of Medical Theory and Practice, 450-452. https://doi.org/10.19381/j.issn.1001-7585.2018.03.080

Zhang, M., & Shi, W. (2021). [Effect of five elements music therapy on blood pressure and emotion of patients with hypertension of hyperactivity of liver Yan]. Journal of Xinjiang Medical University, 44(11), 1289-1293. https://doi.org/10.3639/j.issn.1009-5551.2021.11.017

Zheng, L., Wu, L., & Chen, F. (2017). [Effects of angular tuning music on vascular endothelial function in hypertensive patients with hyperactive liver yang syndrome]. Chinese Journal of Gerontology, 37(8), 1926-1928. https://doi.org/10.3969/j.issn.1005-9202.2017.08.0

Published

2025-11-03 — Updated on 2026-01-30

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Li Z, Zhang Y. Effect of music therapy on blood pressure and quality of life among individuals with essential hypertension: A systematic review and meta-analysis. WSR. 2026;2(1):1-16. doi:10.54844/wsr.2025.1061

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Review Articles