Essential hypertension requires lifelong treatment, which is ineffective and has many side effects with medications alone, thus, a non-invasive, low-cost non pharmacological therapy to improve treatment rates and compliance is needed. To investigate the effects of music therapy on blood pressure levels, negative emotions, and quality of life in patients with essential hypertension, a systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were performed in the present study. Randomized controlled trials about the effect of music therapy on essential hypertension were retrieved by a systematic search of PubMed, Embase, Scopus, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, VIP, and China Biology Medicine (CBM) databases from inception to February 2025. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias for inclusion in the study. Statistical analyses were performed using Cochrane software Revman 5.3 software and ADDIS 1.16.5 software. A total of 14 studies involving 1472 patients were included. Meta-analysis showed that music therapy reduced systolic blood pressure (mean difference [MD] = -11.18, 95% confidence interval [CI]: -13.17 to - 9.20, P < 0.05) and diastolic blood pressure (MD = -7.06, 95% CI: -9.14 to-4.97, P < 0.05), and alleviated anxiety (MD = 2.15, 95% CI: -2.74 to-1.57, P < 0.05) and depression (MD = -3.66, 95% CI: -5.88 to -1.45, P < 0.05) in patients with essential hypertension. Network meta-analysis indicated that Chinese traditional medicine five-element music (59%) was more effective than other types of music (41%) in lowering systolic blood pressure, but less effective than other music (73%) in lowering diastolic blood pressure. No serious adverse events were reported in any trial. In conclusion, music therapy effectively lowered blood pressure levels, improved the quality of life in patients with hypertension, and had positive efficacy in relieving anxiety and depression.

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