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de Freitas Gonçalves K.S.1,2, Tatagiba Lamas J.L.1
1University of Campinas (Unicamp), Nursing School, Campinas, Brazil, 2Universidade Paulista, Health Sciences Institute, Sorocaba, Brazil
Background: Hypertension is a multifactorial disease and increases the risk of cardiovascular diseases. The prevalence of hypertension is almost one billion people worldwide. The nondrug treatment and the multidisciplinary team approach in hypertension have been widely used and emphasized and, among several kinds of treatment, physiotherapy techniques can also be applied in the treatment of hypertension, such as physical activity, which is considered level of evidence 1A and the technique of slow breathing, which is considered level of evidence 2B. However, other physiotherapy techniques may be used to reduce blood pressure, but their effectiveness are still not comproved.
Purpose: Thus, noticing the presence of hypertensive subjects in all types of physiotherapy practice, the impact of hypertension on public health and for hypertensives and the lack of consensus regarding the different types of techniques that may be applied to treat hypertension, the aim of this study was to carry out a systematic review and meta-analysis to evaluate the effect of physiotherapy on the treatment of hypertension.
Methods: The search strategy was made in the following databases: MEDLINE, LILACS, EMBASE, CINAHL, COCHRANE CENTRAL, PEDRO, DARE, EbscoHost, OVID, SCOPUS, Web of Science, ProQuest, Center Watch, ISRCTNR, mRCT, WHO, ANZCTR, CT GOV, Biosis.org and HMIC, with their respective search strategies and with no restriction to language. Randomized clinical trials that reported the application of physiotherapy and its effects on blood pressure in hypertensive and pre-hypertensive patients were included and the outcomes measures compared were systolic and diastolic blood pressure. Method quality was assessed by two independent evaluators, in agreement with the Cochrane Collaboration Method and the Delphi List. The Weighted Kappa Test was used to evaluate agreement among quality studies results.
Results: For continuous variables, the difference between average means (random effect) was calculated, with a reliability interval of 95%. Considering the methodology applied, sixteen randomized clinical trials were included, but only five studies were considered for meta-analyses. In total, 1411 patients were enrolled (563 in the treatment group, 848 in control group).
Conclusion(s): It is concluded that there is insufficient evidence to demonstrate clinical and statistical significant difference when compared to another physiotherapy techniques or to the physiotherapy absence. This may be related to the reduced number of randomized controlled trials with appropriate methodology that could be included in this systematic review. However, the results showed a tendency to small reduction in blood pressure in favor of the group that performed the physiotherapy, as was also observed in some studies that have worked with these same techniques, but in isolation.
Implications: This study demonstrated that some techniques can be apply to treat hypertension, but the breath guided is the most interesting for further studies.
Funding acknowledgements: We thank the Coordination for the Training of Higher Education Personnel (CAPES).
Topic: Cardiorespiratory
Ethics approval: The ethics approval for Systematic Review is not required.
All authors, affiliations and abstracts have been published as submitted.
