Mindfulness for Hypertension Worth Contemplating

Damian McNamara

December 12, 2019

Mindfulness training can significantly reduce blood pressure and stress levels in hypertensive patients, early research shows.  

Investigators found mindfulness was associated with a significant decrease in systolic blood pressure at 1 year and had other gains including better adherence to a recommended diet, lower salt intake, reduced alcohol consumption, and increased physical activity.

"Mindfulness training may improve blood pressure," lead investigator Eric Loucks, PhD, director of the Mindfulness Center at Brown University, Providence, Rhode Island, told Medscape Medical News.

"We know enough about hypertension that we can theoretically control it in everybody — yet in about half of all people diagnosed it is still out of control, Mindfulness may represent another approach to helping these people bring their blood pressure down, by allowing them to understand what's happening in their minds and bodies," he noted in a statement.

The study was published online December 4 in PLoS ONE.

Custom-Made Intervention

Estimates from 2014 show the annual costs associated with high blood pressure in the United States topped out at $53.2 billion. In addition, it is estimated elimination of hypertension would have a larger impact on cardiovascular disease (CVD) mortality than the removal of any other risk factor in females and, with the exception of smoking, any risk factor in males, the investigators note. They add that only about half of US patients with hypertension have it under control.

In 2017, as reported by Medscape Medical News, the American Heart Association issued the first scientific statement endorsing meditation to reduce cardiovascular risk, suggesting it be included as an adjunct to current medical and lifestyle interventions.

Although there is some research to suggest mindfulness meditation has the potential to reduce blood pressure levels, investigators note that the evidence is "equivocal."

For example, a small, but significant, improvement in blood pressure emerged in a 2014 systematic review and meta-analysis. However, when researchers excluded the study showing the greatest benefit, the results were no longer significant. Furthermore, none of the mindfulness interventions included in the analysis was specifically designed to address hypertension.

For the current pilot study, investigators modified the well-known Mindfulness-Based Stress Reduction (MSBR) program to specifically target hypertension.

The result was the Mindfulness-Based Blood Pressure Reduction (MB-BP) intervention, a 10-session program that teaches attention control, emotional regulation, and self-awareness of healthy and unhealthy habits to mitigate hypertension risk factors.

The study population included 48 participants. Of these, 61% were women and 96% were white. The cohort had a mean age of 60 years (range, 26-83 years). Approximately 60% of participants were taking antihypertensive medication at baseline.

Hypertension was defined as a baseline systolic blood pressure ≥ 120 mmHg or a diastolic blood pressure ≥ 80 mmHg.

Dose-Dependent Effect

The final analysis was based on data from 43 participants who had attended at least seven of the 10 MB-BP classes. Based on focus groups and one-on-one feedback, researchers found the intervention was feasible and well accepted by study participants.

At 1-year, investigators found patients with stage 2 uncontrolled hypertension, defined as a systolic blood pressure ≥ 140 mmHg, experienced a mean 15.1-mmHg reduction in blood pressure.

In addition, self-awareness, attention, and emotion regulation had all improved at the 1-year follow-up.

Researchers also found there was a dose-dependent effect. Results of a post hoc analysis revealed that participants who spent a median 18 hours a week outside of class practicing mindfulness experienced a mean 15.2-mmHg decrease in blood pressure at 3 months and an 11.4-mmHg decrease at 1 year.

In contrast, those who reported a mean of 0 hours spent practicing mindfulness experienced a mean 4.4-mmHg decrease at 3 months and a 6.0-mmHg decrease at 1 year.

The 1-year follow-up and use of a mindfulness program "grounded in both the evidence-based MBSR as well as in hypertension etiology and treatment" were among the strengths of the study, the researchers note. The single-arm design without a control condition was a potential limitation.

More search is warranted and randomized controlled trials will be key to validating the findings, Loucks told Medscape Medical News.

He added that his team is currently training instructors in MB-BP adding there is an NIH-funded study underway to test the intervention in more than 200 participants.

This trial will assess blood pressure and lifestyle changes in participants randomized to receive MB-BP or enhanced usual care, with results expected by mid-2020.

'Cautious Optimism'

Commenting on the study for Medscape Medical News, Glenn Levine, MD, director of the cardiac care unit at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, described the preliminary findings as "exciting."

Levine, who served as chair of the writing group of the 2017 AHA scientific statement on meditation, applauded the researchers for the "careful manner in which they enrolled, educated, tracked, and later evaluated patients and endpoints."

He said that the findings on the potential benefits of a mindfulness-based intervention program on measurable factors — including those associated with positive psychological health, as well as the harder endpoint of blood pressure and blood pressure reduction — were notable.

He agreed that a large randomized trial is necessary as the next step. However, he added that in the meantime the current results provide reason for "cautious optimism to those who believe that we need to begin to further explore the effects of mind-heart-body interventions on cardiovascular health."

The study is a "great step" in the direction of expanding research beyond disease, drugs, and devices, Levine added. Going forward, the focus should also be "on interventions that actually improve the physical and psychological wellness" of patients.

PLoS ONE. Published online December 4, 2019. Full text

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