A meta-analysis of non-invasive brain stimulation and autonomic functioning: Implications for brain-heart pathways to cardiovascular disease
Open accessAbstract
Given the intrinsic connection between the brain and the heart, a recent body of research emerged with the aim to influence cardiovascular system functioning by non-invasive brain stimulation (NIBS) methods such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Despite the implications of cardiovascular activity modulation for therapeutic purposes, such effects of NIBS have not yet been quantified. The aim of this study was to meta-analyze studies on NIBS effects on blood pressure (BP), heart rate (HR) and its variability (HRV). PubMed and Scopus databases were searched for English language studies conducted in humans. Twenty-nine studies were eligible for the analyses. Pooled effect sizes (Hedges' g) were compared. Random effect models were used. NIBS was effective in reducing HR (g=0.17) and enhancing HRV (g=0.30). A marginal effect emerged for BP (g=0.21). Significant moderators were the stimulation technique and the site of stimulation. Results show that NIBS affects cardiovascular and autonomic nervous system activity, confirming a potential pathogenic brain-heart pathway to cardiovascular disease.
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Dorsolateral prefrontal cortex targeting is best for TMS effects on autonomic balance, with both excitatory and inhibitory protocols restoring autonomic balance in healthy and diseased populations.
“Dorsolateral prefrontal cortex targeting is best for achieving these effects, with both excitatory and inhibitory protocols restoring autonomic balance in healthy individuals and diseased populations, including depression, schizophrenia, PTSD, obesity, bulimia nervosa, chronic pain, and spinal cord injury [11,12].”
From The Heart’s Electromagnetic Field in Emotions, Empathy and Human Connection: Biosensor-Derived Insights into Heart–Brain Axis Mechanisms and a Basis for Novel BioMagnetoTherapies (2026) · cites this paper as [11]
The Discussion (page unavailable) reports small autonomic effects of non-invasive brain stimulation and larger effects for TMS and prefrontal stimulation, supporting the general direction of the claim. But the moderation analysis (section 3.3.1; page unavailable) does not establish the dorsolateral prefrontal cortex as the best target, and the paper does not show that both excitatory and inhibitory protocols restore autonomic balance. The Discussion explicitly cautions that its healthy-versus-pathological comparison cannot establish equal effectiveness across populations; its list of studied conditions does not include schizophrenia, PTSD, or obesity. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTMS enhances vagal activity, improves HRV, and causes minor heart rate reductions.
“TMS is also promising in the context of cardiovascular autonomic modulation where it has been shown to enhance vagal activity, improve HRV and cause minor heart rate reductions [11,12,15].”
High HRV is considered a marker of emotion regulation and stress adaptability, and it has been associated with increased PFC activity.
“High HRV is considered a marker of emotion regulation and stress adaptability, and it has been associated with increased PFC activity (Makovac et al., 2017;Park et al., 2014;Thayer et al., 2012;Vanderhasselt et al., 2015).”
From Cortisol Response to Stress: The Role of Expectancy and Anticipatory Stress Regulation (2020) · cites this paper as Makovac et al., 2017
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References 81 · Cited by 136
- Authors
- Makovac, E., Thayer, J. F., & Ottaviani, C.
- Affiliations
- Fondazione Santa Lucia (IT)
- The Ohio State University (US)
- Corresponding author
- Ottaviani, Cristina
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 74
- Issue
- Pt B
- Pages
- 330-341
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W2369104392
- Cited by
- 136
- References
- 81
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 13 · 2023: 22 · 2022: 13 · 2021: 24 · 2020: 17 · 2019: 13 · 2018: 5 · 2017: 5 · 2016: 3
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 353 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Neuroscience & Biobehavioral Reviews (acceptedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Italian Ministry of Health (GR-2011-02348232)
- US National Science Foundation (IIS 134482)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- non-invasive brain stimulation, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, autonomic nervous system, heart rate variability, blood pressure, heart rate, cardiovascular disease, neurocardiology
- MeSH terms
- Brain, Cardiovascular Diseases, Heart, Humans, Language, Transcranial Magnetic Stimulation, Transcranial Direct Current Stimulation
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