Effects of Listening to Music During Blood Pressure Check in Primary Care Clinic Settings

Abstract

Background: Nearly half of adults in the United States (47% or 116 million) have hypertension and only 1 in 4 adults (24%) have their blood pressure under control. In 2020, more than 670, 000 death had hypertension as contributing cause. Listening to sounds of music can lead to reduction in blood pressure which was demonstrated in previous studies. To our knowledge it is the first study done in busy clinical practice with control group evaluating effects of 30 to 50 seconds of listening to music while blood pressure measurement was repeated. Methods:102 consecutive patients seen in primary care clinic from October 4, 2022, through December 14, 2022, were verbally consented to listening to the solo saxophone music while blood pressure measurement was repeated after initial blood pressure measurement revealed systolic blood above 139 millimeters of mercury (mmHg) and diastolic blood pressure above 89 mmHg. They were compared to 100 consecutive control patients, who were presented to clinic at the same time with the same blood pressure elevation parameters for medical assistant blood pressure check and no music intervention was done when blood pressure was repeated. Results:Systolic blood pressure drop in the study group with music intervention was 29.26 mmHg compared to 11.17 mmHg in control subjects (P value .006) and diastolic blood pressure drop was from 5.99 mmHg to 3.98 mmHg (P value .03). When separated by gender large systolic blood pressure drop was seen in control group in female patients 30.52 mmHg compared to controls 11.4 (P value .002) but diastolic blood pressure did not drop significantly 5.43 mmHg to 4.41 mmHg decrease (P value .184). Male subjects had significant drop in systolic and diastolic blood pressure in study group compared to control: 24.68 mmHg to 10.71 mmHg (P value .001) and 8 mmHg to 3.71 mmHg (P value .02), respectively. Conclusion: No significant extra time was required to implement recorded on smart phone music during repeat blood pressure check, which lead to significant improvement in blood pressure levels which could be lifesaving, taking into consideration harmful effects of the elevated blood pressure. This practice could be implemented in many busy primary care clinics and could lead to more relaxing patients’ experience and better blood pressure control. Patients may be advised to consider listening to music as a stress reduction in post pandemic time.

“The review of music on the heart rate emphasizes urgent need for high quality research on effects of music on the heart.”

Introduction

Humans have made music since prehistoric times, when it played a vital role in social life, from healing and ritual to hunting and warfare.^1-4 Traces of prehistorical musical practice survive in folk and traditional music in many parts of the world. Neuroimaging and electrophysiological studies in normal individuals as well as in patients with focal neurological lesions, reveal that music can change the state of large-scale neural systems of the human brain. The changes are not confined to brain sectors related to auditory and motor processing; they also occur in regions related to the regulation of life processes (homeostasis), including those related to emotions and feelings, most prominently in the insula and cingulate cortices, in the ventral striatum, in the amygdala, and in certain upper brainstem nuclei. The ease with which music leads to feelings, the predictability with which it does so, the fact that human beings of many cultures actively seek and consume music, and the evidence that early humans engaged in music practices lead us to hypothesize that music had a consistent relation to the neural devices of human life regulation. ⁵ Hypertension remains the big threat to human lives worldwide and having it under better control with simple, enjoyable, and affordable intervention would be very beneficial to everyone who has elevated blood pressure.

Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively. ⁶

At least four in ten U.S. adults (41%) have experienced high levels of psychological distress at least once since the early stages of the coronavirus outbreak according to a new Pew Research Center analysis that examines survey responses from the same Americans over time. ⁷ The goal of this study was to evaluate the effects of listening to music during blood pressure check in busy primary care settings. To our knowledge it is the first study evaluating the effects of music in a real practice environment. We are hoping that finding of this study will be able to shed some light on the effects of music and promote it as the way to reduce stress and reduce blood pressure, which is a known risk factor for premature death worldwide due to stroke and heart attack.

Methods

Study Design

The study was designed as observational study assessing effects of music listening on blood pressure in the same primary care settings for study subjects and controls. The study was conducted at Kaiser Primary care clinic in Clovis, California, USA and reflected a typical population sample of the local community. Study started on October 4, 2022, and concluded December 14, 2022.

Patients

Patients were ambulatory, community-dwelling men and women, who presented to primary care clinic for clinic visit or medical assistant blood pressure check and met criteria set for the study (the initial blood pressure measurement by medical assistant revealed systolic blood pressure above 139 millimeters of mercury (mmHg) and diastolic blood pressure above 89 mmHg). There were no patients excluded from this study and study was concluded when desired study sample was reached.

Interventions

All patients in the study have had blood pressure measurement repeated within 10-20 min after the initial measurement based on clinic set protocol.

The study group patients were verbally consented if blood pressure could be repeated while the music was playing, and they were encouraged to listen to the music. None of the consecutive patients refused to listen to the music and was excluded from the study.

The Concerto in E flat major solo for alto saxophone and string orchestra, written by Alexander Glazunov in 1934 was used. The piece lasts about fourteen minutes and is played without pause. It is deeply rooted in Romanticism, and has entered the standard saxophone repertoire and had been played worldwide for almost 100 years. For our study, we used up to first 50 seconds of the recording done by saxophone alto player Robert Volkov and recorded on the iPhone. Average duration for listening to the music was 30 seconds and varied depending on the blood pressure measuring cuff size and the time needed to proceed with measurement. Music was turned on exactly at the start of blood pressure measurement.

Results

The data was collected for both groups and summarized below in the tables with separation of groups of female and male patients.

Table 1 represents the study subjects and reflects initial blood pressure measurement with age and gender and blood pressure measurement while music was played and summarizes the decrease in systolic and diastolic blood pressure

Table 1.

Study subjects.

	Age	Gender	Initial SBP	Initial DBP	Repeat SBP	Repeat DBP	Decrease SBP	Decrease DBP
1	88	F	164	60	126	70	38	0
2	39	F	169	97	120	80	49	0
3	36	F	154	99	126	82	28	17
4	78	F	145	67	136	82	9	0
5	74	F	149	68	115	70	34	0
6	67	F	157	82	139	76	18	6
7	46	F	150	104	118	70	32	34
8	52	F	168	99	132	89	36	10
9	88	F	172	91	132	78	40	13
10	62	F	155	72	118	70	37	2
11	50	F	172	80	139	70	33	10
12	66	F	176	88	150	84	26	4
13	70	F	152	77	118	70	34	7
14	73	F	157	77	138	80	19	0
15	75	F	185	62	150	60	35	2
16	24	F	153	56	110	60	43	0
17	88	F	208	72	138	70	70	2
18	49	F	148	85	130	72	18	7
19	79	F	149	72	130	80	19	0
20	42	F	180	92	139	80	41	12
21	72	F	157	62	130	70	27	0
22	73	F	197	68	149	89	48	0
23	75	F	155	73	132	60	23	13
24	69	F	150	71	136	70	14	1
25	78	F	169	74	120	82	49	0
26	19	F	164	75	136	80	28	0
27	65	F	147	80	128	70	19	10
28	72	F	173	39	146	50	27	0
29	72	F	148	68	128	70	20	0
30	50	F	161	91	136	70	25	21
31	69	F	161	73	138	70	23	3
32	68	F	165	64	136	78	29	0
33	69	F	187	67	138	70	49	0
34	69	F	176	83	138	70	38	13
35	58	F	146	48	130	70	16	0
36	26	F	158	91	128	68	30	23
37	83	F	221	93	168	80	53	13
37	38	F	185	88	139	72	46	16
39	65	F	152	45	129	70	23	0
40	80	F	180	78	136	78	44	0
41	60	F	149	81	117	70	32	11
42	47	F	149	93	130	68	19	25
43	62	F	162	75	118	70	44	5
44	88	F	166	61	137	72	29	0
45	90	F	189	64	130	70	59	0
46	33	F	152	78	135	74	17	4
47	45	F	153	88	128	72	25	16
48	63	F	148	73	130	70	18	3
49	83	F	169	69	128	78	41	0
50	74	F	180	62	130	80	50	0
51	44	F	156	85	118	78	38	7
52	63	F	153	69	120	70	33	0
53	41	F	175	97	139	84	36	13
54	75	F	169	55	132	68	37	0
55	83	F	164	65	139	70	25	0
56	76	F	146	77	128	72	18	5
57	77	F	186	93	136	76	50	17
58	44	F	172	96	148	95	24	1
59	36	F	172	101	126	85	46	16
60	35	F	142	86	128	70	14	16
61	85	F	155	59	138	72	17	0
62	72	F	156	44	136	55	20	0
63	60	F	160	76	139	80	21	0
64	77	F	165	74	138	70	27	4
65	55	F	186	89	157	84	29	5
66	73	F	152	52	136	68	16	0
67	48	F	160	66	138	60	22	6
68	82	F	184	56	160	60	24	0
69	68	F	141	71	138	68	3	3
70	86	F	162	62	139	70	23	0
71	53	F	164	81	138	68	26	13
72	56	F	167	77	136	70	31	7
73	73	F	162	72	132	80	30	0
74	69	F	168	81	136	82	32	0
75	83	F	152	53	122	60	30	0
76	79	F	160	60	130	70	30	0
77	62	F	151	84	138	76	13	8
78	58	F	154	71	122	70	32	1
79	76	F	153	48	118	72	36	0
80	67	F	157	80	122	70	35	10
81	54	M	160	86	126	70	34	16
82	71	M	181	76	137	70	44	0
83	50	M	143	88	138	70	5	18
84	34	M	152	74	138	80	14	0
85	24	M	161	84	128	80	33	4
86	49	M	192	122	159	89	33	33
87	28	M	146	83	138	70	8	13
88	55	M	157	71	128	64	29	7
89	68	M	164	108	130	88	34	20
90	78	M	163	71	130	80	33	0
91	85	M	154	75	136	72	18	3
92	76	M	152	63	115	70	37	0
93	66	M	156	85	126	70	30	15
94	22	M	165	74	142	70	23	4
95	26	M	149	79	118	70	31	9
96	69	M	142	72	132	78	10	0
97	55	M	154	107	132	86	22	21
98	39	M	161	72	132	85	29	0
99	50	M	146	82	136	78	10	4
100	78	M	151	55	128	60	23	0
101	62	M	171	96	150	90	21	6
102	63	M	165	81	143	78	22	3

Age: in years.

Gender: M-male, F-Female.

SBP: Systolic blood pressure measured in millimeters of mercury (mmHg).

DBP: Diastolic blood pressure measured in millimeters of mercury (mmHg).

The study patients’ group had 80 females and 54 males. Average age for women was 63 years old with range from 19 years to 90 years. Average age for men was 54 years old and ranging from 22 years to 85 years.

The control study group data was summarized in Table 2 and reflects initial blood pressure measurement with age and gender and blood pressure measurement after 10-20 minutest were lapsed, no music was played for those patients. Table 2 also summarizes the decrease in systolic and diastolic blood pressure. There were total 65 females and 35 males in the control group. Average age for women was 63 years old (which is the same as the study group) and range was 30 years to 86 years old. It was total 35 male patients with average age 64 years old, which ranged from 38 years to 82 years old)

Table 2.

Control subjects.

	Age	Gender	Initial SBP	Initial DBP	Repeat SBP	Repeat DBP	Decrease SBP	Decrease DBP
1	74	F	154	61	140	61	14	0
2	39	F	154	79	137	83	17	0
3	86	F	162	75	140	75	22	0
4	76	F	146	60	125	59	19	1
5	71	F	142	66	128	69	14	0
6	61	F	142	88	140	88	2	0
7	49	F	144	81	135	82	9	0
8	82	F	152	48	151	45	1	3
9	62	F	170	71	157	59	13	12
10	82	F	141	60	139	64	3	0
11	61	F	164	84	157	89	7	0
12	52	F	167	87	159	87	8	0
13	81	F	185	80	177	79	8	1
14	44	F	153	87	134	87	19	0
15	67	F	164	64	160	78	4	0
16	58	F	162	91	153	79	9	12
17	76	F	164	59	141	58	17	0
18	76	F	143	52	120	52	23	0
19	84	F	183	75	167	74	16	0
20	41	F	150	74	130	66	20	8
21	62	F	151	92	146	78	5	14
22	60	F	153	81	147	92	6	0
23	56	F	160	88	157	93	3	0
24	45	F	157	99	151	87	6	12
25	74	F	152	63	128	61	34	2
26	51	F	148	81	139	70	9	11
27	70	F	183	81	177	87	6	0
28	59	F	146	76	140	73	6	3
29	77	F	200	81	169	69	41	12
30	66	F	176	86	168	80	8	6
31	64	F	148	69	140	60	8	9
32	78	F	172	105	163	88	11	17
33	32	F	144	89	135	86	9	3
34	47	F	140	91	125	93	15	2
35	74	F	143	51	134	48	9	3
36	66	F	168	86	142	87	26	0
37	82	F	156	55	152	48	4	7
38	69	F	184	95	177	93	7	2
39	62	F	146	53	140	51	6	2
40	65	F	147	86	139	74	8	12
41	52	F	157	90	151	92	6	0
42	85	F	174	86	164	78	10	14
43	58	F	151	87	153	79	0	8
44	78	F	160	73	154	80	6	7
45	37	F	148	96	130	89	18	7
46	37	F	194	97	192	101	2	0
47	30	F	173	116	160	98	13	18
48	75	F	161	69	134	65	27	4
49	85	F	169	77	163	65	6	12
50	81	F	193	49	193	41	0	7
51	61	F	169	66	167	76	2	0
52	75	F	177	72	166	70	11	2
53	48	F	159	74	137	71	22	3
54	60	F	163	78	141	73	22	5
55	72	F	143	85	128	77	15	12
56	59	F	159	62	152	69	7	0
57	42	F	166	110	167	113	0	0
58	52	F	154	77	146	81	8	0
59	77	F	144	67	131	63	13	4
60	45	F	156	90	148	85	8	5
61	57	F	150	93	133	80	17	13
62	55	F	175	80	167	90	8	10
63	72	F	141	66	111	66	30	0
64	68	F	148	46	129	46	19	0
65	75	M	175	76	142	85	33	0
67	60	M	148	67	138	68	10	0
68	65	M	145	78	133	79	12	0
69	74	M	165	81	141	71	24	10
70	68	M	150	73	154	97	0	0
71	49	M	140	72	137	75	3	0
72	73	M	168	63	158	61	10	2
73	68	M	150	93	138	73	12	20
74	45	M	151	55	151	88	0	0
75	65	M	156	87	145	80	11	7
76	74	M	157	78	155	82	2	0
77	70	M	150	88	134	89	16	0
78	53	M	145	95	141	100	4	0
79	77	M	176	110	170	107	6	3
80	73	M	143	71	140	69	3	2
81	58	M	149	104	139	100	10	4
82	77	M	167	83	167	78	0	5
83	58	M	188	88	160	100	28	0
84	72	M	145	54	131	51	14	3
85	70	M	160	77	150	81	10	4
86	66	M	149	78	147	83	2	0
87	74	M	155	82	145	81	10	1
88	75	M	143	79	141	82	2	0
89	82	M	150	73	149	72	1	1
90	39	M	146	90	141	65	5	25
91	72	M	208	61	186	86	22	0
92	38	M	159	92	152	92	7	0
93	52	M	159	87	152	92	7	0
94	54	M	157	99	145	89	12	10
95	70	M	146	65	128	58	18	0
96	54	M	150	95	134	88	16	7
97	66	M	155	78	138	65	17	0
98	44	M	150	103	148	98	18	0
99	72	M	154	76	140	78	14	0
100	54	M	150	95	134	88	16	7

Age: in years.

Gender: M-male, F-Female.

SBP: Systolic blood pressure measured in millimeters of mercury (mmHg).

DBP: Diastolic blood pressure measured in millimeters of mercury (mmHg).

The study results we summarized in Table 3.

Table 3.

Results analysis.

	Study SBP Drop	Control SBP Drop	P Value	Study DBP Drop	Control DBP	P Value
TOTAL	29.26	11.17	.006	5.99	3.98	.03
FEMALE	30.52	11.4	.002	5.43	4.41	.18
MALE	24.68	10.71	.001	8	3.71	.02

SBP: Systolic blood pressure measured in millimeters of mercury (mmHg).

DBP: Diastolic blood pressure measured in millimeters of mercury (mmHg).

To calculate statistical significance we used google sheets T.Test compare range 1 to range 2 and used two-tailed t-test and type 2 two sample t-test with equal variance. When separated by gender in female group systolic blood pressure drop was 11.4 mmHg (range 0-41 mmHg) and diastolic drop was 4.41 mmHg (range 0-18 mmHg) and male drop in systolic was 10.71 (range 0-33 mmHg) and diastolic was 3.71 mmHg (range 0-25 mmHg).

We noted statistical significance of the drop in systolic and diastolic blood pressure when music was used as an intervention in total group not separated by gender and male patients separately. Female diastolic blood pressure did not have statistically significant drop while systolic blood pressure still dropped significantly.

Female patient has higher than male systolic and diastolic blood pressure drop which can be because female patients are more sensitive to music sound stimuli.

Discussion

It is very intriguing that despite music being used since the beginning of civilization for medicinal purposes we still do not understand how it affects our brain, heart and how it affects blood pressure. The study on hypertensive rats found that classical Mozart’s music improved dopaminergic transmission in the rats’ brain but is not clearly applicable to humans.^8,9

Intuitively, music is supposed relax, decrease the anxiety and stress and though those effects low blood pressure. The study on 24 human subjects found the positive for happiness emotional effect of pictures was not as pronounced as emotional effect of music and pictures combined. ¹⁰ Systolic blood pressure was reduced significantly in pre-hypertensive young adults in a small, randomized control trial with music therapy. ³ Systolic blood pressure was reduced in older adults with music therapy combined with muscle relaxation with significant effect for systolic but not diastolic blood pressure after 11 sessions of 6 days music therapy trial compared to controlled group. ¹¹

Participants with hypertension with weekly music therapy for 12 weeks were found to have improvement in blood pressure in study patients. ¹²

When 75 study subjects were listening to classical, jazz and pop music after mental arithmetic task only classical music group had statistically significantly lower post-task blood pressure level. ¹³

We did use classical orchestra music for our study. It is possible that just sounds of musical instrument relaxing our minds more than sounds of songs which we must process. Another 2 reviews we found were confirming antianxiety effects of music. Group of students were presented with stress and effects of music were noted to decrease anxiety, blood pressure and heart rate during the stress. ¹⁴ Cochrane library meta-analysis found that music listening may have beneficial effect on preoperative anxiety. ¹⁵

The review of music on the heart rate emphasizes urgent need for high quality research on effects of music on the heart. ¹⁶ Music was also found to improve athletic performance and widely used during exercise and sports training. ¹⁷ Olympic swimming team USA gold-medal champion Caeleb Dressel attributed his win to drum music beat he plays on his drums and uses it to swim faster.

Lifestyle modifications are well-known to improve blood pressure control and routinely recommended in general practice since dietary approach to stop hypertension study was published more than 30 years ago.^18,19 When listening to music scale was added to the lifestyle changers in randomized controlled trial it led to adjunct benefit of reduction of blood pressure in pre-hypertensive adults. ²⁰

Our study is the first study done in not academic busy primary care clinical practice found statistically significant effect on less than one minute listening to solo classic alto saxophone music on reduction in blood pressure. Most likely effects are related to relaxation and decrease in anxiety. Due to Covid19 pandemic and severe increase in stress in general population this inexpensive and not time-consuming intervention in every clinic can provide tremendous benefit not only in reducing blood pressure but also in improving experience while visiting clinic. We suggest that classical music (e.g., music by W.A. Mozart) should be played in the waiting rooms even before patient’s blood pressure check. Easily found online professional recording of the A. Glazounov’s Concerto alto saxophone music can be also used and no more than one minute needed to play it for blood pressure check.

Limitations

This study has several limitations. First, we did not randomize our patients and the study and control sample were selected consequently. Second, we did not include race in our study. Third, our study did not evaluate the effects of music on age subgroups. Fourth, this study was limited to one clinic and represented only the sample of one local community population.

Conclusion

This is the first study in busy primary care clinic which demonstrated statistically significant decrease in blood pressure when it was measured while solo saxophone music piece A. Glazounov’s Concerto was played for less than one minute during blood pressure repeat measurement and compared to control group which had blood pressure measured in the same clinic during the same time frame without music. We hope that this study will help to implement classical music listening to clinic waiting rooms and blood pressure check areas and will help to reduce blood pressure burden and its well-known negative sequels. We also believe that more studies need to be done to research if music listening at home will help with blood pressure reduction in hypertensive patients in addition to lifestyle changers and stress reductions.