Cold therapy for essential (primary) hypertension
Evidence review
Overview
No study has tested cold-water immersion or whole-body cryotherapy as a treatment for hypertension. Two small studies measured acute responses to whole-body cryotherapy chambers (-166 F to -193 F) in adults with hypertension: blood pressure rose after sessions, without a change in blood-pressure behavior over a 21-session course, and cardiovascular and autonomic responses differed between hypertensive and normotensive men. Sudden cold-water immersion triggers a cold shock response that includes a rise in blood pressure and heart rate.
Key findings
- Whole-body cryotherapy at -166 F, 21 sessions (n=23 including treated and untreated hypertensive adults): BP rose after sessions; no change in BP behavior over the course; authors considered it acceptable for adults under 70 with mild or treated hypertension, with individual monitoring.
- Single 3-min whole-body cryotherapy session at -175 to -193 F (13 hypertensive vs 26 normotensive young men): strong cardiovascular and autonomic responses with several between-group differences.
- Head-out cold-water immersion at 54 F after sauna raised systolic BP in heart failure, coronary and control patients (PMID 26152773).
Every study we reviewed
2 mixed results
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 44 studies on hypertension, across all heat and cold therapies, including case reports and older work not graded here.
Impact of Whole Body Cryotherapy at -110 °C on Subjects with Arterial Hypertension.
Missmann M et al. Arch Immunol Ther Exp (Warsz). 2016. PubMed 26408646 · DOI
- Who
- Adults aged 35-69 with rheumatic disorders: treated hypertension, untreated mild hypertension, or normotensive (Austria)
- What
- Whole-body cryotherapy chamber at -166 F (-110 C), 21 applications; BP measured before and after each
- Protocol
- -166 °F
- Measured
- Blood pressure immediately before and after each session and across the course
- Result
- BP rose significantly after cryotherapy in the whole sample and in the normotensive group; BP behavior did not change over the course of treatment except a wider systolic range in normotensive subjects. Authors judged cryotherapy safe with respect to BP for adults under 70 with untreated mild or treated hypertension, but larger BP changes occurred infrequently.
- Limitations
- Small; no hypertension-lowering endpoint; patients were selected for rheumatic disease and screened with standard exclusion criteria; subgroup sizes small.
Cardiovascular and autonomic responses to whole-body cryostimulation in essential hypertension.
Zalewski P et al. Cryobiology. 2014. PubMed 25108050 · DOI · Free full text
- Who
- Young men with untreated essential hypertension (n=13) and normotensive controls (n=26) (Poland)
- What
- Single whole-body cryotherapy session at -175 to -193 F (-115 to -125 C) for 3 min
- Protocol
- -175 to -193 °F · 3 min · single session/wk
- Measured
- Cardiovascular and autonomic parameters at rest and on tilt testing, before and after cryotherapy
- Result
- Cryotherapy had strong modulatory effects on myocardial, vascular and autonomic parameters in both groups, with several differences between hypertensive and normotensive men (numeric values not in abstract). Authors advise careful prescription in people with any degree of cardiovascular failure.
- Limitations
- Single session; small; young men only; numeric results not in abstract; no blood-pressure-lowering endpoint.
Protocols used in the studies
Whole-body cryotherapy chambers at -166 F (-110 C) for 21 applications, or a single 3-min exposure at -175 to -193 F (-115 to -125 C). No cold-water immersion protocol has been studied in hypertensive patients.
What is still unknown
Whether repeated cold exposure has any sustained effect on blood pressure in hypertensive patients; safety of cold-water immersion in treated and untreated hypertension; interaction with antihypertensive drugs.
Safety
Cautions for cold therapy in this condition
- Cold exposure acutely raises blood pressure: BP rose after whole-body cryotherapy sessions (PMID 26408646), and cold-water immersion raised systolic BP in cardiac patients (PMID 26152773).
- Sudden cold-water immersion triggers the cold shock response (gasp, hyperventilation, tachycardia, BP rise) that can incapacitate within seconds (PMID 2691172).
- Study authors advise careful prescription and individual BP monitoring for people with cardiovascular disease (PMID 25108050, PMID 26408646); standard cryotherapy exclusion criteria were applied (PMID 26408646).
For clinicians
Suggested rationale
There is no evidence that cold-water immersion or whole-body cryotherapy treats hypertension; the available studies (Missmann 2016; Zalewski 2014) address only acute responses to whole-body cryotherapy, during which blood pressure rises, so cold therapy cannot be justified as a treatment for hypertension on current evidence.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: I10. Examples only; the clinician assigns the code.
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