Posted 12.21.2018 | by AMRA

High blood pressure is a major cardiovascular risk factor impacting 35% of U.S. adults. Stress, anxiety, and depression can contribute to its onset and intensification. The condition is usually treated with antihypertensive medications, but a significant proportion of patients fail to achieve adequate control with medication alone.

Researchers are interested in whether stress-reduction interventions together with conventional medical care can improve outcomes compared to medication alone. In a randomized controlled trial, Marquez et al. [Journal of Human Hypertension] compared relative effectiveness of mindfulness meditation and health education programs in reducing blood pressure as well as levels of stress, anxiety, and depression.

The researchers randomly assigned 42 meditation-naïve participants (average age = 57 years; 43% male; 69% on antihypertensive medication) with high-normal blood pressure or stage 1 hypertension to a Mindfulness Meditation or Health Education intervention. Both interventions were offered in two-hour group sessions that met weekly over the course of 8 weeks.

Mindfulness Meditation content was similar to that offered in Mindfulness-Based Stress Reduction (MBSR). The Health Education intervention offered didactic information on hypertension risk factors, along with methods of prevention through medication, diet, and exercise. Participants were assessed at baseline, 4, 8, and 20 weeks on measures of mindfulness (evaluated using the Five Facet Mindfulness Questionnaire), mood, perceived stress, anxiety, depression, and clinically assessed blood pressure (BP).

Additionally, each participant’s ambulatory BP was assessed over a 24-hour period at baseline and at week 8 using a body-worn automated device that measured BP at 15-30 minute intervals throughout the day and night. Ambulatory BP is a sound measure because it eliminates the error associated with the “white coat” effect—the spurious elevation in BP that occurs when doctors measure it.

At post-intervention, the mindfulness group had significantly lower clinically assessed systolic BP (130 mmHg) than the controls (133 mmHg). Similar results were found for 24-hour ambulatory BP: the mindfulness group had significantly lower systolic BP (124 mmHg) and diastolic BP (78 mmHg) than controls (126 mmHg and 80 mmHg, respectively). When ambulatory BP was divided into measures taken while awake and measures taken while asleep, only measures taken while asleep proved significant (109 vs.114 mmHg and 65 vs. 69 mmHg).

At 20 weeks, clinically assessed systolic BP in the mindfulness group dropped 13 mmHg from baseline, whereas the control group dropped only 1 mmHg, a statistically significant difference. Diastolic BP dropped by 14 mmHg in the mindfulness group but only by 3 mmHg in the control group, a difference that failed to reach statistical significance.

At 8 weeks, the mindfulness group reported significantly lower levels of anxiety, stress, and depression, and significantly higher levels of mindfulness. At 20 weeks, the mindfulness group reported significantly lower perceived stress levels than controls, but none of the other group differences in psychological scores reached significance.

The study shows that mindfulness meditation in combination with conventional medication treatment reduces blood pressure and stress levels, while improving mindfulness and mood more than medication coupled with health education. The findings appear to be clinically meaningful as a 3 mmHg reduction in systolic blood pressure can reduce stroke mortality by 8% and cardiovascular mortality by 5%. The reductions in this study are equivalent in magnitude to those obtained through regular aerobic exercise. The study is limited by its small sample size and three-month follow-up period.

Reference:

Márquez, P. H. P., Feliu-Soler, A., Solé-Villa, M. J., Matas-Pericas, L., Filella-Agullo, D., Ruiz-Herrerias, M., . . . Arroyo-Díaz, J. A. (2018). Beneits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. Journal of Human Hypertension.

[Link to abstract]