MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Music therapy is the use of music for therapeutic purposes. Several forms of music therapy exist. They can consist of a patient listening to live or recorded music, or of patients participating in performing music. Music therapy is usually employed to complement other treatments; it is never a curative or causal approach and mostly aimed at inducing relaxation and enhancing physical and emotional well-being, or at promoting motor and communication skills.

There is a paucity of rigorous studies assessing the effectiveness of music therapy for specific condition, not least due to methodological obstacles and funding issues. Several systematic reviews of clinical studies have nevertheless emerged and results are generally encouraging. As for hypertension, the evidence is contradictory whether passive listening to music works. One review concluded that Music may improve systolic blood pressure and should be considered as a component of care of hypertensive patients. And another review revealed a trend towards a decrease in blood pressure in hypertensive patients who received music interventions, but failed to establish a cause-effect relationship between music interventions and blood pressure reduction.

A new study might bring more clarity:

Its authors evaluated the effect of musical auditory stimulus associated with anti-hypertensive medication on heart rate (HR) autonomic control in hypertensive subjects. They included in this trial 37 well-controlled hypertensive patients designated for anti-hypertensive medication. Heart rate variability (HRV) was calculated from the HR monitor recordings of two different, randomly sorted protocols (control and music) on two separate days. Patients were examined in a resting condition 10 minutes before medication and 20 minutes, 40 minutes and 60 minutes after oral anti-hypertensive medications. Music was played throughout the 60 minutes after medication with the same intensity for all subjects in the music protocol.

The results showed analogous response of systolic and diastolic arterial pressure in both protocols. HR decreased 60 minutes after medication in the music protocol, while it remained unchanged in the control protocol. The effects of anti-hypertensive medication on SDNN (Standard deviation of all normal RR intervals), LF (low frequency, nu), HF (high frequency, nu) and alpha-1 scale were more intense in the music protocol. Blood pressure readings showed no significant differences between the two groups.

The authors concluded that musical auditory stimulus increased HR autonomic responses to anti-hypertensive medication in well-controlled hypertensive subjects.

So, there were some acute effects on HRV. But what is the clinical relevance of this effect? I am not sure, and the authors tell us little about this.

Crucially, there was no effect on blood pressure. But the study design might have been ill-suited for detecting one. I think that a much simpler trial with two parallel groups of untreated hypertensives would have been more efficient for this purpose.

As a music-lover, I would like to believe that music can be used therapeutically. Yet, for hypertensives, I find it difficult to see how this could work. Even if passive listening to music had an anti-hypertensive effect, could it be employed in clinical routine? I somehow doubt it; we can hear music for a while, but our daily activities would largely prohibit doing it for prolonged periods (and most likely it would become a nuisance after a while and would put our pressure up rather than down – think of the background music that bothers us in some shops, for instance). And how would it work when we sleep, a time during which blood pressure control can be vital?

As a music-lover, I would also argue that listening to music can be pleasantly relaxing – presumably, the anti-hypertensive effect observed in some trials relies on this effect. But surely, it can also have the opposite effect. If I strongly dislike a piece of music, I might increase my blood pressure. If a piece moves me deeply, it could easily do the same. It is probably only a certain type of music that induces relaxation; and, to make it even more complex, this type might differ from person to person.

So, is music therapy potentially a usable anti-hypertensive?

Somehow, I don’t think so!

5 Responses to Is music a practical therapy for hypertension? Sadly not, I think

  • According to the figure (Fig. 1 in the paper), the heart rate decreased from ~ 78 bpm to ~75 bpm in the control group, and from ~73 to ~64 in the music group.
    Question: From a medical point of view, would the difference between the groups (-3 BMP vs. -9 BPM) be of great value in terms of health improvement?

    Many authors keep on harping about the statistical significance of differences and the p-values that that they have observed, but forget that a statistical difference is by no means to be equated with biological importance (in this case, a significant health improvement for hypertensive patients). This should at least be discussed by the authors, which has not been done.

    A figure of this poor quality should not have been published, because the numbers on the y-axis seem to be off (making it difficult to identify the absolute BPM numbers) and, even more importantly, the error bars are not explained appropriately in the figure legend. Not a great job from the authors and the peer reviewers.

  • think of the background music that bothers us in some shops, for instance

    Indeed. It is why I am (almost) always wearing active noise-cancelling headphones when I am shopping. Unfortunately, this seems to be something of an arms race: I have the impression (but have not investigated it, and can certainly not provide solid evidence) that shop managers are steadily increasing the volume of their muzak to overcome headphones, since more and more people seem to be wearing noise-cancelling headphones.

  • The article claims that “musical auditory stimulus increased HR autonomic responses to anti-hypertensive medication in well-controlled hypertensive subjects”. This conclusion cannot be extracted from the experiment described in the mentioned article for the following reasons:

    1) If the authors want to correlate music and anti-hypertensive medication the experiment should at least investigate patients on and off medication. The conducted experiment studied 37 patients on medication, but did not include a control group of patientes who were not current users.

    2) The relaxing effect is a technique known for its ability to decrease blood pressure and heart rate in such a way the authors should have investigated other relaxing techniques (like, e.g., yoga, meditation, etc.) before establish a cause-effect relationship with anti-hypertensive medication. There are reports of breathing yoga exercises and even contact with pets that showed heart rate and blood pressure decrease, and surely those could not be related to increasing drug absorption.

    3) There is no pharmacological study about the elimination of the medication with and without music to check whether the musical effect increased or decreased its absorption.

    In conclusion, the methodology employed in the experiment reported in the mentioned article is very poor and it is hard to extracte any solid conclusion about it. It is not possible to establish a cause-effect relation between music and anti-hypertensive medication. At most, it would be possible to say that a specific relaxing technique has some influence on blood pressure and heart rate in medicated hypertensive patients. And that would hardly come as a surprise.

  • It occurs to me that music therapy likely would cancel any effect of the drugs as I am one of those strange people who actively dislikes most kinds of music. Bagpipes are okay.

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