Cardiovascular disease (CVD) remains the leading cause of global morbidity and mortality, driven in part by modifiable risk factors such as hypertension, stress, and autonomic dysfunction. Non‑pharmacological lifestyle interventions — including meditation — have gained increasing interest as potential adjuncts to conventional prevention and management strategies. Meditation represents a heterogeneous set of mind–body practices aimed at cultivating attentional control, relaxation, and psychophysiological recalibration; proponents suggest that these practices may beneficially influence cardiovascular regulation through modulation of autonomic tone, vascular function, and stress responses [1,2].

A growing body of empirical evidence has explored the impact of meditation on cardiovascular parameters. Several randomized trials and cohort studies have investigated associations between meditation, blood pressure reduction, heart rate variability (HRV), and other markers of autonomic and vascular health [3]. A recent systematic review of mindfulness- and meditation-based interventions (MBIs) concluded that MBIs were associated with clinically relevant reductions in systolic blood pressure among patients with CVD, though heterogeneity was substantial [4]. Similarly, controlled studies of different meditation techniques have reported acute and sustained improvements in autonomic balance, including enhanced vagal activity as measured by HRV indices [5].

Nevertheless, the totality of evidence remains inconsistent, likely because of wide variation in meditation modalities (mindfulness, transcendental, guided imagery, slow-breathing, etc.), differences in study populations (healthy individuals vs patients with CVD), and heterogeneity in outcome measures and follow-up duration. Additionally, some controlled trials report minimal or no significant effect on HRV or blood pressure after meditation interventions, highlighting the need for careful evaluation [6].

Given these uncertainties, there is a need for a rigorous synthesis of published data — evaluating the magnitude, consistency, and limitations of cardiovascular effects attributed to meditation. The present systematic review aims to collate and critically appraise existing human studies that examined cardiovascular outcomes following meditation practices, with a focus on autonomic regulation (HRV, heart rate), blood pressure, and other relevant markers, to inform evidence-based conclusions about the role of meditation in cardiovascular health [7].

Data Extraction: A structured data extraction approach was applied to ensure consistency across all included studies. A standardized form was used to collect essential study characteristics, including the author and year of publication, study design, and the clinical or community setting in which the research was conducted. Information on sample size and participant demographics was recorded alongside details of the meditation modality used, such as the type of practice, session frequency, and total duration of the intervention. Where applicable, the nature of the comparator group was also documented. Cardiovascular outcome measures were extracted as reported, encompassing variables such as blood pressure, autonomic function indices, vascular parameters, metabolic markers, and stress-related physiological indicators. Key quantitative results from each study were summarized to facilitate cross-study comparison. Data extraction was carried out independently by two reviewers, and any disagreements were resolved through mutual discussion to maintain accuracy and methodological rigor.

Quality Assessment: The methodological rigor of the included studies was appraised using design-specific quality assessment tools. Randomized controlled trials were evaluated with the Cochrane Risk of Bias 2 (RoB-2) tool [9], which examines domains such as randomization procedures, deviations from intended interventions, completeness of outcome data, outcome measurement, and selection of reported results. Non-randomized studies were assessed using the Newcastle–Ottawa Scale (NOS) [10], focusing on participant selection, comparability of study groups, and outcome ascertainment. Based on these evaluations, each study was classified as having a low, moderate, or high risk of bias. These quality ratings were incorporated into the interpretation of findings and informed the overall synthesis to ensure that conclusions reflected the strength and limitations of the available evidence.

Data Synthesis: Given the heterogeneity in meditation practices, outcome measures, duration of interventions, and study designs, a narrative synthesis was chosen. Quantitative pooling (meta-analysis) was not performed due to variability in methodologies and inconsistent reporting of effect sizes across studies.

The systematic review included 15 studies that met all inclusion criteria, encompassing randomized controlled trials, single-arm clinical trials, physiological experiments, and systematic reviews, examining the effects of meditation on cardiovascular outcomes. For clarity, the included studies are categorized based on the type of meditation intervention: Transcendental Meditation (TM), Mindfulness-Based Interventions (MBI), and physiological or walking meditation studies (Tables 1–3).

Three studies investigated the effects of TM on cardiovascular parameters and metabolic risk factors in diverse populations, including patients with coronary heart disease and young adults [Table 1]. Paul-Labrador et al. (2006) reported that 16 weeks of TM significantly reduced systolic and diastolic blood pressure and improved components of the metabolic syndrome compared with health education. Schneider et al. (2012) observed reductions in major cardiovascular events and improvements in blood pressure and psychosocial risk factors in a Black cohort receiving TM. Similarly, Nidich et al. (2009) found significant reductions in clinic systolic blood pressure and psychological distress among young adults practicing TM relative to controls. Collectively, these studies suggest that TM can exert beneficial effects on cardiovascular risk markers and autonomic regulation.

Five studies evaluated structured mindfulness-based programs, including Mindfulness-Based Blood Pressure Reduction (MB-BP) and Mindfulness-Based Stress Reduction (MBSR), primarily in adults with elevated blood pressure or cardiac conditions [Table 2]. Loucks et al. (2019, 2023) demonstrated that MB-BP was feasible, acceptable, and effective in reducing systolic blood pressure in participants with elevated office BP compared with enhanced usual care. van der Zwan et al. (2015) reported improvements in heart rate variability (HRV) and perceived stress following mindfulness meditation compared with physical activity or HRV biofeedback interventions. Babak et al. (2022) and Momeni et al. (2016) found that 12-week MBSR programs led to significant reductions in systolic and diastolic blood pressure, perceived stress, and anger, while improving quality of life. These findings indicate that structured mindfulness programs may be effective in lowering blood pressure and enhancing stress regulation in both hypertensive and cardiac populations.

Seven studies focused on physiological effects, including HRV modulation, autonomic function, or the impact of walking-based meditative practices [Table 3]. Short-term experimental studies (Azam et al., 2015; Léonard et al., 2019; Kirk & Axelsen, 2020; Rai et al., 2019) demonstrated that brief meditation sessions or online mindfulness interventions enhanced parasympathetic activity and increased HRV, although individual response varied by participant characteristics. Systematic reviews of mindful walking or Buddhist walking meditation (Davis et al., 2022; Montalva-Valenzuela et al., 2025) reported improvements in blood pressure, arterial stiffness, and general cardiovascular health, albeit with heterogeneity across studies. Finally, a long-term intervention in older adults (Garnier-Crussard et al., 2024) indicated that 18 months of meditation training improved diastolic blood pressure in an at-risk subgroup, although no significant changes were observed in the overall composite cardiovascular risk.

Table 1: Meditation studies (n=3)

Table 2: Mindfulness-Based Interventions studies (n=5)

Table 3: Physiological / HRV / Walking Meditation studies (n=7)

The present systematic review of 15 primary studies indicates that meditation-based interventions have potential beneficial effects on cardiovascular health, particularly in lowering blood pressure, improving autonomic regulation, and reducing cardiovascular risk markers. These findings align with a growing body of recent literature supporting the cardiovascular benefits of mind-body and meditation practices.

Recent umbrella‑level evidence summarizes the impact of mindfulness‑based interventions (MBIs) on cardiovascular risk factors: an umbrella review of 27 meta-analyses (≈14,900 participants) found that MBIs significantly lowered systolic and diastolic blood pressure compared with controls (SMD −5.53 mmHg and −2.13 mmHg, respectively) along with reductions in stress and smoking behavior [26]. Similarly, a 2024 meta-analysis of randomized controlled trials in prehypertensive or hypertensive adults (12 trials, n=715) reported mean reductions in systolic blood pressure of −9.12 mmHg and diastolic BP of −5.66 mmHg after mindfulness-based interventions [27]. These results reinforce the positive BP-lowering trends observed in our included MBIs and TM studies.

Notwithstanding these promising results, the picture is not uniformly positive. A meta-analysis focusing specifically on resting‑state heart rate variability (HRV) — a surrogate for autonomic (parasympathetic) tone — found no statistically significant effect of MBIs on vagally mediated HRV compared to control conditions (Hedges’ g = 0.38, 95% CI −0.014 to 0.77) [28]. This suggests that although many trials report improved HRV or autonomic indices, the overall evidence remains mixed, especially when measured under resting conditions. This heterogeneity may reflect differences in meditation modality, session duration, participant characteristics, or measurement techniques.

Newer data continue to explore refined meditation forms: for instance, a 2024 mixed‑methods study on Heart Rhythm Meditation (HRM) — a slow-breath, heart‑focused meditation — reported increased vagal tone (via HRV measurements) and improved well‑being after a 10‑week practice period [29]. Such findings suggest that specific meditation techniques with emphasis on breath and cardiac focus may yield more consistent autonomic or parasympathetic gains than more generic or brief practices.

On the other hand, a recent secondary analysis from the Age-Well randomized controlled trial (older adults, 18‑month meditation vs control) showed modest or subgroup‑specific benefits: while a general composite cardiovascular risk score did not significantly improve in the whole cohort, a reduction in diastolic blood pressure was observed in a prespecified high-risk subgroup [25]. This highlights that long‑term meditation may confer cardiovascular benefits, but effects may be modest and dependent on baseline risk, adherence, and participant characteristics.

Taken together, these external data suggest both encouraging potential and significant limitations. The consistent BP reductions echo our review’s findings; yet the mixed HRV results and modest long-term risk reductions emphasize that physiological benefits may not always translate into robust, durable cardiovascular protection.

Possible mechanisms underlying the beneficial cardiovascular effects include modulation of autonomic balance (shift towards parasympathetic dominance), reduced sympathetic overactivity and stress response, improved vascular tone and endothelial function (via reduced stress‑induced vascular reactivity), and favorable metabolic effects (improved insulin sensitivity, lipid profile) [30,31]. But variability in study design (type of meditation, duration, frequency), population (normotensive vs hypertensive, age, comorbidities), and outcome measures (clinic BP vs ambulatory BP, HRV metrics, short-term vs long-term) complicates direct comparison and meta-analytic pooling.

Limitations of the evidence base remain substantial. Meta-analyses highlight high heterogeneity across studies, small sample sizes, inconsistent intervention protocols, and short follow-up durations [32,33]. In addition, resting-state HRV may not fully capture autonomic shifts that occur during or immediately after meditation, and long-term impact on “hard” cardiovascular outcomes (MI, stroke, mortality) remains insufficiently studied.

To clarify the role of meditation in cardiovascular prevention and management, future research should adopt standardized protocols (type, duration, frequency), include larger and more diverse populations (hypertensive, pre-hypertensive, different age groups), track long-term “hard” cardiovascular outcomes, and employ consistent, validated measures of autonomic function (e.g., 24‑h HRV, ambulatory BP, endothelial function, vascular stiffness). Inclusion of mechanistic biomarkers (inflammation, oxidative stress, endothelial markers) and stratification by baseline risk may further elucidate who benefits most from meditation interventions.

Meditation-based interventions improve cardiovascular outcomes. Transcendental Meditation lowered blood pressure, improved metabolic syndrome components, and reduced psychosocial stress and cardiovascular events. Mindfulness programs (MBSR, MB-BP) decreased clinic and office blood pressure, enhanced heart rate variability, reduced stress, and improved quality of life. Physiological and walking meditation studies increased parasympathetic activity and HRV, with modest blood pressure reductions in some subgroups. Overall, meditation supports cardiovascular risk reduction, though effects vary by intervention type, population, and study design. Standardized protocols and longer follow-up are needed to strengthen the evidence and clarify mechanisms.

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