ArticleLiterature Review

Investigating the effect of transcendental meditation on blood pressure: A systematic review and meta-analysis

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Abstract

Some evidence from previous randomized controlled trials and systematic reviews has demonstrated a positive association between hypertension and transcendental meditation (TM). However, other trials and reviews showed the effect of TM on blood pressure (BP) was unclear but did not use subgroup analysis to rigorously investigate this relationship. The American Heart Association has stated that TM is potentially beneficial but did not give a standard indication. The present study explored several subgroup analyses in systematic reviews to investigate the effect of TM on BP. Medline, Embase, Cochrane Library, Web of Science and Chinese BioMedical Literature Database were searched through August 2014. Randomized controlled trials of TM as a primary intervention for BP were included. Two reviewers independently used the Cochrane Collaboration's quality assessment tool to assess each study's quality. Twelve studies with 996 participants indicated an approximate reduction of systolic and diastolic BP of -4.26 mm Hg (95% CI=-6.06, -2.23) and -2.33 mm Hg (95% CI=-3.70, -0.97), respectively, in TM groups compared with control groups. Results from subgroup analysis suggested that TM had a greater effect on systolic BP among older participants, those with higher initial BP levels, and women, respectively. In terms of diastolic BP, it appears that TM might be more efficient in a short-term intervention and with individuals experiencing higher BP levels. However, some biases may have influenced the results, primarily a lack of information about study design and methods of BP measurement in primary studies.Journal of Human Hypertension advance online publication, 12 February 2015; doi:10.1038/jhh.2015.6.

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... TM had a greater effect on systolic BP among older participants, those with higher initial BP levels, and women, respectively. In terms of diastolic BP, it appears that TM might be more efficient in a short-term intervention and with individuals experiencing higher BP levels [7] . The Rajyoga meditation of Brahmakumaris is practiced with 'open eyes' without any mantras or rituals which makes the meditation versatile, simple and easy to practice. ...
... Practicing TM may has not been consistently seen to produce significant reduction in blood pressure [2] . The observed beneficial effect is comparable with other lifestyle interventions such as weight-loss diet and exercise [7] . Reduction of BP by Sudarshan Kriya [4] is of similar clinical magnitude as in our study. ...
Article
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Cardiovascular disease remains a leading cause of morbidity and mortality worldwide. Meditation can have long standing effects on the brain, which provides some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Rajyoga meditation of Brahmakumaris has shown overall healthy changes in cardiovascular, metabolic and psychological parameters, decline in absolute percent diameter coronary stenosis and cardiac events in patients of CAD. Hence this study was conducted in the Brahmakumaris centre at Jhanjirimangala, Cuttack from May 2016 to November 2016. 28 males (age 45-55 years) with hypertension, unwilling to take antihypertensives or having adverse effects, were enrolled into the study based on their willingness. Their cardiovascular disease risk factor stratification was done and baseline parameters were recorded. The modifiable risk factors, smoking status and blood pressure, were specifically noted and reevaluated after 6 weeks of Rajyoga practice with minimum 80% adherence. There was clinical reduction of both systolic and diastolic BP in our study. The reduction in diastolic BP is highly significant statistically. There is a highly appreciable decline in smoking status (83.3%).There were no adverse effects. This low cost risk free intervention may be considered as an adjunct to standard guideline directed risk factor reduction for cardiovascular disease.
... Thus, many non-drug treatments are used as a supplement or alterative to antihypertensive drugs, such as acupuncture, 11 massage, 12 tai chi, 13 yoga 14 and meditation. 15 Their effects on BP reduction have been systematically reviewed at least once [15][16][17][18][19][20][21][22][23] Consequently, many systematic reviews (SRs) of randomized controlled trials (RCTs), which are considered to constitute the highest grade of evidence in evidence-based medicine, are available to health care providers, clinicians, consumers, researchers, and policy makers to support their medical decisions for unmanageable hypertensive patients ...
... Thus, many non-drug treatments are used as a supplement or alterative to antihypertensive drugs, such as acupuncture, 11 massage, 12 tai chi, 13 yoga 14 and meditation. 15 Their effects on BP reduction have been systematically reviewed at least once [15][16][17][18][19][20][21][22][23] Consequently, many systematic reviews (SRs) of randomized controlled trials (RCTs), which are considered to constitute the highest grade of evidence in evidence-based medicine, are available to health care providers, clinicians, consumers, researchers, and policy makers to support their medical decisions for unmanageable hypertensive patients ...
Article
Background This review aims to rate the quality of evidence and the strength of recommendations in high-quality systematic reviews of non-drug therapies. Hypertensive patients who are resistant or non-adherent to antihypertensive drugs may be easier to manage if they choose alternative non-drug therapies for hypertension, based on this review. Methods P: Adults (>18 years), except pregnant women, with essential hypertension. I: Cupping, moxibustion, acupuncture, acupoint stimulation, yoga, meditation, tai chi, Qi gong, Chinese massage, massage, spinal manipulation, biofeedback, device-guided breathing therapy, aromatherapy, music therapy, and relaxation approaches. C: 1. No treatment. 2. Sham therapy. 3. Conventional treatment, including antihypertensive drugs and lifestyle modification (e.g., exercise). O: 1. Change in the incidence of cardiovascular death. 2. Change in the incidence of myocardial infarction. 3. Change in the incidence of stroke. 4. Change in blood pressure (BP). 5. Efficacy rate of BP lowering. 6. Adverse effects (review specific). S: Systematic reviews of randomized controlled trials, including meta-analyses and assessments of the methodological quality/risk of bias. Information sources Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane library, PubMed, Web of Science, China National Knowledge Infrastructure, and Chinese Scientific Journal Database were searched. The bibliographies of the included articles were also searched for relevant systematic reviews. GRADE criteria were used to rate the quality of evidence in systematic reviews considering 6 factors, including risk of bias. Results This review ultimately included 13 systematic reviews of 14 non-drug therapies (acupuncture, wet cupping, Baduanjin, blood letting, auricular acupuncture, music, massage, Qi gong, moxibustion, relaxation therapies, biofeedback, device-guided breathing, yoga and tai chi) based on the inclusion criteria. The quality of evidence was generally low, and weak recommendations were given for most therapies except massage and acupuncture plus antihypertensive drug. Based on the analyzed evidence, massage and acupuncture plus antihypertensive drug could benefit people who want to lower their BP and do not have contraindications for massage and acupuncture plus antihypertensive drug. Discussion/Strength The GRADE approach makes this review a unique reference for people who are considering the grade of quality of evidence in systematic reviews, the balance of desirable and undesirable consequences and the strength of recommendations to decide which intervention should be used to reduce BP. Limitations Many non-drug therapies were excluded due to the low methodological quality of their systematic reviews, and only 14 therapies were evaluated in this review. As no patient-important outcomes were reviewed, surrogate outcomes were used to rate the strength of recommendations. This approach may cause a decrease in evidence quality according to GRADE, but we argue that this is appropriate in the context of this review.
... A series of clinical trials reported that stress reduction with the Transcendental Meditation technique reduces CHD risk factors (9)(10)(11)(12) surrogate markers of CHD (13), all cause and cardiovascular mortality (14), and the composite of mortality, myocardial infarction and stroke (15) in African Americans and whites. However, despite these findings, stress reduction therapies are not routinely included in CR programs for either the general population or high risk groups, such as African Americans (16,17). ...
... There were also small reductions in cigarette use, total cholesterol and LDL-cholesterol and triglycerides in the TM group compared to controls These changes either together or separately may have contributed to short-term improvements in myocardial blood flow. The changes in blood pressure between the meditation and non-meditation groups were contrary to findings in previous trials of TM and high BP (10,48) and are perhaps related to lack of high BP at baseline and small sample size, and deserve further exploration. ...
Article
Background Psychosocial stress is recognized as a risk factor for coronary heart disease (CHD). High rates of CHD in African-Americans may be related to psychosocial stress. However, standard cardiac rehabilitation (CR) usually does not include a systematic stress-reduction technique. Previous studies suggest that the Transcendental Meditation (TM) technique may reduce CHD risk factors and clinical events. This pilot study explored the effects of standard CR with and without TM on a measure of CHD in African-American patients. Methods Fifty-six CHD patients were assigned to CR, CR + TM, TM alone, or usual care. Testing was done at baseline and after 12 weeks. The primary outcome was myocardial flow reserve (MFR) assessed by ¹³N-ammonia positron emission tomography (PET). Secondary outcomes were CHD risk factors. Based on guidelines for analysis of small pilot studies, data were analyzed for effect size (ES). Results For 37 patients who completed posttesting, there were MFR improvements in the CR + TM group (+20.7%; ES = 0.64) and the TM group alone (+12.8%; ES = 0.36). By comparison, the CR-alone and usual care groups showed modest changes (+ 5.8%; ES = 0.17 and − 10.3%; ES = − 0.31), respectively. For the combined TM group, MFR increased (+ 14%, ES = 0.56) compared to the combined non-TM group (− 2.0%, ES = − 0.08). Conclusions These pilot data suggest that adding the TM technique to standard cardiac rehabilitation or using TM alone may improve the myocardial flow reserve in African-American CHD patients. These results may be applied to the design of controlled clinical trials to definitively test these effects. Trial registration ClinicalTrials.gov registration # NCT01810029.
... Meta-analyses published after the 2013 AHA statement have confirmed the efficacy of TM in reducing BP (60,61). Bai et al. in 2015 conducted a systematic review and meta-analysis of 12 studies including 996 participants and found −4.26 mmHg reduction in SBP and −2.33 mmHg reduction in DBP with TM practice compared with control groups (60). ...
... Meta-analyses published after the 2013 AHA statement have confirmed the efficacy of TM in reducing BP (60,61). Bai et al. in 2015 conducted a systematic review and meta-analysis of 12 studies including 996 participants and found −4.26 mmHg reduction in SBP and −2.33 mmHg reduction in DBP with TM practice compared with control groups (60). Most recently, Ooi et al. conducted an overview of eight systematic reviews and meta-analyses that included a report by the Agency for Healthcare Research and Quality, a Cochrane systematic review, four independent reviews, and two other reviews (61). ...
Article
The multifactorial pathogenesis of hypertension cannot be completely elucidated by physiological, genetic and conventional lifestyle risk factors. Growing evidence suggests the role of psychological stress in the pathogenesis of hypertension (1–3). Although over the last few decades, studies of psychosocial risk factors for hypertension have increased exponentially, questions about the underlying mechanisms, susceptibility and prevention have remained. Hence the present review explores the recent findings on psychosocial risk factors, underlying mechanisms of the stress-hypertension relationship and the evidence for stress reduction interventions for hypertension so that this knowledge may be translated into clinical prevention and management of hypertension. If actual or perceived environmental demands surpass an individual’s capacity to cope, this results in psychological stress (4). This may have acute or lasting effect on emotional, behavioural and physiological responses that predispose an individual to disease, or may affect the course of disease, such as hypertension (5–7). In a 2017 meta-analysis of 11 studies encompassing 5696 participants, Liu et al. found psychosocial stress associated with an increased risk of hypertension (OR = 2.40, 95% CI = 1.65–3.49). The authors proposed cardiovascular reactivity as one of the underlying mechanisms of the stress-hypertension relationship (7). Gasperin et al., in the meta-analysis of six cohort studies including 23 comparison groups and 34,556 subjects, reported 21% more likelihood of developing hypertension in individuals who had greater responses to stressor tasks compared to those with lessor responses (1). Carroll et al. found high systolic blood pressure (SBP) reactivity to acute mental stress associated with increased risk of developing hypertension after a 12-year follow up (8). It has been suggested that repeated episodes of exaggerated cardiovascular reactivity could contribute to hypertension by promoting vascular remodelling (9). Along with increased cardiovascular reactivity, the delayed recovery to the pre-stress level is considered another possible pathway to high blood pressure (BP). In a meta-analysis of 31 cohort studies, Chida and Steptoe found that greater stress reactivity and poor stress recovery are associated longitudinally with elevated BP, hypertension, left ventricular mass, subclinical atherosclerosis and clinical cardiac events (10). Based on 30 years of epidemiological studies, there is a range of well-documented psychosocial stress risk factors for hypertension. These include anxiety (11), depression (12,13), anger (14), posttraumatic stress (15), low social support (16,17), occupational stress (18,19), low socioeconomic status (20), racial discrimination (21,22) and marital distress (23,24). These psychosocial risk factors are discussed in detail in Chapter 18 in this volume
... 3 Health behaviors in persons with hypertension comprise of dietary approach to stop hypertension or DASH consumption 4 including salt intake reduction, physical activities at least 30 to 40 minutes per day, weight management, 5 moderation of alcohol consumption, 3 smoking cessation, 6 stop betel quid chewing, 7 and stress management. 8,9 Myanmar, one of the countries in the South-East Asia region had prevalence rate of hypertension equals 22% in 2014 10 and 30% in 2016. 11 It was elevated in both rural and urban areas 10,11 resulting in mortality rate of 26.26 per 100,000 population. ...
... The possible score was 5-50. A mean score was calculated and classified into three levels by using Bloom's criteria; poor (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), and (35-50) high. The original English version was translated to Myanmar version. ...
Article
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Background: The aim of this study was to describe the relationships between personal and environmental factors and health behaviors in persons with hypertension. Methods: This was a cross-sectional study carried out using a convenient sample of individuals with hypertension from three community health centers in Yangon, Myanmar. Data were collected using a standardized interviewer-administered questionnaire consisting of six sections: demographic characteristics, Self-efficacy to manage Hypertension Scale, Health Behavior Questionnaire, Barriers to Health Promoting Activities Scale, Hypertension Knowledge Questionnaire, and Social Support Questionnaire. The data were analyzed using descriptive statistics, Chi-square, and Pearson's correlation coefficient. Results: Participants had a high level of perceived self-efficacy (42.13 ± 7.58), a low level of perceived barriers (35.32 ± 19.63), a poor social support (49.64 ± 8.51), a good level of hypertension knowledge (10.63 ± 1.90) and a moderate level of health behaviors (70.59 ± 12.39). Health behaviors had significant relationship with income, social support, hypertension knowledge and perceived barriers (r =-0.28, p = 0.004; r = 0.23, p = 0.019; r = 0.27, p = 0.006; r =-0.21, p = 0.034), respectively. Conclusions: These findings suggest that health behaviors in persons with hypertension can be improved using hypertension knowledge, social support, and decrease in perceived barriers.
... The American Heart Association considers that only transcendental meditation may be recommended in clinical practice to patients with EH [24]. Similar results of studies were presented in meta-analyses by Rainfort et al. [38], and Bai et al. [39]. It is worth emphasizing that transcendental meditation shows a greater effectiveness among older people with initially high values of blood pressure [39]. ...
... Similar results of studies were presented in meta-analyses by Rainfort et al. [38], and Bai et al. [39]. It is worth emphasizing that transcendental meditation shows a greater effectiveness among older people with initially high values of blood pressure [39]. In experimental studies, where adolescents with elevated blood pressure performed mental stress tests, it was found that transcendental meditation exerts a positive effect on the cardiovascular system [40]. ...
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Background. The article presents the results of research into the most commonly used methods of psychological support in the treatment of hypertensive patients, including relaxation and meditation techniques, mindfulness training, music therapy, yoga, aromatherapy and biofeedback techniques. Selected psychological aspects of adherence to the antihypertensive treatment are reviewed. Some notes about personality-oriented counselling and psychotherapy in the treatment of hypertension are raised. Material and methods. In the search for high quality studies, mainly PubMed and EBSCO databases were used, and the journals of such publishers as Elsevier, Hindawi and the American Psychological Association. Results. Studies on methods of psychological support in hypertensive treatment are mostly controversial due to the lack of assessment of the long-term effects of the intervention, and the complexity of the subject of the study. The most convincing is to use individually selected methods based on the development of mental self-regulation skills (Jacobson’s relaxation technique, meditation, biofeedback therapy and mindfulness training). Music therapy, yoga and aromatherapy can also be helpful for patients involved in antihypertensive treatment. Using methods of psychological help, one should take into account restrictions and contraindications, as well as take some precautions. In order to increase the effectiveness of the antihypertensive therapy, it is proposed to conduct health and educational programmes for hypertensive patients, as well as short training courses on communication skills for health care workers. Conclusion. Responsible use of individually selected assistive treatment psychological methods can be helpful for people with arterial hypertension.
... The American Heart Association considers that only transcendental meditation may be recommended in clinical practice to patients with EH [24]. Similar results of studies were presented in meta-analyses by Rainfort et al. [38], and Bai et al. [39]. It is worth emphasizing that transcendental meditation shows a greater effectiveness among older people with initially high values of blood pressure [39]. ...
... Similar results of studies were presented in meta-analyses by Rainfort et al. [38], and Bai et al. [39]. It is worth emphasizing that transcendental meditation shows a greater effectiveness among older people with initially high values of blood pressure [39]. In experimental studies, where adolescents with elevated blood pressure performed mental stress tests, it was found that transcendental meditation exerts a positive effect on the cardiovascular system [40]. ...
Article
Full-text available
Background: The article presents the results of research into the most commonly used methods of psychological support in the treatment of hypertensive patients, including relaxation and meditation techniques, mindfulness training, music therapy, yoga, aromatherapy and biofeedback techniques. Selected psychological aspects of adherence to the antihypertensive treatment are reviewed. Some notes about personality-oriented counselling and psychotherapy in the treatment of hypertension are raised. Material and methods: In the search for high quality studies, mainly PubMed and EBSCO databases were used, and the journals of such publishers as Elsevier, Hindawi and the American Psychological Association. Results: Studies on methods of psychological support in hypertensive treatment are mostly controversial due to the lack of assessment of the long-term effects of the intervention, and the complexity of the subject of the study. The most convincing is to use individually selected methods based on the development of mental self-regulation skills (Jacobson’s relaxation technique, meditation, biofeedback therapy and mindfulness training). Music therapy, yoga and aromatherapy can also be helpful for patients involved in antihypertensive treatment. Using methods of psychological help, one should take into account restrictions and contraindications, as well as take some precautions. In order to increase the effectiveness of the antihypertensive therapy, it is proposed to conduct health and educational programmes for hypertensive patients, as well as short training courses on communication skills for health care workers. Conclusion: Responsible use of individually selected assistive treatment psychological methods can be helpful for people with arterial hypertension.
... The small to moderate improvements noted within groups receiving TM alone converges with prior meta-analyses identifying BP reductions following TM. 50,51 Mean changes in systolic (3.46 mmHg) and diastolic BP (3.75 mmHg) in the TM group were observed compared to controls (1.26 mmHg and 2.43 mmHg, respectively). The findings support the Class IIB level of evidence recommended within the AHA statement on integrative methods to reduce BP. 13 TM may lead to reduced BP through several pathways. ...
... In contrast, prior reviews and meta-analyses evaluating TM in broader populations have reported between-group differences. 11,50,51 This difference may be explained by methodological differences. For example, we included studies not evaluated in prior meta-analyses. ...
Article
Background: Transcendental Meditation (TM) as a stress management technique may offer an adjunctive strategy to improve health and well-being in adults with cardiovascular disease (CVD). Objectives: To examine the efficacy of TM to improve aspects of cardiovascular health and psychological functioning in adults with CVD. Method: Studies (a) evaluating TM in adults with hypertension or CVD and (b) assessing a physiological or psychological outcome were retrieved and meta-analyzed. Weighted mean effect sizes were computed to assess between- and within-group changes. Results: Nine studies met inclusion criteria (N = 851; mean age = 60 ± 8 years; 47% women). Between-group analyses revealed no differences between TM and control groups. However, within-group (i.e., pre- to post-intervention) analyses revealed reductions in systolic (d+ = 0.31) and diastolic (d+ = 0.53) blood pressure (BP) for the TM group. There were no changes in depressive symptoms for TM or control participants. Conclusions: TM was associated with within-group (but not between-groups) improvements in BP. Continued research using randomized controlled trials with larger samples, and measuring psychophysiological outcomes at longer follow-up intervals is recommended.
... [38] oraz Bai z wsp. [39]. Warto podkreślić, iż medytacja transcendentalna wykazuje większą skuteczność wśród osób starszych z początkowo znacznie podwyższonymi wartościami ciśnienia tętniczego [39]. ...
... [39]. Warto podkreślić, iż medytacja transcendentalna wykazuje większą skuteczność wśród osób starszych z początkowo znacznie podwyższonymi wartościami ciśnienia tętniczego [39]. W badaniach eksperymentalnych z udziałem nastolatków z podwyższonym ciśnieniem przy wykonaniu testów zadań umysłowych wywołujących stres (mental stress tests) stwierdzono, iż medytacja transcendentalna korzystnie wpływa na ich układ sercowo-naczyniowy [40]. ...
Article
Wstęp: W artykule przedstawiono wyniki badań dotyczące najczęściej stosowanych metod pomocy psychologicznej w leczeniu osób chorych na pierwotne nadciśnienie tętnicze (NT), w tym technik relaksacyjnych i medytacyjnych, treningu uważności, muzykoterapii, jogi, aromaterapii, technik bazujących na metodzie biofeedback. Omówiono wybrane aspekty psychologiczne przestrzegania zaleceń terapeutycznych oraz poruszono kwestię psychoterapii zorientowanej na osobowość w leczeniu NT. Materiał i metody: W celu poszukiwania badań wysokiej jakości wykorzystano głównie naukowe bazy danych PubMed i EBSCO oraz czasopisma wydawnictw Elsevier, Hindawi i American Psychological Association. Wyniki: Wyniki badań dotyczące metod pomocy psychologicznej w leczeniu NT są w większości kontrowersyjne z powodu braku oceny długoterminowych efektów interwencji oraz złożoności przedmiotu badań. Najbardziej przekonujące jest użycie indywidualnie dobranych metod bazujących na kształtowaniu się umiejętności samoregulacji psychicznej (relaksacja wg Jacobsona, medytacja, techniki bazujące na metodzie biofeedback oraz trening uważności). Muzykoterapia, joga i aromaterapia również mogą być pomocne u pacjentów zaangażowanych w leczenie NT. Korzystając z metod pomocy psychologicznej, należy uwzględniać ograniczenia oraz przeciwwskazania, a także zachować pewne środki ostrożności. W celu zwiększenia skuteczności terapii przeciwnadciśnieniowej proponuje się przeprowadzenie programów zdrowotnych i edukacyjnych dla pacjentów z NT, a także krótkich szkoleń wśród pracowników sektora zdrowia poświęconych umiejętnościom komunikacyjnym. Wnioski: Odpowiedzialne stosowanie indywidualnie dobranych wspomagających leczenie metod pomocy psychologicznej może być pomocne u osób z NT. Nadciśnienie Tętnicze w Praktyce 2021;7(2):71-80. https://journals.viamedica.pl/nadcisnienie_tetnicze_w_praktyce/article/view/84788
... TM seems to attenuate sympathetic responses to loud noises 21 and violent images in patients with PTSD, 22 and might thus be expected to attenuate the hyperarousal caused by the memories of traumatic events. Additionally, TM has been shown to decrease anxiety, 23 reduce blood pressure, 24,25 and be therapeutic in various stressful situations. 20,26,27 How these TM benefits might compare with an established psychotherapy such as PE, however, is unknown. ...
Article
Background: Post-traumatic stress disorder (PTSD) is a complex and difficult-to-treat disorder, affecting 10-20% of military veterans. Previous research has raised the question of whether a non-trauma-focused treatment can be as effective as trauma exposure therapy in reducing PTSD symptoms. This study aimed to compare the non-trauma-focused practice of Transcendental Meditation (TM) with prolonged exposure therapy (PE) in a non-inferiority clinical trial, and to compare both therapies with a control of PTSD health education (HE). Methods: We did a randomised controlled trial at the Department of Veterans Affairs San Diego Healthcare System in CA, USA. We included 203 veterans with a current diagnosis of PTSD resulting from active military service randomly assigned to a TM or PE group, or an active control group of HE, using stratified block randomisation. Each treatment provided 12 sessions over 12 weeks, with daily home practice. TM and HE were mainly given in a group setting and PE was given individually. The primary outcome was change in PTSD symptom severity over 3 months, assessed by the Clinician-Administered PTSD Scale (CAPS). Analysis was by intention to treat. We hypothesised that TM would show non-inferiority to PE in improvement of CAPS score (Δ=10), with TM and PE superior to PTSD HE. This study is registered with ClinicalTrials.gov, number NCT01865123. Findings: Between June 10, 2013, and Oct 7, 2016, 203 veterans were randomly assigned to an intervention group (68 to the TM group, 68 to the PE group, and 67 to the PTSD HE group). TM was significantly non-inferior to PE on change in CAPS score from baseline to 3-month post-test (difference between groups in mean change -5·9, 95% CI -14·3 to 2·4, p=0·0002). In standard superiority comparisons, significant reductions in CAPS scores were found for TM versus PTSD HE (-14·6 95% CI, -23·3 to -5·9, p=0·0009), and PE versus PTSD HE (-8·7 95% CI, -17·0 to -0·32, p=0·041). 61% of those receiving TM, 42% of those receiving PE, and 32% of those receiving HE showed clinically significant improvements on the CAPS score. Interpretation: A non-trauma-focused-therapy, TM, might be a viable option for decreasing the severity of PTSD symptoms in veterans and represents an efficacious alternative for veterans who prefer not to receive or who do not respond to traditional exposure-based treatments of PTSD. Funding: Department of Defense, US Army Medical Research.
... There is strong evidence that mind-body techniques such as meditation are linked to low blood pressure [68][69][70]. The main themes that emerged from the video content feedback were centered on the health benefits of the mind-body practices, self-reflection on healthy behaviors and beliefs, behavior change or reinforcement of healthy behaviors, and new health and nutrition knowledge and skills (Textbox 1). ...
Article
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Background: Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective: The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods: We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results: Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants' average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income <US $30,000 per year. Among the 22 participants who logged in to OWL-H, the average number of mindfulness practices completed was 7 and the average number of module sessions accessed was 4. In all, 73% (16/22) of participants reported that they were "very satisfied" with using OWL-H to help manage their HTN. Participants' blood pressure knowledge significantly increased from baseline (mean 5.58, SD 1.44) to follow-up (mean 6.13, SD 1.23; P=.03). Participants significantly increased their adherence to a Mediterranean diet from baseline (mean 7.65, SD 2.19) to follow-up (mean 9, SD 1.68; P=.004). Participants' self-efficacy in applying heart-healthy habits, as measured by the Hypertension Self-Care Profile Self-Efficacy Instrument, increased from baseline (mean 63.67, SD 9.06) to follow-up (mean 65.54, SD 7.56; P=.14). At the 8-week follow-up, 82% (18/22) of the participants had self-reported their blood pressure on the OWL-H platform at least once during the 8 weeks. Conclusions: The eHealth platform for HTN self-management, OWL-H, and accompanying in-person TKMGVs have the potential to effectively improve lifestyle management of HTN. Trial registration: ClinicalTrials.gov NCT03974334; https://clinicaltrials.gov/ct2/show/NCT03974334.
... Studies claim that meditation techniques, behavioral psychotherapies (Bai et. al, 2015;Sharma & Rush, 2014), relaxation and biofeedback therapy (BT) (Brook et. al, 2013) demonstrate significant effects on these patients, due to their decreasing effects on BP levels (Greenberg et. al, 20088). Such therapies may provide self-regulation of the autonomic nervous system, providing effects on cardiac coherence, i.e., the balance ...
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Efeitos de um dispositivo de biofeedback com respiração ritmada sobre a pressão sanguínea, níveis de estresse e ansiedade em hipertensos Efecto de la respiración guiada por dispositivo de biofeedback sobre la presión arterial, el estrés y los niveles de ansiedad en hipertensos Abstract The present study aimed to evaluate the influence of cardiac coherence through Biofeedback Therapy (BT) with paced breathing on blood pressure, stress and anxiety levels in individuals with essential arterial hypertension. The participants underwent 8 sessions of paced breathing guided by biofeedback visual therapy for 20 minutes, in which they were evaluated through clinical assessment, Hamilton Anxiety Rating Scale, Perceived Stress Scale and cardiovascular variables. Comparisons of means were performed using the paired and unpaired Student's t-test. Statistically significant correlations were considered when p ≤ 0.05 with a 95% confidence interval. The effect size (Cohen's d) and common language effect size were calculated to assess the effect of such therapy. Sixteen patients with mean age of 57.3 ± 14 years old participated in this study. Comparisons between mean initial and final systolic blood pressure levels (SBP) in women (p = 0.007; Cohen's d = 0.50), pre-and post-training heart rate (p = 0.02; Cohen's d = 0.60) and anxiety levels (p = 0.01; Cohen's d = 1.04) were significant. Comparisons between pre-and post-training SBP (p = 0.006; Cohen's d = 0.81) and pre-and post-training anxiety levels (p = 0.04; Cohen's d = 0.32) were significant among males. In conclusion, paced breathing training with biofeedback therapy can be promising to reduce anxiety levels in individuals with essential arterial hypertension. Resumo O presente estudo teve como objetivo avaliar a influência da coerência cardíaca por meio da Terapia de Biofeedback (BT) com respiração estimulada sobre a pressão arterial, níveis de estresse e ansiedade em indivíduos com hipertensão arterial essencial. Os participantes foram submetidos a 8 sessões de respiração estimulada guiada por terapia visual de biofeedback por 20 minutos, nas quais foram avaliados por meio de avaliação clínica, Escala de Hamilton para Ansiedade, Escala de Estresse Percebido e variáveis cardiovasculares. As comparações de médias foram realizadas usando o teste t de Student pareado e não pareado. Correlações estatisticamente significativas foram consideradas quando p ≤ 0,05 com intervalo de confiança de 95%. O tamanho do efeito (d de Cohen) e o tamanho do efeito da Research, Society and Development, v. 10, n. 9, e56110918525, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i9.18525 2 linguagem comum foram calculados para avaliar o efeito de tal terapia. Dezesseis pacientes com idade média de 57,3 ± 14 anos participaram deste estudo. Comparações entre os níveis médios de pressão arterial sistólica (PAS) inicial e final em mulheres (p = 0,007; d de Cohen = 0,50), frequência cardíaca pré e pós-treinamento (p = 0,02; d de Cohen = 0,60) e níveis de ansiedade (p = 0,01; d de Cohen = 1,04) foram significativos. As comparações entre a PAS pré e pós-treinamento (p = 0,006; d de Cohen = 0,81) e os níveis de ansiedade pré e pós-treinamento (p = 0,04; d de Cohen = 0,32) foram significativas entre os homens. Em conclusão, o treinamento respiratório estimulado com terapia de biofeedback pode ser promissor para reduzir os níveis de ansiedade em indivíduos com hipertensão arterial essencial. Palavras-chave: Hipertensão; Biofeedback da psicologia; Coerência cardíaca; Estresse psicológico; Ansiedade. Resumen El presente estudio tiene como objetivo evaluar la influencia de la Terapia de Biofeedback (BT) con la respiración ritmada sobre la presión arterial, el estrés y los niveles de ansiedad en individuos con hipertensión arterial esencial. Los participantes fueron sometidos a 8 sesiones de respiración estimulada guiada por terapia de biorretroalimentación visual durante 20 minutos, en las que fueron evaluados mediante evaluación clínica, Escala de Ansiedad de Hamilton, Escala de Estrés Percibido y variables cardiovasculares. Las comparaciones de medias se realizaron utilizando la prueba t de Student para datos apareados y no apareados. Se consideraron correlaciones estadísticamente significativas cuando p ≤ 0.05 con un intervalo de confianza del 95%. Se calcularon el tamaño del efecto (d de Cohen) y el tamaño del efecto del lenguaje común para evaluar el efecto de dicha terapia. Participaron en este estudio 16 pacientes con una edad media de 57,3 ± 14 años. Comparaciones entre los niveles medios de presión arterial sistólica (PAS) inicial y final en mujeres (p = 0,007; d de Cohen = 0,50), frecuencia cardíaca antes y después del entrenamiento (p = 0,02; d de Cohen = 0,60) y niveles de ansiedad (p = 0,01; d de Cohen = 1,04) fueron significativas. Las comparaciones entre la PAS antes y después del entrenamiento (p = 0,006; d de Cohen = 0,81) y los niveles de ansiedad antes y después del entrenamiento (p = 0,04; d de Cohen = 0,32) fueron significativas entre los hombres. En conclusión, el entrenamiento respiratorio estimulado con terapia de biorretroalimentación puede ser prometedor para reducir los niveles de ansiedad en personas con hipertensión arterial esencial.
... Transcendental Meditation® (TM) is a sitting meditation from ancient Vedic tradition that originated in India and has spread worldwide since the 1950's [26]. It is a well-established that is easily practised technique while sitting with the eyes closed in adults for 20 minutes twice daily, and in TM has been used in adults and adolescents to reduce stress in conditions such as cardiovascular disease and negative school behaviours [27][28][29][30][31]. Meta-analysis of stress reduction trials including TM has shown beneficial effects on stress and blood pressure in adults [30,32] with increasing use recently [33]. Sitting meditation practises including TM and mindfulness may have some beneficial effects in physiological, psychological and behavioural conditions in children and adolescents [34]. ...
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BACKGROUND Polycystic Ovary Syndrome (PCOS) is a common endocrine condition characterised by irregular periods, hirsutism, acne and/or hyperandrogenemia. Adolescents with PCOS have impaired quality of life (QOL) and increased psychological distress. Transcendental Meditation® (TM) is a well-established self-management strategy that has been used to improve stress and well-being. Meta-analysis of TM trials has shown beneficial effects on stress and blood pressure in adults. There are recent data suggesting that another self-management strategy called mindfulness stress management program has a role in improving QOL in women with PCOS, but there are no studies in adolescents. OBJECTIVE The aim of this study is to evaluate the effect of TM on QOL and psychological distress in adolescent girls with PCOS. METHODS This study is a randomised controlled trial over 8 weeks that will be conducted at the Women’s and Children’s Hospital in Adelaide, South Australia to determine the effect of TM on QOL and psychological distress in adolescent girls (aged 12-20 years) with PCOS. Forty girls will be randomised into either the TM (n=20) or control group (n=20). TM group will be asked to practise TM in a comfortable sitting position with the eyes closed 15 minutes twice daily for 8 weeks. The control group will be asked to sit quietly for 15 minutes twice daily for 8 weeks. The primary outcomes are the QOL and psychological distress. Secondary outcomes are blood pressure and salivary cortisol levels. RESULTS Recruitment of study participants began in March 2019 and is expected to be completed by June 2020. It is expected that the adolescent girls with PCOS practicing TM over 8 weeks will have a significant improvement in QOL and psychological distress compared to adolescents in the control group. Also it is expected that adolescent girls in the TM group will have lower salivary cortisol levels and lower blood pressure. CONCLUSIONS This study will be first to evaluate the effect of TM on QOL in adolescent girls with PCOS. The study will provide important information on a potential self-management strategy to improve QOL and well-being in adolescent girls with PCOS. CLINICALTRIAL ACTRN1261900019010. http://www.anzctr.org.au/ Registered 11 February 2019.
... Several randomised trials have evaluated the effect of meditation on arterial hypertension, with varying effects from a reduction of a mean of 21.9 (±8.3)/16.7 (±4.6) mmHg after 8 weeks of meditation treatment to no significant benefit, as shown by Blom et al. in the Hypertension Analysis of stress Reduction using Mindfulness meditatiON and Yoga (HARMONY) trial. 18,[31][32][33][34][35][36][37][38][39] Of note, it needs to be highlighted that styles of meditation, which additionally cover physical activity, appear to be even more effective in this regard. 7 ...
Article
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Meditation as a form of body–mind interaction for primary and secondary prevention in cardiovascular disease has been discussed critically in the past. However, data that aimed to link this intervention to a reduction of various aspects of cardiovascular disease, rendering it a potential part of a cost-effective treatment approach in patients at risk, remain scarce and inconclusive. This article aims to provide an overview of currently available evidence in the literature and the potential impact of meditation on cardiovascular health. However, the data highlighted in this article cannot render with certainty directly reproducible effects of meditation on patients’ cardiovascular disease profiles. Meditation may be suggested only as an additional link in the chain of primary and secondary prevention until future research provides sufficient data on this topic.
... Nor can local factors explain why some forms of sudden psychological disruption should be associated with an immediate and sharp drop of blood pressure (that can be extreme enough to produce loss of consciousness, i.e., vasovagal syncope), not corrected by an immediate rise. Furthermore a therapeutic anomaly of the homeostasis paradigm is shown in evidence which indicates that ''mental'' (non-physical) interventions, that by definition do not ''directly'' interact with any known physical factors, can nonetheless have an impact on blood pressure (albeit to modest degrees, e.g., Bai et al., 2015). Despite inordinate study of blood pressure homeostasis, the complexity of factor interactions (or the difficulty of accommodating anomalies) is reflected in the absence of a consistent schematic across textbooks of physiology or medicine, to represent a broad scientific consensus regarding its essential mechanisms. ...
Article
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There are two main paradigms for brain-related science, with different implications for brain-focused intervention or advancement. The paradigm of homeostasis (“stability through constancy,” Walter Cannon), originating from laboratory-based experimental physiology pioneered by Claude Bernard, shows that living systems tend to maintain system functionality in the direction of constancy (or similitude). The aim of physiology is to elucidate the factors that maintain homeostasis, and therapeutics aim to correct abnormal factor functions. The homeostasis paradigm does not formally recognize influences outside its controlled experimental frames and it is variable in its modeling of neural contributions. The paradigm of allostatic orchestration (PAO) extends the principle of allostasis (“stability through change”) as originally put forth by Peter Sterling. The PAO originates from an evolutionary perspective and recognizes that biological set points change in anticipation of changing environments. The brain is the organ of central command, orchestrating cross-system operations to support optimal behavior at the level of the whole organism. Alternative views of blood pressure regulation and posttraumatic stress disorder (PTSD) illustrate differences between the paradigms. For the PAO, complexities of top-down neural effects and environmental context are foundational (not to be “factored out”), and anticipatory regulation is the principle of their interface. The allostatic state represents the integrated totality of brain-body interactions. Health itself is an allostatic state of optimal anticipatory oscillation, hypothesized to relate to the state of criticality, a mathematical point of poise between phases, on the border between order and disorder (or the “edge of chaos”). Diseases are allostatic states of impaired anticipatory oscillations, demonstrated as rigidifications of set points across the brain and body (disease comorbidity). Conciliation of the paradigms is possible, with “reactive homeostasis” resolved as an illusion stemming from the anticipation of environmental monotony. Considerations are presented with respect to implications of the two paradigms for brain-focused intervention or advancement; the hypothesis that the state of criticality is a vehicle for evolutionary processes; concordance with a philosophy of freedom based on ethical individualism as well as self-creativity, non-obsolescence, empowerment, and citizenship; and concluding reflections on the science and ethics of the placebo, and the potential for virtuous cycles of brain-Anthropocene interactions.
... In several studies there have been shown to be non-pharmacologic treatments that can decrease blood pressure such as yoga, meditation, etc. Slow and deep breathing is important thing in yoga and meditation (Bai et al., 2015) (Posadzki, Cramer, Kuzdzal, Lee, & Ernst, 2014). Slow breathing could reduce the systolic blood pressure (Elliot W.J, 2004). ...
Article
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Various non-pharmacological therapies can be used to reduce blood pressure. One of them is deep breathing relaxation. This study aimed to know the influence of deep breath relaxation to decrease the blood pressure of people with hypertension. The design of this study was an Pre-Experimental One Group Pretest-Post-test design which covered 30 respondents as the sample. They fulfilled the inclusion criteria and were chosen through purposive sampling. The independent variable in this study was deep breath relaxation and the dependent variable was blood pressure. The data collection technique was using the observation sheet of blood pressure measurement. Data were analyzed using the paired t test. The findings of this study majority there were decrease blood pressure after deep breath. Before doing the breath relaxation exercise, most of the respondents were hypertension level 1. Nonetheless, after the deep breath relaxation had been executed, most found that their blood pressure decreased although several respondents were at hypertension level 2 with stable blood pressure. The results showed that there were differences in the blood pressure patients with hypertension before and after the deep breath relaxation. There were several points which influenced the decrease in blood pressure after implementing the deep breath relaxation such as stress, cigarettes etc.
... Dos 207 relatos encontrados nas bases, identificamos 132 estudos não repetidos, os quais foram avaliados considerando título e resumo (Figura 1). Os 36 estudos elegíveis foram lidos na íntegra, dos quais 26 foram excluídos por não atenderem aos critérios de elegibilidade: cinco analisaram intervenções baseadas apenas em yoga 6,7,8,9,10 , dois tinham como foco a redução de estresse, ansiedade e/ou depressão não relacionados a doenças cardiovasculares 11,12 , três não avaliaram doenças cardiovasculares 13,14,15 , três não eram revisão sistemática 16,17,18 , três não avaliaram meditação/mindfulness 19,20,21 um não analisou a relação entre doença cardiovascular e meditação 22 , uma revisão sistemática de estudos de caso 23 , uma revisão que incluiu crianças e adolescentes 24 . Sete não estavam disponíveis para leitura completa. ...
Technical Report
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Revisão Rápida sobre a questão: Qual a eficácia/efetividade e segurança do uso complementar da meditação/mindfulness para o tratamento de doenças cardiovasculares na população adulta e idosa?
... Previous research has also demonstrated the positive effects of the TM technique on physical health. For example, the practice of TM leads to health improvements among patients with high blood pressure (Bai et al. 2015), coronary heart disease (Paul-Labrador, 2006) and alcohol, tobacco, and drug addictions (Alexander et al.1994). Moreover, both meditation techniques have been found to promote psychological well-being. ...
Preprint
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Change blindness engenders an inability to detect changes made to a visual scene and has negative implications for areas such as road safety and eye-witness memory. Therefore, it’s important to find ways of reducing change blindness to create a safer society. One way this might be achieved is through the practice of meditation. Regular practice of meditation may reduce the effects of change blindness by expanding a practitioner’s consciousness and brain potential over time. This study compared the influence of practitioner experience and medi- tation style- Transcendental Meditation (TM) or Mindfulness-based Meditation (MBM), on change blindness susceptibility. Forty-six participants (30 female and 16 male) with a com- bined mean age of 42 years old, were assigned to two experimental groups depending on the pre-existing meditation style they practiced. Both groups completed an identical experimen- tal task known as a flicker-paradigm where they had to identify changes made to various images. A two-way independent ANOVA revealed a significant effect of meditation style and experience on change-detection reaction times- (F(1,42) =7.22, p < 0.05, = .147), with long-term transcendental meditation practitioners recording faster reaction times (mean = 5927.73, SD = 606.92) on average than long-term mindfulness-based practitioners (mean = 10949.92 SD = 984.72). These results support the contention that long-term practice of transcendental meditation is more effective at reducing change blindness than long-term practice of mindfulness-based meditation.
...  A reduction of medication needed after mindfulness training in the treatment of childhood ADHD (Meppelink, de Bruin, & Bögels, 2016;Gibson, 2017), and the treatment of ADHD in adults (Bachmann, Lam, & Philipsen, 2016);  Reduction of mental health issues such as anxiety, stress, and depression in adults (Cramer et al., 2016);  Significant reduction in the examination anxiety of secondary school students (Arjunan & Joseph, 2016);  Effective contemplative interventions in reducing PTSD symptoms in women with breast cancer (Offidani et al., 2017;Charlson et al., 2014);  Clinically significant results from multiple studies and meta-analyses on hypertension, reducing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (Bai et al., 2015;Ooi, Giovino, & Pak 2107;Shi et al., 2017). ...
Article
Full-text available
Meditation is a term applied to a group of contemplative practices that train attention and awareness ostensibly to support psychological and spiritual well-being, usually with a focus on either breathing techniques or a chant/mantra that is repeated silently or aloud. Recently, meditation has been used in Western culture outside of religion and as part of complementary and alternative medicine (CAM) practices to promote calmness and physical relaxation, to cope with illness or disease, to improve psychological functioning and balance, and to improve overall wellness and health. This essay examines and reviews current research related to the physiological, psychological, and spiritual benefits of a meditation practice.
... Studies claim that meditation techniques, behavioral psychotherapies (Bai et. al, 2015;Sharma & Rush, 2014), relaxation and biofeedback therapy (BT) (Brook et. al, 2013) demonstrate significant effects on these patients, due to their decreasing effects on BP levels (Greenberg et. al, 20088). Such therapies may provide self-regulation of the autonomic nervous system, providing effects on cardiac coherence, i.e., the balance ...
Article
The present study aimed to evaluate the influence of cardiac coherence through Biofeedback Therapy (BT) with paced breathing on blood pressure, stress and anxiety levels in individuals with essential arterial hypertension. The participants underwent 8 sessions of paced breathing guided by biofeedback visual therapy for 20 minutes, in which they were evaluated through clinical assessment, Hamilton Anxiety Rating Scale, Perceived Stress Scale and cardiovascular variables. Comparisons of means were performed using the paired and unpaired Student's t-test. Statistically significant correlations were considered when p ≤ 0.05 with a 95% confidence interval. The effect size (Cohen's d) and common language effect size were calculated to assess the effect of such therapy. Sixteen patients with mean age of 57.3 ± 14 years old participated in this study. Comparisons between mean initial and final systolic blood pressure levels (SBP) in women (p = 0.007; Cohen's d = 0.50), pre-and post-training heart rate (p = 0.02; Cohen's d = 0.60) and anxiety levels (p = 0.01; Cohen's d = 1.04) were significant. Comparisons between pre-and post-training SBP (p = 0.006; Cohen's d = 0.81) and pre-and post-training anxiety levels (p = 0.04; Cohen's d = 0.32) were significant among males. In conclusion, paced breathing training with biofeedback therapy can be promising to reduce anxiety levels in individuals with essential arterial hypertension.
... Meditation is an ancient practice which has its roots in India about 2,500 years ago and it has been perpetuated until today in various form and through different traditions. Only in the last few decades, meditation has gained consideration in the academic world, given the arising of scientific evidences regarding its beneficial effects on psychological, neurological, endocrine and immune variables, as well as positive influence on well-being and a broad range of biological processes (Paul-Labrador et al., 2006;Rubik, 2011;Bai et al., 2015;Aherne et al., 2016;Chiesa et al., 2017;Wood et al., 2017). Thanks to this evidence, nowdays, meditation practice is frequently integrated in contemporary psychotherapy treatments and used to enhance well-being in several medical conditions and to improve quality of life. ...
Article
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The practice of meditation has been historically linked to beneficial effects, not only in terms of spirituality but also in terms of well-being, general improvement of psychophysiological conditions and quality of life. The present study aims to assess the beneficial effects of a short-term intervention (a combination of 12 practical 1-h sessions of meditation, called Integral Meditation, and lectures on neuroscience of meditation) on psychological indicators of well-being in subjects from the general population. We used a one-group pretest-posttest quasi-experimental design, in which all participants (n = 41, 17 men and 24 women, with a mean age of 41.1 years) underwent the same intervention. Out of these, 24 had already experienced meditation practice, but only 12 in a continuative way. Effects were assessed by the standardized Italian version of three self-report questionnaires: Core Outcome in Routine Evaluation-Outcome Measure (CORE-OM), Five-Facet Mindfulness Questionnaire (FFMQ), and Emotion Regulation Questionnaire (ERQ). The questionnaires were filled in at baseline and immediately after the last meditation session. Linear mixed effect models were used to evaluate pre-post treatment changes on each outcome. Participants showed a general, close to a statistically significant threshold, improvement in the total score of CORE-OM and its different domains. The total score of FFMQ (β = 0.154, p = 0.012) indicates a statistically significant increase in the level of mindfulness as well as in the domains acting with awareness (β = 0.212, p = 0.024), and non-judging of inner experiences (β = 0.384, p < 0.0001). Lastly, we observed a statistically significant improvement in the cognitive reappraisal ERQ domain (β = 0.541, p = 0.0003). Despite some limitations (i.e., small sample size, lack of a randomised control group and sole use of “soft” measurements, such as self-report questionnaires), this study offers promising results regarding the within-subject effectiveness of our intervention that includes a meditation practice on psychological indicators, thus providing interesting preliminary results.
... Os efeitos de redução da PA de suplementos alimentares são, em geral, discretos e heterogêneos. [58][59][60][61][62][63][64][65][66][67][68] As substâncias cuja suplementação tem alguma evidência de discreta redução da PA são: vitamina C, peptídeos bioativos derivados de alimentos, alho, fibras dietéticas, linhaça, chocolate amargo (cacau), soja, nitratos orgânicos e ômega 3. 38,47,69 As suplementações de magnésio, vitaminas combinadas, chá e coenzima Q10 não demonstraram redução significativa da PA. 64,65,70 ...
... Contrasting with our findings, the HARMONY study [12], published in 2012, found no beneficial effect on clinically measured BP. The authors of that study refer to different possible explanations, such as the existence of white-coat AHT, the contribution of behavioural factors to clinically measured BP (e.g., patterns of activity) and seasonal changes (starting a study in a summer month and drawing comparisons with data collected in winter months, as reported in the meta-analysis by Bain [27]). Seasonal factors, in fact, may have contributed in part to the lack of statistical significance in our study by the end of follow-up, since patients were recruited in early autumn (September) and the study was completed in early spring (March). ...
Article
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The objective of this randomized controlled trial is to evaluate the benefits of mindfulness meditation in controlling ambulatory blood pressure (BP) and the impact of the intervention on anxiety, stress and depression levels in a Mediterranean population. Twenty-four and 18 patients [n = 42; mean age 56.5 (7.7) years; similar men and women proportions] with high-normal BP or grade I hypertension were enrolled to an intervention and a control group, respectively. For 2 h/week over 8 weeks, the intervention group received mindfulness training and the control group attended health education talks. The patients attended pre-intervention, week 4, week 8 and week 20 follow-up visits. 61.9% of the patients had anxiety, 21.4% depression, 19.0% were smokers and 14.2% were diabetic (no significant differences between the 2 groups). At baseline, the intervention group had non-significant higher clinically measured BP values, whereas both groups had similar ambulatory BP monitoring (ABPM) values. At week 8, the intervention group had statistically significant lower ABPM scores than the control group (124/77 mmHg vs 126/80 mmHg (p < 0.05) and 108/65 mmHg vs 114/69 mmHg (p < 0.05) for 24-h and night-time systolic BP (SBP), respectively) and also had lower clinically measured SBP values (130 mmHg vs 133 mmHg; p = 0.02). At week 20 (follow-up), means were lower in the intervention group (although not statistically significant). Improvements were observed in the intervention group in terms of being less judgemental, more accepting and less depressed. In conclusion, by week 8 the mindfulness group had lower clinically measured SBP, 24-h SBP, at-rest SBP and diastolic BP values.
... TM has been used in adults and adolescents to reduce stress in conditions such as cardiovascular disease and negative school behaviors [27][28][29][30][31]. Meta-analysis of stress reduction trials, including TM, has shown beneficial effects on stress and blood pressure in adults, with systolic and diastolic blood pressures of -4.26 mm Hg (95% CI -6.06 to -2.23) and -2.33 mm Hg (95% CI -3.70 to -0.97) respectively, compared to control groups [30,32], with increasing use recently [33]. Sitting meditation practices, including TM and mindfulness, may have some beneficial effects in physiological, psychological, and behavioral conditions in children and adolescents [34]. ...
Article
Full-text available
Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine condition characterized by irregular periods and hyperandrogenism. Adolescents with PCOS have impaired quality of life (QOL) and increased psychological distress. Transcendental Meditation (TM) is a well-established self-management strategy that has been used to improve stress and well-being. A meta-analysis of TM trials has shown beneficial effects on stress and blood pressure in adults. Recent data are suggesting that another self-management strategy called a mindfulness stress management program has a role in improving QOL in women with PCOS, but there are no studies in adolescents. Objective: This study aims to evaluate the effect of TM on QOL and psychological distress in adolescent girls with PCOS. Methods: This study is a randomized controlled trial that will be conducted over eight weeks at the Women's and Children's Hospital in Adelaide, South Australia, to determine the effect of TM on QOL and psychological distress in adolescent girls (aged 12-20 years) with PCOS. A total of 40 girls will be randomized into either the TM (n=20) or control group (n=20). The TM group will be asked to practice TM in a comfortable sitting position with the eyes closed, for 15 minutes twice daily over eight weeks. The control group will be asked to sit quietly for 15 minutes twice daily for eight weeks. The primary outcomes are any effects on improving QOL and psychological distress, and the secondary outcomes are any effects on lowering blood pressure and salivary cortisol levels. Results: The recruitment of study participants began in May 2019 and is expected to be completed by June 2020. It is expected that the adolescent girls with PCOS practicing TM over eight weeks will have a significant improvement in QOL and psychological distress compared to adolescents in the control group. Also, it is expected that adolescent girls in the TM group will have lower salivary cortisol levels and lower blood pressure. Conclusions: This study will be the first to evaluate the effect of TM on QOL in adolescent girls with PCOS. The study will provide valuable information on a potential self-management strategy to improve QOL and well-being in adolescent girls with PCOS. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN1261900019010; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376657&isReview=true. International registered report identifier (irrid): PRR1-10.2196/14542.
... MBCT-PD could also have impacted physiological indices of distress, given that mindfulness has been proposed to enhance the underlying biological systems involved in adaptation to stress (Garland et al. 2017). Indeed, there is burgeoning evidence that MBIs can improve physiological stress reactivity including blood pressure and heart rate variability (Bai et al. 2015;Heckenberg et al. 2018;Rådmark et al. 2019), as well as reduce cortisol levels and ACTH reactivity (Heckenberg et al. 2018;Hoge et al. 2018;Sanada et al. 2016). ...
Article
Full-text available
Objectives Given stress, anxiety, and depression affect 15–25% of women during pregnancy and are associated with adverse outcomes for maternal and child health if untreated, a randomized controlled trial evaluated the effectiveness of an 8-week modified Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT-PD) intervention for psychological distress.MethodsA community sample of pregnant women who self-identified as experiencing high levels of psychological distress was randomized into MBCT-PD (n = 28) or treatment as usual (n = 32). Participants completed online questionnaires assessing symptoms of distress, pregnancy and generalized anxiety, depression, and stress during lab visits at enrolment (before allocation), immediately following the intervention, and at follow-up (3 months postpartum). Women also reported delivery type and gestational age of their newborn.ResultsUsing an intention-to-treat approach, multilevel modeling indicated a significant effect of MBCT-PD treatment on overall psychological distress, but not on other symptoms. Path analysis revealed a moderated mediation, with an indirect effect of MBCT-PD treatment on lengthening gestational age through decreasing pregnancy anxiety among women with higher baseline symptoms.Conclusions In pregnant women seeking treatment for high levels of psychological distress, MBCT-PD was associated with improved overall distress, but not other specific symptoms such as anxiety and depression beyond treatment as usual. MBCT-PD has the potential to reduce the risk of preterm birth by targeting and reducing high levels of pregnancy anxiety during early gestation. Further research is warranted to examine other outcomes (e.g., coping skills, interpersonal functioning) and comparisons to other interventions.
... In a systematic review, meditation reduced SBP and DBP values in 4.26 mm Hg and 2.33 mm Hg, respectively (Bai et al., 2015). Importantly, the greater effect was observed on SBP among older individuals, those with higher initial BP levels, and women. ...
Article
Mindfulness-based approaches that promote health, improve quality of life, and reduce the impact of comorbidities are key aspects in chronic diseases management. We aimed to verify the impact of a short-term meditation protocol on psychosocial and physiological parameters in chronic hemodialysis patients. We enrolled twenty-two patients, median age of 69.5 years old, into a 12-week meditation protocol that occurred during each hemodialysis session for 10–20 minutes, 3x/week, in a private tertiary hospital. We then evaluated clinical, psychological, and laboratorial parameters pre- and post-meditation. Patients exhibited a better control of serum phosphorus (−0.72 mg/dL; P = 0.002), a decrease in systolic blood pressure (−1.90 mmHg; P = 0.009), a 23% decrease in depressive symptoms (P = 0.014), and an increase of 7% in the self-compassion scale (P = 0.048) after meditation. To note, we observed an increase in 13% of the mindfulness score (P = 0.019). Our preliminary study describes the effects of a short-term meditation protocol in chronic hemodialysis setting. We observed a decrease in depressive symptoms and in blood pressure values, an improvement in self-compassion and serum phosphorous levels. In conjunction with the promising results of meditation in chronic kidney disease setting, this encouraging preliminary study supports the need for additional clinical trials.
... Os efeitos de redução da PA de suplementos alimentares são, em geral, discretos e heterogêneos. [58][59][60][61][62][63][64][65][66][67][68] As substâncias cuja suplementação tem alguma evidência de discreta redução da PA são: vitamina C, peptídeos bioativos derivados de alimentos, alho, fibras dietéticas, linhaça, chocolate amargo (cacau), soja, nitratos orgânicos e ômega 3. 38,47,69 As suplementações de magnésio, vitaminas combinadas, chá e coenzima Q10 não demonstraram redução significativa da PA. 64,65,70 ...
... 81 Some, but not all, studies and meta-analyses have found that meditation can decrease various forms of psychological and psychosocial distress such as perceived stress, anxiety, and negative affect; increase smoking cessation rates; and modestly lower systolic and diastolic blood pressures. 81,[213][214][215][216][217][218] A recent systematic review including 16 studies concluded that mindfulness-based interventions led to greater improvements in negative psychological outcomes (eg, less anxiety, depression, stress) and reduced systolic blood pressure. 219 Several modest-sized studies of meditation for primary and secondary prevention have reported surprisingly robust decreases in nonfatal MI, cardiovascular mortality, and all-cause mortality; these findings need to be reproduced in larger multicenter studies. ...
Article
As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.
... In the meta-analyses of randomized controlled trials of Transcendental Meditation and blood pressure, the average reduction in SBP was -4 to 5 mm Hg and in DBP -2 to 3 mm Hg for all BP groups. At the same time, these meta-analyses found that changes were inversely associated with baseline BP [63] . That is, the higher the baseline BP, the greater BP reduction over time. ...
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Background Blacks suffer from disparities in hypertension, CVD, and currently, COVID-19. These conditions are associated with social determinants of health and psychosocial stress. While previous trials demonstrated stress reduction lowering BP in the grade I range in Black adults, there is a paucity of clinical trial data with high normal and normal BP. Objective This randomized controlled trial was conducted to evaluate the effect of stress reduction with the Transcendental Meditation (TM) technique in Black adults with high normal BP and normal BP using international definitions Methods A total of 304 Black men and women with high normal (130-139/85-89 mm Hg) and normal BP (120-129/80-84 mm Hg) were randomized to either TM or health education (HE) groups. BP was recorded at 3, 6, 9, 12, 24, 30 and 36 months after baseline. Linear mixed model analysis was conducted to compare the BP change between TM and HE participants in the high-normal BP and normal-BP groups. Survival analysis for hypertensive events was conducted. Results After an average of 19.9±11.1 months follow-up, TM participants in the high-normal BP group showed significantly lower posttest SBP (-3.33 mm Hg, p=0.045). There was no difference in DBP (-0.785 mm Hg, p=0.367) compared to HE participants. In the normal BP group, the SBP and DBP were not different between the TM and HE participants. The hazard ratio for hypertensive events was 0.76 (p =.15) in the high normal BP group with no difference in the normal BP group Conclusion This RCT found that meditation lowered SBP in Black men and women with high normal BP but not in normal BP participants. These results may be relevant to reducing health disparities in CVD.
... The effects of dietary supplements on lowering BP are usually small and heterogeneous. [58][59][60][61][62][63][64][65][66][67][68] There is evidence that the following supplements can help lower BP to a small degree: vitamin C, food-derived bioactive peptides, garlic, dietary fiber, flaxseed, dark chocolate (cocoa), soy, organic nitrates, and Omega-3 fatty acids. 38,47,69 Magnesium supplements, multivitamins, tea, and coenzyme Q10 have not been shown to lead to significant decreases in BP. 64,65,70 ...
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The goal of this chapter is to discuss, based on evolving scientific knowledge about hypertension in the last few decades and more recent evidence, the possible advances and adjustments that will impact daily clinical practices and the challenges involved in diagnosis, treatment, and follow- up for hypertensive patients. It should be stressed that, unlike the previous chapters, where recommendations were rigorously classified by level of scientific evidence and level of recommendation, this section was designed to introduce possible rational vistas, based on the knowledge we have acquired thus far for this complex, multifactorial disease, with cardiovascular (CV), cerebral, and renal consequences that heavily determine morbidity and mortality, to the point that it has become the leading cause of death throughout the world
... The effects of dietary supplements on lowering BP are usually small and heterogeneous. [58][59][60][61][62][63][64][65][66][67][68] There is evidence that the following supplements can help lower BP to a small degree: vitamin C, food-derived bioactive peptides, garlic, dietary fiber, flaxseed, dark chocolate (cocoa), soy, organic nitrates, and Omega-3 fatty acids. 38,47,69 Magnesium supplements, multivitamins, tea, and coenzyme Q10 have not been shown to lead to significant decreases in BP. 64,65,70 ...
... In many experimental studies using control group design, TM is found to have helped people with stress reduction, depression, and burnout (Elder, Nidich, Moriarty, & Nidich, 2014), blood pressure (Bai, Chang, Chen, Li, Yang, & Chi, 2015), and reduced usage of psychotropic medications among military service members dealing with anxiety and post-traumatic stress disorder (PTSD) management (Barnes, Monto, Williams, & Rigg, 2016). It is also found to have enhanced creativity, and many professional artists and musicians have credited their achievements to the practice of TM (Forem, 1973, Mason, 1994Rosenthal, 2011;Roth, 2011). ...
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Research in creativity has hitherto neglected the contribution of indigenous cultures, and especially the relationship between spirituality and creativity. In this chapter, I present a spirituality-based theory of creativity by synthesizing theories from the microworld or academic world of theory using the wisdom of upaniSads, the repository of Indian philosophical and psychological theories, and the lifeworld or world of practice, using the teachings of sages from Indian culture. Theory from the microworld is derived from bRhadAraNyakopaniSad, and this is corroborated by the teachings of two sages, ramaNa maharSi and nisargadatta mahArAja, from the lifeworld. This is one of the few papers or chapters that have adopted the synthesis of the lifeworld and microworld, and that has also attempted to show how spirituality is the foundation of all creativity, building a bridge between the spiritual and the material domains. The paper further examines the relevance of major Western theories of creativity in light of this indigenous theory, thus enriching the field of creativity research. Within India, the theory needs to be examined in various domains like music, dance, art, architecture, literature, and so forth, to test the generalizability of the theory. We also need to examine whether the theory presented in this paper is applicable to other indigenous cultures by studying indigenous models of creativity and examining the role of spirituality in it.
... 18 Systematic reviews, based on methodologically rigorous randomised controlled trials (RCTs) with relatively large numbers of subjects, have shown beneficial effects of daily TM or mindfulness meditation on different aspects of health, such as psychological wellbeing, immune health and cardiovascular health, with the most significant effects identified in psychological wellbeing. 17,[19][20][21][22] An additional systematic review of 12 RCTs and observational studies identified that overall daily meditation (including TM, mindfulness, yogabased meditation and muscle relaxation) for 8 weeks or more may improve the rate of age-related cognitive decline in older adults. 23 ...
Article
In the United States, it is reported that up to 7 million of the population practice some form of meditation with the main purpose of improving emotional wellbeing and reducing stress. As the prevalence of mental health conditions continues to climb, other forms of health management strategies, including meditation practices, are increasingly used in adults. The evidence continues to emerge for the use of meditation as a way of managing health conditions in adults as demonstrated in systematic reviews and randomised controlled trials. There is also growing evidence evaluating the use of meditation practices and their potential benefits for child and adolescent health. Studies have identified improvements in mood and mental health conditions, school attendance and attention in the classroom in children and adolescents. This article aims to provide a perspective on commonly evaluated meditation types, such as Transcendental Meditation and mindfulness‐based stress reduction. The article also aims to discuss the available evidence for the use of meditation to improve health and general wellbeing of children, including the use of meditation programs in schools, the current downfalls and limitations to the existing literature around meditation, and important points that healthcare practitioners need to consider when discussing the use of meditation as an additional strategy to manage and improve health and wellbeing in children and adolescents.
Objectives Meditation has shown promise in clinical trials in reducing systolic blood pressure, one of the main risk factors for stroke. We aim to estimate the potential benefits of popularizing meditation on stroke incidence and mortality in the United States (U.S.). Methods We developed a dynamic population-based microsimulation model to simulate the disease progression of each individual and compute disease burden. We calibrated the microsimulation model for stroke incidence and further validated it by comparing the stroke-related mortality for each age group generated by the model with that observed in the U.S. We used the population simulation model to estimate the effects of meditation intervention on the number of stroke cases and deaths over a course of 15 years. Results Our results show that we could avert nearly 200,000 stroke cases and 50,000 stroke-related deaths over the course of 15 years. Our sensitivity analysis reveals that most of the benefits come from applying the intervention for individuals older than 60 years. In addition, meditation acceptance and adherence rate play a critical role in its effectiveness. Conclusions The practice of meditation, if properly utilized along with the regular antihypertensive medication, could substantially alleviate the burden of stroke in the U.S. In order to design an effective meditation program, policymakers may prioritize funding to the programs that aim to encourage older individuals to practice meditation.
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Over three decades of research on the role of meditation in hypertension have shown beneficial effects. The authors glue together the effects of different forms of meditation on hypertension from the earliest to the latest.KeywordsMeditationCardiovascular diseaseRisk factorsPsychological stressStress reductionMBSRTMYoga
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Cardiovascular disease (CVD) is the leading cause of death worldwide and in Brazil, leading to increased morbidity and disability-adjusted life year (DALY). Despite the decrease in mortality rates and DALY standardized by age in Brazil, possibly as a result of successful health policies, their total number is increasing, mainly due to aging and illnesses in the population.1 Classical risk factors (hypertension, dyslipidemia, obesity, sedentary lifestyle, smoking, diabetes, and family history) raise the pre-test probability of CVD - particularly of coronary artery disease (CAD) - and determine primary and secondary prevention. Several other factors, including sociodemographic, ethnic, cultural, dietary, and behavioral aspects, can also explain the differences in CVD burden among populations and their trends over the decades. The implementation of health policies, among them, encouraging healthy lifestyle habits and providing access to primary and secondary CVD prevention measures, associated with the treatment of cardiovascular (CV) events are essential to control CVD in all countries, including Brazil. The I Brazilian Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology (Sociedade Brasileira de Cardiologia - SBC), published in 2013,2 aimed at helping reduce CV mortality, as established by the World Health Assembly in May 2012; SBC reaffirmed its commitment to decreasing the premature CVD mortality rate by 25%.3 However, the reduction in CVD mortality has reached a plateau in the past five years in Brazil, with significant regional variation, suggesting the need for renewing strategies to combat these diseases.4 With this purpose, SBC revisited its CV prevention guideline,2 proposing to update themes related to the primary prevention of CVD and suggesting strategies that could assist Brazilian cardiologists in reducing morbidity and mortality from these groups of causes. The Brazilian Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology - 2019 updates the strategies that address classical risk factors and discusses new concepts, such as the need to gather knowledge about emerging risk factors - for instance, spirituality -, socioeconomic and environmental factors, as well as additional strategies, like the use of vaccines. We hope to contribute to renew the SBC commitment with the Brazilian society and the Strategic Action Plan for tackling Chronic Non-Communicable Diseases (NCD),5 of which CVD is the main component, with an instrument that will allow systematized access to the current literature, disseminating the knowledge necessary to resume the decreasing trend in CV mortality in Brazil.
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Updated Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology – 2019 Development: Brazilian Society of Cardiology (Sociedade Brasileira de Cardiologia – SBC) Norms and Guidelines Council: Fernando Bacal, Leandro Ioschpe Zimerman, Paulo Ricardo Avancini Caramori and Pedro Alves Lemos Neto Norms and Guidelines Coordinator: Ludhmila Abrahão Hajjar General Coordinator: Dalton Bertolim Précoma Writing Committee: Dalton Bertolim Précoma, Gláucia Maria Moraes de Oliveira Editors: Dalton Bertolim Précoma, Gláucia Maria Moraes de Oliveira, Antonio Felipe Simão and Oscar Pereira Dutra Introduction Dalton Bertolim Précoma and Gláucia Maria Moraes de Oliveira 1. Risk Stratification Coordinator: Francisco Antonio Helfenstein Fonseca Authors: Emilio Hideyuki Moriguchi, Jamil Cherem Schneider, José Francisco Kerr Saraiva, Marcelo Heitor Vieira Assad, Sergio Emanuel Kaiser 2. Dyslipidemia Coordinator: Maria Cristina de Oliveira Izar Authors: Adriana Bertolami, Harry Correa Filho, Hermes Toros Xavier, José Rocha Faria-Neto, Marcelo Chiara Bertolami, Viviane Zorzanelli Rocha Giraldez 3. Diabetes and Metabolic Syndrome Coordinator: Otávio Rizzi Coelho Authors: Andrei C. Sposito, Bruno Halpern, José Francisco Kerr Saraiva, Luiz Sergio Fernandes Carvalho, Marcos Antônio Tambascia, Otávio Rizzi Coelho Filho 4. Obesity and Overweight Coordinator: Carlos Scherr Authors: Dalton Bertolim Précoma, Thiago Veiga Jardim 5. Arterial Hypertension Coordinator: Rui Manuel dos Santos Povoa Authors: Andrea Araújo Brandão, Audes Diógenes de Magalhães Feitosa, Celso Amodeo, Dilma do Socorro Moraes de Souza, Eduardo Costa Duarte Barbosa, Marcus Vinícius Bolívar Malachias, Weimar Kunz Sebba Barroso de Souza 6. Vitamins and Omega-3 Fatty Acids Coordinator: Raul Dias dos Santos Filho Authors: Ana Maria Pita Lottenberg, Carlos Daniel Magnoni, Marcio Hiroshi Miname, Roberta Soares Lara 7. Smoking Coordinator: Aristóteles Comte de Alencar Filho Authors: Aloyzio Cechella Achutti, André Ribeiro Langowiski, Carla Janice Baister Lantieri, Jaqueline Ribeiro Scholz, Silvia Maria Cury Ismael 8. Physical Activity, Physical Exercise, and Sports Coordinator: Tales de Carvalho Authors: Artur Haddad Herdy, Cláudio Gil Soares de Araújo, Mauricio Milani, Miguel Morita Fernandes da Silva, Ricardo Stein 9. Spirituality and Psychosocial Factors in Cardiovascular Medicine Coordinators: Álvaro Avezum Jr e Roberto Esporcatte Authors: Emilio Hideyuki Moriguchi, Fernando Antonio Lucchese, Fernando Nobre, Hermilo Borba Griz, Lucélia Batista Neves Cunha Magalhães, Mario Henrique Elesbão de Borba, Mauro Ricardo Nunes Pontes, Ricardo Mourilhe-Rocha 10. Associated Diseases, Socioeconomic and Environmental Factors in Cardiovascular Prevention Coordinator: Glaucia Maria Moraes de Oliveira Authors: Bruno Ramos Nascimento, David de Pádua Brasil, Gabriel Porto Soares, Paolo Blanco Villela, Roberto Muniz Ferreira, Wolney de Andrade Martins 11. Childhood and Adolescence Coordinator: Isabela de Carlos Back Authors: Ivan Romero Rivera, Lucia Campos Pellanda, Maria Alayde Mendonça da Silva 12. Population Approaches to Risk Factors for Cardiovascular Diseases Coordinator: Carlos Alberto Machado Authors: Carlos Alberto Machado, José Carlos Aidar Ayoub, Luiz César Nazário Scala, Mario Fritsch Neves, Sandra Costa Fuchs, Paulo Cesar Veiga Jardim e Thiago Veiga Jardim
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Background: African Americans have disproportionately high rates of cardiovascular disease (CVD). Left ventricular hypertrophy (LVH) is an independent risk factor for CVD and may contribute to this disparity. Psychological stress contributes to LVH in African Americans and other populations. Objective: This study evaluated the effects of stress reduction with the Transcendental Meditation (TM) technique on preventing LVH in African American adults with hypertension. Setting: Martin Luther King Hospital - Charles R. Drew University of Medicine and Science, Los Angeles, CA. Method: In this trial, 85 African American adults (average 52.8 years) were randomly assigned to either TM program or health education (HE) control group and completed posttesting. Participants were tested at baseline and after six months for left ventricular mass index (LVMI) by M-mode echocardiography, blood pressure, psychosocial stress and behavioral factors. Change in outcomes was analyzed between groups by ANCOVA and within groups by paired t-test. Results: The TM group had significantly lower LVMI compared with the HE group (-7.55gm/m2, 95% CI -14.78 to -.34 gm/m2, P=.040). Both interventions showed significant within group reductions in BP, (SBP/DBP changes for TM: -5/ -3 mm Hg, and for HE: -7/-6 mm Hg, P=.028 to <.001) although between group changes were not significant. In addition, both groups showed significant reductions in anger (P=.002 to .001). There were no other changes in lifestyle factors. Conclusions: These findings indicate that stress reduction with TM was effective in preventing LVMI progression and thus may prevent LVH and associated CVD in high-risk African American patients.
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Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the developed world. The economic impact of the epidemic is expected to total more than $800 billion by 2030. Low-cost interventions such as meditation and mindfulness, physical activity, and improvement in dietary habits are of particular interest in curbing the impact of CVD. The chapter will review the evidence for these interventions in primary and secondary prevention of CVD.
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Background: Occupational stress is known as harmful physical and emotional responses that occur when the requirements of the job do not match the resources, needs, or capabilities of an employee, leading to poor mental and physical health. Objective: The objective of the present study was to assess the effect of 1-week residential yoga training program on occupational stress and its subscales among principals. Methods: Thirty-three principals with ages 40-59 years completed the assessment. They received yoga training at Kaivalyadham Yoga Institute. All the participants were recruited by Kendriya Vidyalaya Sangathan as part of their on-duty yoga training. At the baseline and after 1 week of yoga training participants were assessed for occupational stress. The yoga intervention was given in the morning and evening for 105 min. Apart from yoga training, all the participants were engaged in lectures based on stress management, yoga for total health, meditation, yoga in school education, and scientific basis of yoga, daily for 3 h. Results: The principals showed a significant decrease in role overload (P < 0.001), role ambiguity (P < 0.01), role conflict (P < 0.05), under participation (P < 0.001), powerlessness (P < 0.001), intrinsic impoverishment (P < 0.01), law status (P < 0.001), and overall occupational stress (P < 0.001) after 7 days of yoga training intervention. However, there was no significant change in unreasonable group and political pressure (P > 0.05), responsibility for persons (P > 0.05), poor peer relations (P > 0.05), strenuous working conditions (P > 0.05), and unprofitability (P > 0.05) after yoga training intervention. Conclusion: The present study suggests that 1 week of residential yoga training program can improve occupational stress in principals.
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Background: The World Health Organization estimates that 1.13 billion people worldwide have hypertension. Although pharmaceutical management of blood pressure is available, there are reasons why people prefer not to take medications including costs, adverse effects, and lack of access. Nonpharmacological healthy lifestyle methods are needed. One alternative method is transcendental meditation (TM). Objective: The purpose of this study was to quantitatively synthesize the effects of TM on blood pressure. In addition, we examined the moderator effects of participant, methods, and intervention characteristics. Methods: We searched 19 electronic databases without date restrictions to March 2021 including the gray literature and specific journals for primary studies evaluating TM to reduce blood pressure in adults and written in English. We coded primary studies for 5 categories (source, method, intervention, participant characteristics, and outcomes). Results: Across 18 primary studies (N = 1207), TM mildly improved systolic blood pressure by -3.3 mm Hg (P = .025) and diastolic blood pressure by -1.8 mm Hg (P = .008) compared with comparison groups, but the effects waned after 3 months. Transcendental meditation reduced systolic blood pressure in samples that were 65 years and older significantly more than in samples that were younger than 65 years (-1.44 vs -9.87, P = .021) but showed no differential effect on diastolic blood pressure. Conclusions: Transcendental meditation mildly reduced blood pressure, but the effect waned after 3 months. Adults older than 65 years benefited more than younger adults. Transcendental meditation might be recommended as one aspect of a healthy lifestyle.
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Lifestyle medicine is a clinical service line within a sponsoring health system that includes inpatient and outpatient programs of care. There is a growing evidence base supporting many options of inpatient lifestyle medicine available to the treatment team to facilitate implementation and improve clinical outcomes. This effort focuses on patients in the midst of acute care, and also in the context of multiple and oftentimes-concurrent prevention modalities in a chronic care model. Broad categories of such interventions include dietary, physical activity, behavioral, mind-body, and spiritual interventions. Notwithstanding knowledge gaps, challenges to optimizing inpatient lifestyle medicine include a recalcitrant healthcare culture (including poor health of many hospital staff and professionals), inadequate patient education, and incomplete infrastructure. Developing a clinically and economically successful inpatient lifestyle medicine consultation service that focuses on the prevention of chronic disease should be a priority for healthcare systems, medical centers, hospitals, and other inpatient facilities.
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Im Hier und Jetzt präsent zu sein, ist eine der wichtigsten und hilfreichsten Fertigkeiten für traumatisierte Menschen (Fisher 1999). Um sie zu erlangen und zu entwickeln, sind Achtsamkeit und Selbstgewahrsein nötig. Beide bilden somit auch ganz grundlegende Elemente der Stabilisierung; sie ermöglichen uns, auf unseren Körper regulierend einzuwirken, so dass sich dieser und mit ihm auch unser Inneres beruhigen kann. Wir können uns durch sie zentrieren und in unsere Mitte finden. Und wir können mit ihrer Hilfe innere Distanz zu aufwühlenden, belastenden und bedrohlichen Emotionen, Gedanken, Erinnerungen, inneren Bildern und Körperempfindungen gewinnen.
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A paucity of data in school children generally, and in non-Western schools specifically, related to health, school performance, and practice of meditation necessitated this study. The fact that almost no prior research of this type has been conducted in Latin America makes the present investigation especially worthwhile. This mostly quantitative study was carried out with 91 randomly selected school children, ranging in age from 11 to 16 years, in a remote Peruvian town in the central Andean mountains called Huay-Huay. Using a 47-question, paper-and-pencil instrument to ask students about their experience with meditation in four categories (i.e., physical health, cognitive health, emotional health, and school performance), this observational study considered whether or not the practice of meditation had a self-reported impact on student personal health and academic life, and if so to what extent. Data indicate that a majority of children in Huay-Huay reported benefits across all measures, and these were apparently stronger when students practiced meditation more regularly. Qualitative reports support these conclusions. Gender and grade level did not appear to influence this outcome.
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Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
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The present study investigates the effect of Sahaja yoga meditation on quality of life, anxiety, and blood pressure control. The prospective observational cohort study enrolled two study groups: those receiving treatment from the International Sahaja Yoga Research and Health Center (meditation group) and those receiving treatment from the Mahatma Gandhi Mission Hospital (control group). Researchers measured quality of life, anxiety, and blood pressure before and after treatment. Sixty-seven (67) participants in the meditation group and 62 participants in the control group completed the study. The two groups were comparable in demographic and clinical characteristics. At baseline, the meditation group had higher quality of life (p<0.001) than controls but similar anxiety level (p=0.74) to controls. Within-group pre- versus post-treatment comparisons showed significant improvement in quality of life, anxiety, and blood pressure in the meditation group (p<0.001), while in controls, quality of life deteriorated and there was no improvement in blood pressure. The improvement in quality of life, anxiety reduction, and blood pressure control was greater in the meditation group. The beneficial effect of meditation remained significant after adjusting for confounders. Meditation treatment was associated with significant improvements in quality of life, anxiety reduction, and blood pressure control.
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Background. An early sign of ventricular remodeling is increased left ventricular mass (LVM) which over time may lead to left ventricular hypertrophy, the strongest predictor of cardiovascular morbidity and mortality, other than advancing age. Methods. 62 (30 TM; 32 CTL) African American adolescents (age 16.2 ± 1.3 years) with high normal systolic BP were randomly assigned to either 4-month Transcendental Meditation (TM) or health education control groups. The echocardiographic-derived measure of LVM index (LVMI = LVM/ht(2.7)) was measured before and after the 4-month TM study and at 4-month followup. 2D-guided M-mode echocardiography using a Hewlett Packard 5500 echosonograph was used to determine LVMI. Results. The TM group exhibited a greater decrease in LVMI at 4-month followup compared to the CTL group (-2.6 versus +0.3 gm/ht(2.7), P < 0.04). The TM group exhibited a lesser increase in BMI at 4-month follow-up compared to the CTL group (0.2 ± 1.6 versus 1.1 ± 1.4, P < 0.03). Conclusion. These findings indicate that among a group of prehypertensive African American adolescents, 4 months of TM compared to heath education resulted in a significant decrease in LVMI, and these changes were maintained at 4-month follow-up.
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Meditation techniques are increasingly popular practices that may be useful in preventing or reducing elevated blood pressure. We reviewed landmark studies and recent literature concerning the use of meditation for reducing blood pressure in pre-hypertensive and hypertensive individuals. We sought to highlight underlying assumptions, identify strengths and weaknesses of the research, and suggest avenues for further research, reporting of results, and dissemination of findings. Meditation techniques appear to produce small yet meaningful reductions in blood pressure either as monotherapy or in conjunction with traditional pharmacotherapy. Transcendental meditation and mindfulness-based stress reduction may produce clinically significant reductions in systolic and diastolic blood pressure. More randomized clinical trials are necessary before strong recommendations regarding the use of meditation for high BP can be made.
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Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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The present study is a waitlist-controlled investigation of the impact of a Mindfulness-Based Stress Reduction (MBSR) program on mindful attentiveness, rumination and blood pressure (BP) in women with cancer. Female post-treatment cancer patients were recruited from the MBSR program waitlist. Participants completed self-report measures of mindfulness and rumination and measured casual BP at home before and after the 8-week MBSR program or waiting period. MBSR group participants demonstrated higher levels of mindful attentiveness and decreased ruminative thinking following the intervention but no difference in BP, when compared to controls. In the MBSR group, decreases in rumination correlated with decreases in SBP and increases in mindful attention. When participants were assigned to "Higher BP" and "Lower BP" conditions based on mean BP values at week 1, "Higher BP" participants in the MBSR group (n=19) had lower SBP at week 8 relative to the control group (n=16). A MBSR program may be efficacious in increasing mindful attention and decreasing rumination in women with cancer. Randomized controlled trials are needed to evaluate an impact on clinically elevated BP.
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To evaluate the effect of breathing awareness meditation (BAM), Botvin LifeSkills Training (LST), and health education control (HEC) on ambulatory blood pressure and sodium excretion in African American adolescents. Following 3 consecutive days of systolic blood pressure (SBP) screenings, 166 eligible participants (i.e., SBP >50th-95th percentile) were randomized by school to either BAM (n = 53), LST (n = 69), or HEC (n = 44). In-school intervention sessions were administered for 3 months by health education teachers. Before and after the intervention, overnight urine samples and 24-hour ambulatory SBP, diastolic blood pressure, and heart rate were obtained. Significant group differences were found for changes in overnight SBP and SBP, diastolic blood pressure, and heart rate over the 24-hour period and during school hours. The BAM treatment exhibited the greatest overall decreases on these measures (Bonferroni adjusted, ps < .05). For example, for school-time SBP, BAM showed a change of -3.7 mmHg compared with no change for LST and a change of -.1 mmHg for HEC. There was a nonsignificant trend for overnight urinary sodium excretion (p = .07), with the BAM group displaying a reduction of -.92 ± 1.1 mEq/hr compared with increases of .89 ± 1.2 mEq/hr for LST and .58 ± .9 mEq/hr for HEC group. BAM appears to improve hemodynamic function and may affect sodium handling among African American adolescents who are at increased risk for development of cardiovascular disease.
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The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
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Psychological distress contributes to the development of hypertension in young adults. This trial assessed the effects of a mind-body intervention on blood pressure (BP), psychological distress, and coping in college students. This was a randomized controlled trial (RCT) of 298 university students randomly allocated to either the Transcendental Meditation (TM) program or wait-list control. At baseline and after 3 months, BP, psychological distress, and coping ability were assessed. A subgroup of 159 subjects at risk for hypertension was analyzed similarly. Changes in systolic BP (SBP)/diastolic BP (DBP) for the overall sample were -2.0/-1.2 mm Hg for the TM group compared to +0.4/+0.5 mm Hg for controls (P = 0.15, P = 0.15, respectively). Changes in SBP/DBP for the hypertension risk subgroup were -5.0/-2.8 mm Hg for the TM group compared to +1.3/+1.2 mm Hg for controls (P = 0.014, P = 0.028, respectively). Significant improvements were found in total psychological distress, anxiety, depression, anger/hostility, and coping (P values < 0.05). Changes in psychological distress and coping correlated with changes in SBP (P values < 0.05) and DBP (P values < 0.08). This is the first RCT to demonstrate that a selected mind-body intervention, the TM program, decreased BP in association with decreased psychological distress, and increased coping in young adults at risk for hypertension. This mind-body program may reduce the risk for future development of hypertension in young adults.
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Can direct change in state of consciousness through specific mental techniques extend human life and reverse age-related declines? To address this question, 73 residents of 8 homes for the elderly (mean age = 81 years) were randomly assigned among no treatment and 3 treatments highly similar in external structure and expectations: the Transcendental Meditation (TM) program, mindfulness training (MF) in active distinction making, or a relaxation (low mindfulness) program. A planned comparison indicated that the "restful alert" TM group improved most, followed by MF, in contrast to relaxation and no-treatment groups, on paired associate learning; 2 measures of cognitive flexibility; mental health; systolic blood pressure; and ratings of behavioral flexibility, aging, and treatment efficacy. The MF group improved most, followed by TM, on perceived control and word fluency. After 3 years, survival rate was 100% for TM and 87.5% for MF in contrast to lower rates for other groups.
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We tested the short-term efficacy and feasibility of two stress education approaches toe the treatment of mild hypertension in older African Americans. This was a randomized, controlled, single-blind trial with 3 months of follow-up in primary care, inner-city health center. Of 213 African American men and women screened, 127 individuals (aged 55 to 85 years with initial diastolic pressure of 90 to 109 mm Hg, systolic pressure of < or = 189 mm Hg, and final baseline blood pressure of < or = 179/104 mm Hg) were selected. Of these, 16 did not complete follow-up blood pressure measurements. Mental and physical stress reduction approaches (Transcendental Meditation and progressive muscle relaxation) were compared with a lifestyle modification education control program and with each other. The primary outcome measures were changes in clinic diastolic and systolic pressures from baseline to final follow-up, measured by blinded observers. The secondary measures were linear blood pressure trends, changes in home blood pressure, and intervention compliance. Adjusted for significant baseline differences and compared with control, Transcendental Meditation reduced systolic pressure by 10.7 mm Hg (P < .0003) and diastolic pressure by 6.4 mm Hg (P <.00005). Progressive muscle relaxation lowered systolic pressure by 4.7 mm Hg (P = 0054) and diastolic pressure by 3.3 mm Hg (P <.02). The reductions in the Transcendental Meditation group were significantly greater than in the progressive muscle relaxation group for both systolic blood pressure (P = .02) and diastolic blood pressure (P = .03). Linear trend analysis confirmed these patterns.(ABSTRACT TRUNCATED AT 250 WORDS)
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Our objective was to test the short-term efficacy and feasibility of two stress-reduction approaches for the treatment of hypertension in older African Americans, focusing on subgroup analysis by sex and by high and low risk on six measures of hypertension risk: psychosocial stress, obesity, alcohol use, physical inactivity, dietary sodium-potassium ratio, and a composite measure. The study involved a follow-up subgroup analysis of a 3-month randomized, controlled, single-blind trial conducted in a primary care, inner-city health center. Subjects were 127 African American men and women, aged 55 to 85 years, with diastolic pressure of 90 to 104 mm Hg and systolic pressure less than or equal to 179 mm Hg. Of these, 16 did not complete follow-up blood pressure measurements. Mental and physical stress-reduction approaches-the Transcendental Meditation technique and progressive muscle relaxation, respectively-were compared with a life-style modification education control and with each other. Both systolic and diastolic pressures changed from baseline to follow-up for both sexes and for high and low risk level (defined by median split) on the six measures of hypertension risk. Compared with education control subjects, women practicing the Transcendental Meditation technique showed adjusted declines in systolic (10.4 mm Hg, P < .01) and diastolic (5.9 mm Hg, P < .01) pressures. Men in this treatment group also declined in both systolic (12.7 mm Hg, P < .01) and diastolic (8.1 mm Hg, P < .001) pressures compared with control subjects. Women practicing muscle relaxation did not show a significant decrease compared with control subjects, and men declined significantly in diastolic pressure only (6.2 mm Hg, P < .01). For the measure of psychosocial stress, both the high and low risk subgroups using the Transcendental Meditation technique declined in systolic (high risk, P = .0003; low, P = .06) and diastolic (high risk, P = .001; low, P = .008) pressures compared with control subjects, whereas for muscle relaxation, blood pressure dropped significantly only in the high risk subgroup and only for systolic pressure (P = .03) compared with control subjects. For each of the other five risk measures, Transcendental Meditation subjects in both the high and low risk groups declined significantly in systolic and diastolic pressures compared with control subjects. Effects of stress reduction on blood pressure were found to generalize to both sexes and diverse risk factor subgroups and were significantly greater in the Transcendental Meditation treatment group. These effects (along with high compliance) even in individuals with multiple risk factors for hypertension clearly warrant longer-term investigation in this and other populations.
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Cardiovascular responses to stress reactivity has been proposed as a risk factor for hypertension. In this study, we evaluated the effects of stress reduction on both laboratory cardiovascular reactivity and ambulatory blood pressure in real life on 39 normotensive male subjects who were pretested for ambulatory blood pressure and cardiovascular reactivity to stress using a battery of laboratory stressors. Thereafter, subjects were randomly assigned to practice either the Transcendental Meditation (TM) technique or a cognitive-based stress education control (SEC) for four months. After 4 months, there was no change in cardiovascular response to stressors between the TM and control groups. However, the subjects regularly practicing TM demonstrated a significant reduction of 9 mm Hg (p < .04) in average ambulatory DBP compared to controls. Since ambulatory BP monitoring has been shown to be a better predictor of cardiovascular complications of hypertension than clinic BP, this finding may have important implications for primary prevention of CVD in normotensive subjects.
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African Americans suffer disproportionately higher cardiovascular disease mortality rates than do whites. Psychosocial stress influences the development and progression of atherosclerosis. Carotid intima-media thickness (IMT) is a valid surrogate measure for coronary atherosclerosis, is a predictor of coronary outcomes and stroke, and is associated with psychosocial stress factors. Stress reduction with the Transcendental Meditation (TM) program decreases coronary heart disease risk factors and cardiovascular mortality in African Americans. B-mode ultrasound is useful for the noninvasive evaluation of carotid atherosclerosis. This randomized controlled clinical trial evaluated the effects of the TM program on carotid IMT in hypertensive African American men and women, aged >20 years, over a 6- to 9-month period. From the initially enrolled 138 volunteers, 60 subjects completed pretest and posttest carotid IMT data. The assigned interventions were either the TM program or a health education group. By use of B-mode ultrasound, mean maximum IMT from 6 carotid segments was used to determine pretest and posttest IMT values. Regression analysis and ANCOVA were performed. Age and pretest IMT were found to be predictors of posttest IMT values and were used as covariates. The TM group showed a significant decrease of -0.098 mm (95% CI -0. 198 to 0.003 mm) compared with an increase of 0.054 mm (95% CI -0.05 to 0.158 mm) in the control group (P=0.038, 2-tailed). Stress reduction with the TM program is associated with reduced carotid atherosclerosis compared with health education in hypertensive African Americans. Further research with this stress-reduction technique is warranted to confirm these preliminary findings.
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This study examined the impact of the Transcendental Meditation (TM) program on cardiovascular (CV) reactivity in adolescents with high normal BP. Thirty-five adolescents [34 African Americans (AAs), 1 Caucasian American (CA); ages 15-18 years] with resting systolic blood pressure (SBP) between the 85th and 95th percentile for their age and gender on three consecutive occasions, were randomly assigned to either TM (n=17) or health education control (CTL, n=18) groups. The TM group engaged in 15-min meditation twice each day for 2 months including sessions during school lunch break. Primary CV outcome measures were changes in blood pressure (BP), heart rate (HR), and cardiac output (CO) at rest and in response to two laboratory stressors, a simulated car driving stressor and an interpersonal social stressor interview. The TM group exhibited greater decreases in resting SBP (P<.03) from pre- to postintervention, compared to the CTL group. The TM group exhibited greater decreases from pre- to postintervention in SBP, HR, and CO reactivity (P's<.03) to the simulated car driving stressor, and in SBP reactivity (P<.03) to the social stressor interview. The TM program appears to have a beneficial impact upon CV functioning at rest and during acute laboratory stress in adolescents at-risk for hypertension.
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The objective of this study was to determine the impact of stress reduction on blood pressure (BP) in adolescents by the Transcendental Meditation (TM) program. African-American adolescents (aged 16.2 ± 1.3 years) with high normal systolic BP were randomly assigned to either 4-month TM (n = 50) or health education control (n = 50) groups. Ambulatory 24-h BP measures were recorded at pretest, 2- and 4-month post-tests, and 4-month follow-up. Greater decreases in daytime systolic BP (P < .04) and diastolic BP (P < .06) in the TM group compared with the control group across the visits demonstrate a beneficial impact of the TM program in youth at risk for the development of hypertension.
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Because of growing evidence for stress as a major factor contributing to cardiovascular disease (CVD), techniques of meditation are being increasingly used. The Transcendental Meditation (TM) technique is distinct from other techniques of meditation not only in its origin and procedure, but also in the amount and breadth of research testing it. Evidence for its ability to reduce traditional and novel risk factors for CVD includes: 1) decreases in blood pressure, 2) reduced use of tobacco and alcohol, 3) lowering of high cholesterol and lipid oxidation, and 4) decreased psychosocial stress. Changes expected to result from reducing these risk factors, namely, reversal of atherosclerosis, reduction of myocardial ischemia and left ventricular hypertrophy, reduced health insurance claims for CVD, and reduced mortality, also have been found with TM practice. Research on mechanisms suggests that some of the CVD-related benefits as a result of this technique could arise from normalization of neuroendocrine systems whose function has been distorted by chronic stress. Further randomized clinical trials are in progress with a focus on underserved minority populations.
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Psychosocial stress has been implicated in the disproportionately higher rates of hypertension among African Americans. This randomized controlled trial compared the effects of two stress reduction techniques and a health education control program on hypertension during a period of 1 year in African-American men and women (N = 150, mean age 49 +/- 10 years, mean blood pressure (BP) = 142/95 mm Hg) at an urban community health center. Interventions included 20 min twice a day of Transcendental Meditation (TM) or progressive muscle relaxation (PMR), or participation in conventional health education (HE) classes. All subjects continued usual medical care. Outcomes assessed were systolic BP and diastolic BP at 3, 6, 9, and 12 months after treatment, analyzed by repeated measures ANCOVA. The TM group showed decreases in systolic BP/diastolic BP of -3.1/-5.7 mm Hg compared to -0.5/-2.9 mm Hg for PMR or HE, (P = .12 to .17 for systolic BP, P = .01 for diastolic BP). In addition the TM group demonstrated reduced use of antihypertensive medication relative to increases for PMR (P = .001) and HE (P = .09) groups. Group analysis by gender showed that women practicing TM had decreased BP (-7.3/-6.9 mm Hg) significantly more than women practicing PMR (0.7/-2.7 mm Hg) or HE (-.07/-3.0 mm Hg) (P .01 to .03). The change in men praticing TM (0.2 /-4.7 mm Hg) was greater than men practicing HE (-0.9/-2.0 mm Hg) for diastolic BP only (P = .09,) and not different from PMR men (-2.0/-3.1). A selected stress reduction approach, the Transcendental Meditation program, may be useful as an adjunct in the long-term treatment of hypertension in African Americans.
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Psychosocial stress contributes to high blood pressure and subsequent cardiovascular morbidity and mortality. Previous controlled studies have associated decreasing stress with the Transcendental Meditation (TM) program with lower blood pressure. The objective of the present study was to evaluate, over the long term, all-cause and cause-specific mortality in older subjects who had high blood pressure and who participated in randomized controlled trials that included the TM program and other behavioral stress-decreasing interventions. Patient data were pooled from 2 published randomized controlled trials that compared TM, other behavioral interventions, and usual therapy for high blood pressure. There were 202 subjects, including 77 whites (mean age 81 years) and 125 African-American (mean age 66 years) men and women. In these studies, average baseline blood pressure was in the prehypertensive or stage I hypertension range. Follow-up of vital status and cause of death over a maximum of 18.8 years was determined from the National Death Index. Survival analysis was used to compare intervention groups on mortality rates after adjusting for study location. Mean follow-up was 7.6 +/- 3.5 years. Compared with combined controls, the TM group showed a 23% decrease in the primary outcome of all-cause mortality after maximum follow-up (relative risk 0.77, p = 0.039). Secondary analyses showed a 30% decrease in the rate of cardiovascular mortality (relative risk 0.70, p = 0.045) and a 49% decrease in the rate of mortality due to cancer (relative risk 0.49, p = 0.16) in the TM group compared with combined controls. These results suggest that a specific stress-decreasing approach used in the prevention and control of high blood pressure, such as the TM program, may contribute to decreased mortality from all causes and cardiovascular disease in older subjects who have systemic hypertension.
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In the past 30 years, the techniques for measuring blood pressure to determine whether a patient has hypertension have undergone a substantial change. The bulk of our knowledge about the risks of hypertension and the benefits of treating it is based on the traditional method of taking a small number of readings with the auscultatory technique in a medical setting. However, such measurements, which are of enormous value on a population basis, often provide a poor estimate of risk in an individual patient for reasons such as poor technique of the observer, the "white-coat" effect (the transient but variable elevation of blood pressure in a medical setting), 1 and the inherent variability of blood pressure.2 Any clinical measurement of blood pressure may be regarded as a surrogate measure for the "true" blood pressure of the patient, which may be defined as the mean level over prolonged periods. Two techniques have been developed to improve the estimate of true blood pressure - ambulatory monitoring and home monitoring (or self-monitoring). We discuss only ambulatory monitoring in this review.
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The metabolic syndrome is thought to be a contributor to coronary heart disease (CHD), and components of the syndrome have been identified as possible therapeutic targets. Previous data implicate neurohumoral activation related to psychosocial stress as a contributor to the metabolic syndrome. The aim of this study was to evaluate the efficacy of transcendental meditation (TM) on components of the metabolic syndrome and CHD. We conducted a randomized, placebo-controlled clinical trial of 16 weeks of TM or active control treatment (health education), matched for frequency and time, at an academic medical center in a total of 103 subjects with stable CHD. Main outcome measures included blood pressure, lipoprotein profile, and insulin resistance determined by homeostasis model assessment (calculated as follows: [(fasting plasma glucose level [in milligrams per deciliter] x fasting plasma insulin level [in microunits per milliliter]) x 0.0552]/22.5); endothelial function measured by brachial artery reactivity testing; and cardiac autonomic system activity measured by heart rate variability. The TM group had beneficial changes (measured as mean +/- SD) in adjusted systolic blood pressure (-3.4 +/- 2.0 vs 2.8 +/- 2.1 mm Hg; P = .04), insulin resistance (-0.75 +/- 2.04 vs 0.52 +/- 2.84; P = .01), and heart rate variability (0.10 +/- 0.17 vs -0.50 +/- 0.17 high-frequency power; P = .07) compared with the health education group, respectively. There was no effect of brachial artery reactivity testing. Use of TM for 16 weeks in CHD patients improved blood pressure and insulin resistance components of the metabolic syndrome as well as cardiac autonomic nervous system tone compared with a control group receiving health education. These results suggest that TM may modulate the physiological response to stress and improve CHD risk factors, which may be a novel therapeutic target for the treatment of CHD.
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Background: To reduce the cardiovascular disease burden, Healthy People 2020 established US hypertension goals for adults to (1) decrease the prevalence to 26.9% and (2) raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment. Methods and results: To assess the current status and progress toward these Healthy People 2020 goals, time trends in National Health and Nutrition Examination Surveys 1999 to 2012 data in 2-year blocks were assessed in adults ≥18 years of age age-adjusted to US 2010. From 1999 to 2000 to 2011 to 2012, prevalent hypertension was unchanged (30.1% versus 30.8%, P=0.32). Hypertension treatment (59.8% versus 74.7%, P<0.001) and proportion of treated adults controlled (53.3%-68.9%, P=0.0015) increased. Hypertension control to <140/<90 mm Hg rose every 2 years from 1999 to 2000 to 2009 to 2010 (32.2% versus 53.8%, P<0.001) before declining to 51.2% in 2011 to 2012. Modifiable factor(s) significant in multivariable logistic regression modeling include: (1) increasing body mass index with prevalent hypertension (odds ratio [OR], 1.44); (2) lack of health insurance (OR, 1.68) and <2 healthcare visits per year (OR, 4.24) with untreated hypertension; (3) healthcare insurance (OR, 1.69), ≥2 healthcare visits per year (OR, 3.23), and cholesterol treatment (OR, 1.90) with controlled hypertension. Conclusions: The National Health and Nutrition Examination Survey 1999 to 2012 analysis suggests that Healthy People 2020 goals for hypertension ([1] prevalence shows no progress, [2] treatment was exceeded, and [3] control) have flattened below target. Findings are consistent with evidence that (1) obesity prevention and treatment could reduce prevalent hypertension, and (2) healthcare insurance, ≥2 healthcare visits per year, and guideline-based cholesterol treatment could improve hypertension control.
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Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioral therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than acupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), and isometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mmHg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate. A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level of evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for future research priorities are outlined.
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Much of what we understand about the regulation of arterial pressure and extracellular fluid volume has been derived from studies in men. Although the responses that can be mounted against major physiological challenges to extracellular fluid volume (hemorrhage/dehydration) are essentially similar in men and women, there are marked sex-related differences in the regulation of renal and cardiovascular physiology. These possibly underpin the greater risk of renal and cardiovascular disease (CVD) in men and, conversely, confer the relative protection from these conditions in women, at least until menopause. In recent years, advances have been made in understanding the mechanistic bases for sex-related differences in CVD and these have been reviewed in detail.1–3 Therefore, the purpose of this report is to provide an update of findings in the past few years. Increasingly, studies are incorporating sex as a factor into their analyses. Although not all studies demonstrate a sex-specific interaction,4–7 many do, exemplifying the mantra, seek and ye shall find; this appears to be particularly true for sex-related differences in CVD. In recent years, evidence that women have smaller and stiffer hearts because of a greater collagen content has received a good deal of attention for the reason that it may explain some of the puzzling differences in clinical signs of CVD between men and women. Puntmann et al8 examined aortic stiffness by pulse wave velocity and ventricular deformation indices using MRI both at rest and during dobutamine challenge in elderly men and women. At rest, women had greater aortic stiffness and ventricular deformation than men. Moreover, sex-related differences were observed during stress because men had increased longitudinal and circumferential ventricular deformation during dobutamine challenge, whereas women only had an increase in circumferential deformation.8 These data suggest that differential loading of the aortic reservoir …
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Blood pressure is a continuous, not a static, variable. Individuals exhibiting similar clinic or home blood pressure can differ considerably with respect to their average day and nighttime values, beat-by-beat blood pressure variation during wakefulness and sleep, responses to mental and physical stimuli, and intersession and seasonal variation. There now is evidence that several such representations of blood pressure variability, if augmented, increase cardiovascular risk independent of the average of conventionally acquired blood pressure readings. As well, recent retrospective analyses of published trial data have concluded that antihypertensive drug classes differ in their effects on intersession blood pressure variability and associated risk of stroke. If the goal of the hypertension community is to optimize personalized cardiovascular risk assessment and to attenuate fully such risk, future efforts should be directed at determining which representation of blood pressure variability estimates individual cardiovascular risk best, establishing "normal" and "high- risk" variability distributions, testing the hypothesis that attenuating such variability specifically through drug or device therapy reduces cardiovascular risk more than blood pressure reduction per se, and integrating such data into clinical practice.
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Monitoring of patients taking antihypertensive treatment can identify potential adverse drug reactions (ADRs). However, published guidelines give divergent or incomplete recommendations on monitoring for ADRs. Using a predetermined strategy, we undertook a systematic review to identify hypertension guidelines published from January 2001 to October 2011 with recommendations for monitoring for ADRs. We screened 88 abstracts and 187 web-based guidelines, and identified 19 published guidelines on monitoring the biochemical effects of antihypertensive drug therapy. We then produced a set of practical clinical guidelines, synthesized from those recommendations. Our recommendations are designed to provide efficient monitoring. They reduce the number of tests to a minimum consistent with safe practice and align monitoring schedules, so that creatinine, potassium and sodium concentrations are measured at the same times in all cases. The instructions for biochemical monitoring in current guidelines differ greatly, both in the extent of advice and in the detail provided. The current lack of consistent and workable instructions poses serious difficulties for practitioners. The recommendations distilled from this systematic review should help practitioners when they monitor therapy with antihypertensive drugs.
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Background: Blacks have disproportionately high rates of cardiovascular disease. Psychosocial stress may contribute to this disparity. Previous trials on stress reduction with the Transcendental Meditation (TM) program have reported improvements in cardiovascular disease risk factors, surrogate end points, and mortality in blacks and other populations. Methods and results: This was a randomized, controlled trial of 201 black men and women with coronary heart disease who were randomized to the TM program or health education. The primary end point was the composite of all-cause mortality, myocardial infarction, or stroke. Secondary end points included the composite of cardiovascular mortality, revascularizations, and cardiovascular hospitalizations; blood pressure; psychosocial stress factors; and lifestyle behaviors. During an average follow-up of 5.4 years, there was a 48% risk reduction in the primary end point in the TM group (hazard ratio, 0.52; 95% confidence interval, 0.29-0.92; P=0.025). The TM group also showed a 24% risk reduction in the secondary end point (hazard ratio, 0.76; 95% confidence interval, 0.51-0.1.13; P=0.17). There were reductions of 4.9 mmHg in systolic blood pressure (95% confidence interval -8.3 to -1.5 mmHg; P=0.01) and anger expression (P<0.05 for all scales). Adherence was associated with survival. Conclusions: A selected mind-body intervention, the TM program, significantly reduced risk for mortality, myocardial infarction, and stroke in coronary heart disease patients. These changes were associated with lower blood pressure and psychosocial stress factors. Therefore, this practice may be clinically useful in the secondary prevention of cardiovascular disease. Clinical Trial Registration- URL: www.clinicaltrials.gov Unique identifier: NCT01299935.
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The aims of this study were to explore the mean and distribution of systolic and diastolic blood pressure, and to examine the influence of gender, body weight and health behaviors on hypertension in adults with disabilities. We analyzed the 2010 annual community health examination chart of adults with disabilities in east Taiwan. The study samples in