a final project

The Effect of Massage on Blood Pressure

among Patients with Hypertension
 Background
• Hypertension was a major problem that typically
presents as an asymptomatic and chronic
cardiovascular disease (Chockalingam, 2008).
• Blood pressure goals are achieved by only 25%
to 40% of patients who take antihypertensive
drug treatments (Burnier, 2002).
• Successful treatment of high blood pressure is
based on a combination of nonpharmacological
and pharmacological therapies (Glynn, Murphy,
Smith, Schroeder, & Fahey, 2010).
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 Background
• Massage therapy is one of the most widely used
complementary and alternative medicine
therapies, and it has become a multibillion dollar
industry in the United States, with 8.3% of adults
receiving at least 1 massage treatment in 2007
(Moraska, Pollini, Boulanger, Brooks, &
Teitlebaum, 2010; Prasad et al., 2013; Suzuki &
Ohta, 2005).

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 PIO Question

PIO Clinical Questions

Patient/ Population Hypertension
Intervention Massage Therapy
Affect the Blood
Outcome
pressure

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 Foreground Question
• “Among adult patients with hypertension, does
massage therapy affect the blood pressure?”

• Best evidence to answer this question using:

Systematic review/Randomized Control Trials
(RCTs)/Meta analysis of RCTs

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 Clinical Significant
• Cardiovascular disease is the leading global cause of
mortality, accounting for 17.3 million deaths per
year, a number that is expected to grow to more than
23.6 million by 2030.
• Direct and indirect costs of cardiovascular diseases
and stroke total more than $320.1 billion. That
includes health expenditures and lost productivity.
• Hypertension is one of the biggest contributor in
cardiovascular disease and as an important issue in
public health. It is projected to increase about 8
percent between 2013 and 2030 (AHA, 2015).
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 Clinical Significant
• Complementary medicine was suggested in order to
reduce stress and control BP among patients with
hypertension (Olney, 2005).
• In addition, the use of complementary medicine could be
effective in reducing BP, and this method was easy,
available, and more cost-effective compared to
medications (Osborn, Wraa, Watson, & Holleran, 2013).
• Considering the physiopathology of BP and the effective
mechanism of massage therapy, relaxation through
massage can facilitate the response of parasympathetic
nerve, thus reducing anxiety, heart rate, and BP (Moyer,
Rounds, & Hannum, 2004).
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 Search Strategies
• Steps:
1. Use PICO to formulate the search strategies.
2. Filter inclusion criteria.
3. Read abstracts and exclude the duplication references.

• Inclusion criteria:
1. RCT/Systematic Review/Meta-Analysis
2. Have control group
3. Patients with Hypertension.
4. Available in English version.
5. Available in full text version.
6. Published in 2010-2016

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 Search Strategies
Search Strategies/
PIO Clinical Questions
Keywords
Patient/ Hypertension/
Hypertension
Population Hypertensive
Massage/ Massage
Intervention Massage Therapy
Therapy
Blood Pressure/
Affect the Blood Systolic Blood
Outcome
Pressure Pressure/ Diastolic
Blood Pressure

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 Search Strategies
Pubmed : 57
CINAHL : 31
Step 1 Scopus : 120
Cochrane : 4
212 references identified
203 references did not have
appropriate heading related to
the keywords
Pubmed : 5
CINAHL :1
Step 2 Scopus :2
Cochrane : 1
9 references have similarity 6 references 1) Not patients with
in heading HPT; 2) Not RCT/SR/MA; 3) No
control group; 4) No full text
available; 5) Published before
2010; 6) No English version
Pubmed : 1
CINAHL :1
Step 3 Scopus :0
Cochrane : 1
3 references fit in criterua
1 references was exclude due to
duplication
Pubmed : 1
CINAHL :0
Fixed Scopus :0
References Cochrane : 1
3 fixed references to be
synthesized 10
 Selected References
• Mohebbi, Z., Moghadasi, M., Homayouni, K., & Nikou,
M. H. (2014). The Effect of Back Massage on Blood
Pressure in the Patients with Primary
Hypertension in 2012-2013: A Randomized
Clinical Trial. International journal of community
based nursing and midwifery, 2(4), 251.
• Liao, I. C., Chen, S. L., Wang, M. Y., & Tsai, P. S. (2014).
Effects of Massage on Blood Pressure in Patients
With Hypertension and Prehypertension. Journal
of Cardiovascular Nursing.

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Synthesized Reference Table
&
Critical Appraisal

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 Conclusion
• Massage therapy is a simple stress-reduction
method that appears to positively impact blood
pressure both systolic and diastolic.
• Massage, particularly in the back area can be
recommended as a nonpharmacological method
for BP control.
• A combination of massage with antihypertensive
drugs may be more effective than
antihypertensive drugs alone in lowering BP.

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Analyzing of Clinical Application
• Massage can be a part of care plans in the hospitals and
even included in a part of skill and educational
curriculum and retraining courses of the physicians and
nurses.
• Because some studies indicated that nurses were more
competent in control and management of the blood
pressure than other health staff team, so nurses should
be encouraged to earn knowledge and skill about
massage therapy.
• Massage therapy looks promising and applicable in the
clinical setting, especially to be applied in Indonesia,
since it has been widely use in general population.
• Mostly patients with hypertension are highly depending
on antihypertensive drugs, so massage therapy can
become an alternative complement to control BP.

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 References
American Heart Association. (2015). Heart disease and stroke statistics—at a glance.
Burnier, M. (2002). Blood pressure control and the implementation of guidelines in clinical practice: can we
fill the gap? Journal of hypertension, 20(7), 1251-1253.
Chockalingam, A. (2008). World Hypertension Day and global awareness. The Canadian journal of cardiology,
24(6), 441-444.
Glynn, L., Murphy, A., Smith, S., Schroeder, K., & Fahey, T. (2010). Self-monitoring and other non-
pharmacological interventions to improve the management of hypertension in primary care: a
systematic review. British journal of general practice, 60(581), e476-e488.
Liao, I. C., Chen, S.-L., Wang, M.-Y., & Tsai, P.-S. (2016). Effects of Massage on Blood Pressure in Patients With
Hypertension and Prehypertension: A Meta-analysis of Randomized Controlled Trials. Journal of
cardiovascular nursing, 31(1), 73-83.
Mohebbi, Z., Moghadasi, M., Homayouni, K., & Nikou, M. (2014). The effect of back massage on blood pressure
in the patients with primary hypertension in 2012-2013: a randomized clinical trial. International
journal of community based nursing and midwifery, 2(4), 251-258.
Moraska, A., Pollini, R., Boulanger, K., Brooks, M., & Teitlebaum, L. (2010). Physiological adjustments to stress
measures following massage therapy: a review of the literature. Evidence-Based Complementary and
Alternative Medicine, 7(4), 409-418.
Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A meta-analysis of massage therapy research. Psychological
bulletin, 130(1), 3.
Olney, C. M. (2005). The effect of therapeutic back massage in hypertensive persons: a preliminary study.
Biological research for nursing, 7(2), 98-105.
Osborn, K. S., Wraa, C. E., Watson, A. S., & Holleran, R. S. (2013). Medical Surgical Nursing Preparation for
Practice: Pearson Higher Ed.
Prasad, K., Sharma, V., Lackore, K., Jenkins, S. M., Prasad, A., & Sood, A. (2013). Use of complementary
therapies in cardiovascular disease. The American journal of cardiology, 111(3), 339-345.
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