Helping a Client with Hypertension

While It is certainly beyond the course and scope of practice for a massage therapist to diagnose, you should have a general understanding of various medical conditions and be able to speak knowledgeably about them. You must also know when it is contraindicated to continue your work.

What is hypertension? 

If your client/patient tells you that they suffer from hypertension, it means that they have high blood pressure. Blood pressure is a measure of the force of blood as it pushes against the vessel walls. Two pressures are measured: Systolic is a measure of the pressure while the heart is beating and Diastolic is a measure of the pressure between heartbeats, when the heart is relaxed. The number is read as a fraction, for example 120/80 indicates normal range, which is where we want to be.


When blood pressure is high, it means that the heart is working harder and the blood vessels may become less elastic and more apt to become blocked. Over time, high blood pressure can contribute to hardening of the arteries, organ damage heart attack and stroke.


There are many causes of hypertension including smoking, being overweight, lack of exercise, excess alcohol consumption, too much salt in the diet, and certain diseases or disorders. Age, genetics and family history play a role, as well as with suffering from STRESS!


If your client is aware of a hypertensive condition, they are most likely already treating with a physician and may be on medication. This is a condition that you should refer out and not attempt to treat on your own. Instead position yourself a complementary member of a health care team.

Exercising regularly and eating properly are also crucial components to the plan, but unless you are also a personal trainer or nutritionist, it is best to leave that advice to the proper professional as well. (When you refer out, it is more likely that you get referrals back.)

Massage actually helps to reduce blood pressure by allowing the client to relax. During a massage, the parasympathetic nervous system (PNS) is activated which facilitates the release of endorphins (the “feel good” hormones), insulin activity is elevated, digestion and circulation increase as does the ability to rest and recuperate. The heart rate, blood pressure and body temperature lower. Breathing slows down and the client feels an over-all sense of calm. Massage is really a good thing. (Of course I didn’t need to tell you that now, did I?)


As a massage therapist, you will not likely be checking a client’s blood pressure, but you should be doing at least a general health screening at the onset of your appointment. If the client presents with high blood pressure, find out whether or not it is in control. This can be via a physician prescribed medication or through diet and exercise. If so, massage can be quite indicated and an effective complement to treatment. If your client’s blood pressure is not under control, or if it is secondary to another cause, then it is best to reschedule your appointment until after receiving a physician’s clearance. If you have your own practice, this is a good opportunity to ask for permission to contact the physician directly and appropriately to ask for clearance to treat their client. (But that is a whole other article.)

In working on an individual with uncontrolled high blood pressure you are increasing their blood circulation which can worsen the damage done to blood vessels in forcing blood through the body. When in doubt, refer out.

Some clients, particularly if they are on anti-hypertensive medications, may suffer from postural hypotension (low blood pressure) when getting off of the table because you did such a good job getting them so relaxed.You should suggest that they get up slowly from the table and sit for a little bit before coming to a stand in order to allow the pressure to normalize.

Your understanding of basic medical conditions will further your standing, as well as the standing of the professional as a whole, as an important complimentary player on a health care team. You probably spend a lot more time and have a much different rapport with your client than their physician does. Make it your responsibility (without overstepping your scope of practice) to be a source of guidance.