Effect of cervical manipulation on blood pressure and heart rate variability responses in adults: a scoping review

This study aimed to review the blood pressure and heart rate variability responses after different cervical manipulation. A comprehensive literature search was conducted across CINAHL, Cochrane Library, PubMed®, and SciELO databases on December 26, 2024. From an initial pool of 84,625 studies, five met the inclusion criteria for this review. The findings suggest that cervical manipulation may induce a hypotensive response in systolic blood pressure while promoting an overall enhancement in cardiovascular regulation, particularly through an increase in parasympathetic activity. Specifically, 80 % of the reviewed studies reported a reduction in systolic blood pressure following cervical manipulation, highlighting its potential as a therapeutic strategy for blood pressure management. Additionally, 66 % of the included studies demonstrated improvements in sympathetic-vagal balance regulation. Other findings pointed to reductions in both blood pressure and plasma norepinephrine levels, which could indirectly support autonomic and hemodynamic stability. Although these results reinforce the potential benefits of cervical manipulation as a complementary approach for managing blood pressure and autonomic function, the limited number of available studies (n = 5) and their methodological variability (ranging from moderate to high quality) warrant caution in extrapolating these findings to broader clinical populations.