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Autogenic training for hypertension



Clinical bottom line: There are no rigorously designed trials to show whether autogenic training is capable of reducing blood pressure in hypertensive patients. The studies were methodologically flawed and extremely small.

Autogenic training is a kind of relaxation technique which involves passive concentration and psychophysiological stimuli. There are six standard exercises to aid relaxation, increase warmth in the abdominal region and cool the cranial region. The technique takes about eight weeks to learn effectively and sessions three times daily are encouraged. It is used for a variety of conditions, including the treatment of hypertension.

 


Systematic review:

Kanji N, White AR, Ernst E. Anti-hypertensive effects of autogenic training: A systematic review. Perfusion 1999; 12: 279-282.

Date review completed: 1997/8

Number of trials included: Five

Number of patients: (275 total)

Control groups: placebo, biofeedback, spa treatment, progressive relaxation.

Main outcomes: change in blood pressure.

Inclusion criteria were published or unpublished trial which assessed autogenic training in the treatment of hypertension. MEDLINE, PsychLit, CINAHL and CISCOM (all years to 1997/8) were searched for relevant studies. Bibliographies of retrieved reports, reviews, textbooks and the Library of the British Autogenic Society were checked for additional studies. Information was extracted in a pre-defined manner. A descriptive anlaysis was conducted.

Findings:

Five trials were included: three were randomised, two were not. The number of sessions ranged between 2-10 per week with a duration of 15-90 minutes (when stated) for up to 10 weeks (in one study). A six month training regime plus home practice thereafter was used in one randomised study. Most trials recommended daily home practice. Follow-up ranged between two months to five years.

Randomised studies (225 patients):

All three randomised trials showed a significant reduction in systolic blood pressure with autogenic training compared with no treatment, one also showed a significant reduction in diastolic blood pressure. Similar results were shown for biofeedback and progressional relaxation. One of these studies used a placebo group in addition to a no treatment group. A significant reduction in blood pressure was reported with placebo, which means that autogenic training was no more effective than placebo in this trial.

Nonrandomised studies (50 patients):

One compared autogenic training and spa treatment with no treatment and found no significant difference in change in blood pressure or any other variable over two months. One compared autogenic training with placebo (packaged like Atenolol) over eight months and found a significant reduction in systolic and diastolic blood pressure, but only six patients were practising autogenic training at the eight month assessment.


Adverse effects

The reviewers' made no mention of adverse effects.

 

Comment

The reviewers' pointed out methodological flaws in these studies: only two used all six exercises that make up autogenic training; the range of blood pressure readings was not stated in some studies; blood pressure readings were obtained in an inconsistent fashion and it was unclear who had taken them (patient or observer); different outcomes were assessed; levels of compliance with the regimen would also be difficult to assess. In addition all of these studies were small, particularly those which were not randomised, and none were blind. This means that they lacked the power to give a true result and were open to bias. These studies tell us very little about whether autogenic training works in this context.

Further reading


Related topics

Identifier

AT057 - 5899 AUTOGENIC TRAINING FOR HYPERTENSION: Aug-2000