Transcendental Meditation in the 2025 US blood pressure guideline

What the AHA/ACC guideline actually says about TM, who stands behind it, and what it does and does not mean.

The 2025 US guideline on high blood pressure names Transcendental Meditation as the only meditation technique by name. The guideline was written by the American Heart Association and the American College of Cardiology and endorsed by eleven other organisations, including the American Medical Association. Recommendation 8 (class 2b) says that stress reduction through TM may be reasonable to prevent or treat elevated blood pressure, as an adjunct to lifestyle or medication. The guideline puts the average effect at 5 to 7 mmHg systolic in people with hypertension.

What it says, word for word

“In adults with or without hypertension, stress reduction through transcendental meditation may be reasonable to prevent or treat elevated BP and hypertension, as an adjunct to lifestyle or medication interventions.”

Recommendation 8, section 5.1 (Stress Reduction). Class 2b, level of evidence B-R, meaning randomised trials. Other forms of stress management, such as breathing techniques and yoga, are covered in a separate recommendation (9) with the same class. TM is the only technique named.

Who endorses the guideline

The American Heart Association and the American College of Cardiology wrote the guideline. It was developed in collaboration with, and endorsed by:

American Medical Association (AMA)
American Academy of Physician Associates (AAPA)
American Association of Nurse Practitioners (AANP)
American College of Clinical Pharmacy (ACCP)
American College of Preventive Medicine (ACPM)
American Geriatrics Society (AGS)
American Society of Preventive Cardiology (ASPC)
Association of Black Cardiologists (ABC)
National Medical Association (NMA)
Preventive Cardiovascular Nurses Association (PCNA)
Society of General Internal Medicine (SGIM)

They endorse the guideline as a whole; there was no separate vote on TM.

The estimated effect on blood pressure

Table 12 of the guideline lists the non-drug interventions. A selection, average change in systolic pressure:

Intervention	What it involves	With hypertension	Without hypertension
Transcendental Meditation	Training by a professional, then 2 × 20 minutes a day, seated with eyes closed	−5 to −7 mmHg	−5 mmHg
Breathing control	Device-guided, under 10 breaths a minute, 15 minutes a day	−5 mmHg	−5 mmHg
DASH diet	Fruit, vegetables, whole grains, low-fat dairy	−5 to −8 mmHg	−3 to −7 mmHg
Aerobic exercise	90 to 150 minutes a week	−4 to −8 mmHg	−2 to −7 mmHg
Less alcohol	At least halving intake	−4 to −6 mmHg	−3 mmHg

The guideline adds that these values should not be compared directly, because the studies behind each intervention differ.

What this does and does not mean

It does: TM is in the guideline as a possible adjunct for elevated blood pressure, based on randomised trials, for adults with and without hypertension.
It does: the guideline calls the evidence from short-term trials consistent and of moderate to high quality, with an average fall of about 5/2 mmHg.
It does not: replace medication or lifestyle changes. Class 2b means “may be reasonable”, not class 1, “is recommended”.
It does not: make meditation stronger than diet or exercise. The guideline calls it somewhat less effective, and notes that the trials were small and short.

Do you have high blood pressure? Discuss it with your GP or cardiologist. If your GP prescribes TM, Dutch health insurers reimburse the course in most cases; see the course fee page.

Source

Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Circulation. 2025;152. doi:10.1161/CIR.0000000000001356 · PubMed