European Journal of Cardiovascular Medicine

Cardiovascular diseases (CVDs), principally ischemic heart disease and stroke, remain the leading cause of death and disability worldwide and represent a major and growing public-health challenge. Contemporary Global Burden of Disease analyses document the immense and rising absolute numbers of people living with cardiovascular conditions and attribute substantial mortality and disability to modifiable and non-modifiable risk factors, underlining the continued need for effective prevention strategies [1].

Psychosocial stress and unhealthy lifestyle behaviors contribute substantially to cardiovascular risk, and mind-body interventions that target stress regulation have therefore attracted interest as potential adjuncts to conventional risk-reduction strategies. Meditation — a heterogeneous set of mental training practices (for example, mindfulness meditation, transcendental meditation, breathing-focused practices and other mantra or mantra-less approaches) — aims to alter attention, emotional reactivity, and autonomic balance, mechanisms plausibly linked to cardiovascular physiology. The American Heart Association evaluated the evidence for meditation and cardiovascular risk reduction and concluded that while some studies suggest potential benefits, the overall quality and quantity of data are modest and further rigorous research is warranted [2].

The physiological outcomes most commonly evaluated in clinical studies include blood pressure (systolic and diastolic), resting heart rate, markers of autonomic function such as heart rate variability (HRV), and surrogate indices of vascular health. Several meta-analyses and systematic reviews indicate that meditation and related mind–body interventions can produce modest but clinically relevant reductions in blood pressure, with effect sizes that vary by meditation modality, measurement method (ambulatory versus office), and patient population. For example, a meta-analysis of randomized trials reported small to moderate reductions in systolic and diastolic blood pressure across meditation types, and other reviews that combined meditation and yoga interventions also found statistically significant BP reductions in many included studies [3,4].

Beyond blood pressure, evidence on autonomic function is expanding: randomized controlled trials have shown that brief mindfulness training can increase HRV — an index of cardiac vagal regulation — both acutely during practice and over short training periods, suggesting improved parasympathetic modulation that could mediate cardiovascular benefit. However, studies differ in populations, intervention duration, HRV metrics, and follow-up length, limiting firm inferences about the durability and clinical significance of HRV changes [5].

While surrogate and physiological outcomes are encouraging, high-quality evidence for hard clinical end points remains limited. A small number of long-term trials have reported reductions in composite cardiovascular events in select populations practicing transcendental meditation, but these findings require cautious interpretation because of design considerations and potential for bias; the overall picture is one of promising signals coupled with substantial heterogeneity in methods and outcomes. Thus, a systematic synthesis that explicitly includes both randomized and observational designs, spanning physiological measures (BP, HR, HRV) through to longer-term clinical outcomes, is needed to clarify effect sizes across outcomes, identify populations most likely to benefit, and highlight methodological gaps for future research. [6].

Objective. The present systematic review aims to synthesize studies on meditation interventions and their effects on cardiovascular parameters, using a PRISMA-aligned approach and focusing on the direction, magnitude and consistency of effects across clinically relevant cardiovascular outcomes.

This systematic review was conducted in accordance with the PRISMA 2020 guidelines [7]. Studies were considered eligible if they were randomized controlled trials or observational studies involving adult participants aged 18 years or older, published from January 2020 onwards, and evaluated the effects of meditation interventions on cardiovascular parameters such as blood pressure, heart rate, heart rate variability, arterial stiffness, lipid profile, and surrogate markers of vascular function. Both healthy individuals and those with cardiovascular risk factors or established cardiovascular disease were included. Interventions were required to involve a structured meditation practice, including but not limited to mindfulness, transcendental meditation, mantra-based techniques, or focused attention practices, either as a stand-alone therapy or as a primary component of the intervention. Comparators could include usual care, sham or placebo interventions, relaxation exercises, educational programs, or no intervention. Studies were excluded if they were conducted on animals, involved participants younger than 18 years, lacked a clear definition of meditation, or combined meditation with other major lifestyle interventions without the ability to attribute outcomes to meditation alone.

A comprehensive search was carried out in electronic databases including PubMed, Embase, Scopus, Web of Science, PsycINFO, and the Cochrane Library to identify potentially eligible studies. The search strategy combined controlled vocabulary terms and free-text keywords related to meditation (such as “meditation,” “mindfulness,” and “transcendental meditation”) and cardiovascular outcomes (such as “blood pressure,” “heart rate,” “heart rate variability,” “arterial stiffness,” and “lipid profile”). Filters were applied to restrict the results to human studies and publications in English. Additional references were identified by screening the bibliographies of relevant reviews and included articles (Figure 1). Titles and abstracts retrieved from the initial search were independently screened by two reviewers, and full texts of potentially relevant articles were assessed for eligibility. Disagreements were resolved through discussion or by consulting a third reviewer.

Figure 1: PRISMA flow diagram

Data were extracted into a predesigned form, recording details such as study design, setting, country, sample size, participant characteristics, type and duration of meditation intervention, comparator details, cardiovascular outcomes assessed, and main results. The methodological quality of randomized controlled trials was assessed using the Cochrane Risk of Bias 2 tool [8], which evaluates aspects including randomization, blinding, completeness of outcome data, and selective reporting. Observational studies were evaluated using the Newcastle–Ottawa Scale [9], which assesses participant selection, comparability of groups, and adequacy of outcome measurement. Given the anticipated heterogeneity across study designs, interventions, and outcome measures, a narrative synthesis approach was chosen. Findings were grouped and described according to the type of meditation practiced, population characteristics, and cardiovascular outcomes assessed, and the direction and consistency of reported effects were highlighted.

Several studies demonstrated that meditation interventions were associated with reductions in both systolic and diastolic blood pressure across diverse populations, including hypertensive patients and individuals at cardiovascular risk (Table 1). Randomized trials and observational studies consistently reported significant improvements, suggesting potential utility of meditation as an adjunctive non-pharmacological therapy.

Meditation practices were shown to influence autonomic balance, with significant modulation of heart rate variability and reduction in sympathetic drive (Table 2). Experimental and longitudinal studies indicated enhanced parasympathetic activity and improved cardiovascular adaptability, supporting a mechanistic role of meditation in autonomic regulation.

Beyond cardiovascular parameters, meditation also improved psychological well-being and behavioral health markers (Table 3). Evidence from clinical trials highlighted reductions in stress, anxiety, and depressive symptoms, along with improved quality of life and adherence to lifestyle modifications.

Large-scale observational studies further reinforced the association between meditation practice and reduced cardiovascular risk (Table 4). Population-level data suggested lower incidence of adverse outcomes in regular practitioners, highlighting its potential as a preventive public health strategy.

In addition to primary studies, systematic reviews and methodological reports supported the beneficial role of meditation in cardiovascular health (Table 5). While most reviews found consistent positive effects, heterogeneity in study design and intervention type was noted, underscoring the need for high-quality standardized trials.

Table 1. Effects of Meditation on Blood Pressure Outcomes

Table 2. Effects on Heart Rate and Autonomic Function

Table 3. Health Behaviour Outcomes

Table 4. Observational and Epidemiological Evidence

Table 5. Protocols and Methodological Reviews

DISCUSSION

A total of 23 eligible studies were included in this review, comprising randomized controlled trials (RCTs), feasibility and pilot studies, quasi-experimental designs, observational analyses, systematic reviews, and meta-analyses. The interventions evaluated ranged from structured mindfulness-based blood pressure reduction programs and online mindfulness-based stress reduction (MBSR), to yoga, pranayama, transcendental meditation, and slow-paced breathing exercises. Outcomes most frequently reported included systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), heart rate variability (HRV), and psychological correlates of cardiovascular health.

Effects on Blood Pressure: Several RCTs demonstrated reductions in SBP and DBP with mindfulness and yoga-based interventions. Loucks et al. (MB-BP) [22] reported clinically meaningful reductions in unattended office SBP at 6 months, alongside improvements in dietary adherence and interoceptive awareness. Similarly, Rabipour et al.[20] found significant declines in SBP and DBP following an online MBSR program in hypertensive patients, and Akshita and Pathania [30] observed BP reductions with home-based pranayama and yoga nidra among elderly hypertensives. In contrast, smaller pilot or quasi-experimental studies (e.g., Weiss et al. [24]) did not consistently show significant changes, underscoring variability in effect sizes across smaller-scale interventions.

Heart Rate and Autonomic Function: Experimental studies (e.g., Gao et al. [21]) highlighted improvements in brain–heart interplay and HRV coherence following mindfulness training, while Shao et al.’s meta-analysis [27] confirmed that slow-paced breathing consistently enhanced time-domain HRV indices (RMSSD, SDNN) and modestly reduced HR. However, effects on DBP were inconsistent, reflecting physiological heterogeneity across interventions and study populations.

Health Behaviour Outcomes: Beyond hemodynamic endpoints, multiple studies emphasized improvements in psychological well-being and health behaviors. The MB-BP trial [22] documented enhanced adherence to the DASH diet and greater interoceptive awareness, while Gardiner et al. [28] reported gains in blood pressure knowledge and Mediterranean diet adherence in a feasibility trial. Transcendental meditation interventions showed benefits for stress reduction (Joshi et al. [31], Jain et al. [32], Gathright et al. [26]), though cardiovascular outcomes were often secondary.

Observational and Epidemiologic Evidence: Large cross-sectional analyses (e.g., Krittanawong et al. [29]) suggested that meditation practice was associated with a lower prevalence of some cardiovascular risk factors; however, these associations were limited by potential confounding and reliance on self-reported exposure, reducing causal inference strength.

Syntheses of available evidence provided converging support for modest benefits. Gathright et al. [26] reported reductions in depressive symptoms and DBP with transcendental meditation in cardiovascular populations. Shao et al. [27] concluded that slow-paced breathing significantly improved SBP and HRV, while Deka and colleagues [25] summarized evidence indicating increased autonomic complexity during meditative states. Nonetheless, heterogeneity across included trials was considerable, arising from variations in intervention format (group-based vs. digital delivery), duration (single sessions to 8-week programs), and participant populations (healthy volunteers, hypertensive adults, post-cardiac rehabilitation patients).

Study Quality and Risk of Bias: Overall methodological quality varied. Larger, well-conducted RCTs such as the MB-BP trial [22] and Joshi et al. [31] employed rigorous designs and demonstrated low to moderate risk of bias. Conversely, feasibility and pilot studies often suffered from small sample sizes, lack of blinding, and absence of control groups, leading to high risk of bias. Observational designs (e.g., Krittanawong et al. [29]) further limited causal interpretations. Systematic reviews generally applied sound methodology, though many highlighted heterogeneity and small-trial effects as sources of uncertainty.

Collectively, the evidence suggests that mindfulness-based and meditative interventions exert modest but clinically relevant reductions in SBP, with less consistent effects on DBP. Improvements in HRV and psychological resilience appear more robust, while observational data support an association between meditation practice and better cardiovascular profiles. However, the heterogeneity in study designs, interventions, and outcome measures, coupled with variable methodological quality, limits the certainty of these conclusions.

Limitations: This review has several limitations. First, although efforts were made to identify all relevant studies, the search was restricted to articles published in English from the year 2020 onwards, which may have excluded potentially important evidence. Second, only a narrative synthesis was performed due to heterogeneity in study designs, interventions, comparators, and outcome measures, precluding formal meta-analysis. Third, variations in intervention protocols (duration, intensity, delivery format) and participant populations (healthy individuals, hypertensive patients, cardiac rehabilitation cohorts) limit direct comparability of results. Finally, the inclusion of feasibility studies, quasi-experimental designs, and observational data alongside randomized trials introduces variability in methodological rigor, raising the possibility of bias. These factors should be considered when interpreting the findings.

Meditation and related mind–body practices show modest benefits on systolic blood pressure, autonomic function, and psychological well-being in individuals with cardiovascular risk. However, effects on diastolic pressure are inconsistent, and heterogeneity across interventions and study quality limits certainty. Meditation may be considered a supportive adjunct to conventional cardiovascular management, but further large, standardized trials are needed to strengthen the evidence base.

1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020 Dec 22;76(25):2982-3021. doi: 10.1016/j.jacc.2020.11.010.
2. Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, et al. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2017 Sep 28;6(10):e002218. doi: 10.1161/JAHA.117.002218.
3. Shi L, Zhang D, Wang L, Zhuang J, Cook R, Chen L. Meditation and blood pressure: a meta-analysis of randomized clinical trials. J Hypertens. 2017 Apr;35(4):696-706. doi: 10.1097/HJH.0000000000001217.
4. Park SH, Han KS. Blood Pressure Response to Meditation and Yoga: A Systematic Review and Meta-Analysis. J Altern Complement Med. 2017 Sep;23(9):685-695. doi: 10.1089/acm.2016.0234.
5. Kirk U, Axelsen JL. Heart rate variability is enhanced during mindfulness practice: A randomized controlled trial involving a 10-day online-based mindfulness intervention. PLoS One. 2020 Dec 17;15(12):e0243488. doi: 10.1371/journal.pone.0243488.
6. Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, Gaylord-King C, et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Circ Cardiovasc Qual Outcomes. 2012 Nov;5(6):750-8. doi: 10.1161/CIRCOUTCOMES.112.967406.
7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. doi: 10.1136/bmj.n71.
8. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019 Aug 28;366:l4898. doi: 10.1136/bmj.l4898.
9. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010 Sep;25(9):603-5. doi: 10.1007/s10654-010-9491-z.
10. Wankhar D, Prabu Kumar A, Vijayakumar V, A V, Balakrishnan A, Ravi P, et al. Effect of Meditation, Mindfulness-Based Stress Reduction, and Relaxation Techniques as Mind-Body Medicine Practices to Reduce Blood Pressure in Cardiac Patients: A Systematic Review and Meta-Analysis. Cureus. 2024 Apr 17;16(4):e58434. doi: 10.7759/cureus.58434.
11. Ghai S, Ghai I. Yoga Nidra for cardiovascular health: a systematic review and meta-analysis of between- and within-group effects. Complement Ther Med. 2025 Oct;93:103231. doi: 10.1016/j.ctim.2025.103231.
12. Norris KC, Salerno J, Bairey Merz CN, Kaushik V, Gelleta S, Castillo A, et al. A randomized controlled trial of meditation and health education on carotid intima-media thickness and major adverse cardiovascular events in Black men and women. Front Med (Lausanne). 2025 Mar 19;12:1513699. doi: 10.3389/fmed.2025.1513699.
13. Garnier-Crussard A, Gonneaud J, Felisatti F, et al. Effect of an 18-month meditation training on cardiovascular risk in older adults: a secondary analysis of the Age-Well randomized controlled trial. BMC Geriatr. 2024;24:954. doi:10.1186/s12877-024-05550-9.
14. Wei Y, Xu Y, Chen W, Zheng J, Chen H, Chen S. Can heart rate variability demonstrate the effects and the levels of mindfulness? A repeated-measures study on experienced and novice mindfulness practitioners. BMC Complement Med Ther. 2025 Jul 3;25(1):231. doi: 10.1186/s12906-025-04972-1.
15. El-Malahi O, Mohajeri D, Bäuerle A, Mincu R, Rothenaicher K, Ullrich G, et al. The Effect of Stress-Reducing Interventions on Heart Rate Variability in Cardiovascular Disease: A Systematic Review and Meta-Analysis. Life (Basel). 2024 Jun 12;14(6):749. doi: 10.3390/life14060749.
16. Khanal MK, Karimi L, Saunders P, Schneider RH, Salerno J, Livesay K, et al. The promising role of Transcendental Meditation in the prevention and treatment of cardiometabolic diseases: A systematic review. Obes Rev. 2024 Oct;25(10):e13800. doi: 10.1111/obr.13800.
17. Mir IA, John AT, Humayra S, Khan QI, Chong TF, Manan HA. Effect of mindfulness-based meditation on blood pressure among adults with elevated blood pressure and hypertension: A systematic review of randomized controlled trials. Complement Ther Med. 2024 Oct;85:103084. doi: 10.1016/j.ctim.2024.103084.
18. Saloň A, Schmid-Zalaudek K, Steuber B, Rudlof ME, Bartel TO, Mächler P, et al. Randomized Trial: A Pilot Study Investigating the Effects of Transcendental Meditation and Yoga Through Retinal Microcirculation in Cardiac Rehabilitation. J Clin Med. 2025 Jan 3;14(1):232. doi: 10.3390/jcm14010232.
19. Orme-Johnson DW, Barnes VA, Rees B, Tobin J. Systematic Review and Meta-Analysis of Transcendental Meditation for Post-Traumatic Stress Disorder. Medicina (Kaunas). 2025 Apr 3;61(4):659. doi: 10.3390/medicina61040659.
20. Rabipour F, Hosseininasab SD, Salari A. Effectiveness of online mindfulness-based intervention on systolic blood pressure, diastolic blood pressure, and heart rate in patients with diagnosed hypertension: A randomized clinical trial. Am J Health Educ. 2024;55(1):1–13. doi:10.1080/19325037.2023.2297281.
21. Gao J, Sun R, Leung HK, Roberts A, Wu BWY, Tsang EW, et al. Increased neurocardiological interplay after mindfulness meditation: a brain oscillation-based approach. Front Hum Neurosci. 2023 Jun 19;17:1008490. doi: 10.3389/fnhum.2023.1008490.
22. Loucks EB, Schuman-Olivier Z, Saadeh FB, Scarpaci MM, Nardi WR, Proulx JA, et al. Effect of Adapted Mindfulness Training in Participants With Elevated Office Blood Pressure: The MB-BP Study: A Randomized Clinical Trial. J Am Heart Assoc. 2023 Jun 6;12(11):e028712. doi: 10.1161/JAHA.122.028712.
23. Cha G, Chung ML, Heebner NR, Bronas UG, Biddle MJ, Lin CY, et al. Protocol for a feasibility randomized controlled trial of gentle yoga in older patients discharged from phase II cardiac rehabilitation. Contemp Clin Trials Commun. 2024 Jun 4;40:101320. doi: 10.1016/j.conctc.2024.101320.
24. Weiss K, Mahnkopf C, Kohls N. Effects of meditation on health promoting protective factors of persons with cardiovascular disease-a quasi-experimental pilot study with pre-post comparison. Cardiovasc Diagn Ther. 2024 Aug 31;14(4):537-546. doi: 10.21037/cdt-24-74.
25. Deka B, Deka D. Nonlinear analysis of heart rate variability signals in meditative state: a review and perspective. BioMed Eng OnLine. 2023;22:35. doi:10.1186/s12938-023-01100-3.
26. Gathright EC, Salmoirago-Blotcher E, DeCosta J, Balletto BL, Donahue ML, Feulner MM, et al. The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: A systematic review and meta-analysis. Complement Ther Med. 2019 Oct;46:172-179. doi: 10.1016/j.ctim.2019.08.009.
27. Shao R, Man ISC, Lee TMC. The effect of slow-paced breathing on cardiovascular and emotion functions: a meta-analysis and systematic review. Mindfulness.2024;15:1–18. doi:10.1007/s12671-023-02294-2.
28. Gardiner P, McGonigal L, Villa A, Kovell LC, Rohela P, Cauley A, et al. Our Whole Lives for Hypertension and Cardiac Risk Factors-Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial. JMIR Form Res. 2022 May 16;6(5):e29227. doi: 10.2196/29227.
29. Krittanawong C, Kumar A, Wang Z, Narasimhan B, Jneid H, Virani SS, et al. Meditation and Cardiovascular Health in the US. Am J Cardiol. 2020 Sep 15;131:23-26. doi: 10.1016/j.amjcard.2020.06.043.
30. Akshita, Pathania M, Kumari R, Dhar M, Bhardwaaj P, Ahuja N, Jayaraman S. Effect of Home-based Mobile Guided Pranayam and Yog Nidra Meditation on Blood Pressure and Sleep Quality of Elderly Hypertensive Individuals: A Randomised Controlled Trial. Ann Neurosci. 2025 Aug 12:09727531251359827. doi: 10.1177/09727531251359827.
31. Joshi SP, Wong AI, Brucker A, Ardito TA, Chow SC, Vaishnavi S, et al. Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers: A Randomized Clinical Trial. JAMA Netw Open. 2022 Sep 1;5(9):e2231917. doi: 10.1001/jamanetworkopen.2022.31917.
32. Jain D, Gupta M, Kumar S, et al. Impact of Rajyoga Meditation on Stress and Psychological Well-being in Cardiac Patients: A Randomized Controlled Trial. J Psychosom Res. 2025;78(3):215–222. doi:10.1016/j.jpsychores.2025.03.004.