Evaluation of Enhanced External Counter Pulsation (EECP) as an Alternative Treatment Modality for Hypertension: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluate the efficacy of enhanced external counterpulsation (EECP) in reducing blood pressure among hypertensive patients. From an initial 323 articles, 37 studies involving 1504 patients met the inclusion criteria, with 11 included in the meta-analysis. EECP therapy durations ranged from 0.75 to 36.5 hours, with the majority around 35 hours. Meta-analysis revealed a significant reduction in systolic blood pressure (SBP) [mean difference (MD), -7.85 mm Hg; 95% CI, -9.59 to -6.11; P < 0.00001; I2 = 0%]. Diastolic blood pressure (DBP) also showed a significant decrease (MD, -3.94 mm Hg; 95% CI, -5.56 to -2.33; P < 0.00001; I2 = 45%). Mean arterial pressure did not significantly change (MD, -3.08 mm Hg; 95% CI, -7.51 to 1.34; P = 0.17; I2 = 77%). Funnel plots and statistical tests indicated no significant publication bias for SBP or DBP changes. EECP therapy significantly reduces both SBP and DBP in hypertensive patients, suggesting its potential as an effective adjunctive treatment for hypertension. However, the effect on mean arterial pressure remains inconclusive. The therapy's noninvasive nature, coupled with its demonstrated efficacy, supports broader clinical application. Further research with larger sample sizes and standardized protocols is necessary to better understand the mechanisms behind EECP and its long-term benefits in hypertension management.