Stress Management Versus Lifestyle Modification on Systolic Hypertension and Medication Elimination: A Randomized Trial

Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA 02114, USA.
The Journal of Alternative and Complementary Medicine (Impact Factor: 1.59). 04/2008; 14(2):129-38. DOI: 10.1089/acm.2007.0623
Source: PubMed


Isolated systolic hypertension is common in the elderly, but decreasing systolic blood pressure (SBP) without lowering diastolic blood pressure (DBP) remains a therapeutic challenge. Although stress management training, in particular eliciting the relaxation response, reduces essential hypertension its efficacy in treating isolated systolic hypertension has not been evaluated. We conducted a double-blind, randomized trial comparing 8 weeks of stress management, specifically relaxation response training (61 patients), versus lifestyle modification (control, 61 patients). Inclusion criteria were >or=55 years, SBP 140-159 mm Hg, DBP <90 mm Hg, and at least two antihypertensive medications. The primary outcome measure was change in SBP after 8 weeks. Patients who achieved SBP <140 mm Hg and >or=5 mm Hg reduction in SBP were eligible for 8 additional weeks of training with supervised medication elimination. SBP decreased 9.4 (standard deviation [SD] 11.4) and 8.8 (SD 13.0) mm Hg in relaxation response and control groups, respectively (both ps <0.0001) without group difference (p=0.75). DBP decreased 1.5 (SD 6.2) and 2.4 (SD 6.9) mm Hg (p=0.05 and 0.01, respectively) without group difference (p=0.48). Forty-four (44) in the relaxation response group and 36 in the control group were eligible for supervised antihypertensive medication elimination. After controlling for differences in characteristics at the start of medication elimination, patients in the relaxation response group were more likely to successfully eliminate an antihypertensive medication (odds ratio 4.3, 95% confidence interval 1.2-15.9, p=0.03). Although both groups had similar reductions in SBP, significantly more participants in the relaxation response group eliminated an antihypertensive medication while maintaining adequate blood pressure control.

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    • "Recently, Benson modified his original approach to two steps required to elicit the RR: Repetition of a word, sound or movement and the passive disregard of everyday thoughts when they come to mind during the practice of the chosen technique. Through four decades of research, Benson and colleagues have shown that the RR impacts genomic, structural, physical, psychological, and functional outcomes [45] [46] [47] [48] [49] [50] [51] [52]. Other meditation techniques that have been studied prominently include the Transcendental Meditation technique (TM) as taught by Maharishi Mahesh Yogi, which uses a secret, silent, prescribed sound or mantra as its tool, and mindfulness meditation or Mindfulness Based Stress Reduction (MBSR), a Buddhist approach with the focus on the breath as its tool. "
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    ABSTRACT: Although meditation is believed to be over five thousand years old, scientific research on it is in its infancy. Mitigating the extensive negative biochemical effects of stress is a superficially discussed target of Alzheimer's disease (AD) prevention, yet may be critically important. This paper reviews lifestyle and stress as possible factors contributing to AD and meditation's effects on cognition and well-being for reduction of neurodegeneration and prevention of AD. This review highlights Kirtan Kriya (KK), an easy, cost effective meditation technique requiring only 12 minutes a day, which has been successfully employed to improve memory in studies of people with subjective cognitive decline, mild cognitive impairment, and highly stressed caregivers, all of whom are at increased risk for subsequent development of AD. KK has also been shown to improve sleep, decrease depression, reduce anxiety, down regulate inflammatory genes, upregulate immune system genes, improve insulin and glucose regulatory genes, and increase telomerase by 43%; the largest ever recorded. KK also improves psycho-spiritual well-being or spiritual fitness, important for maintenance of cognitive function and prevention of AD. KK is easy to learn and practice by aging individuals. It is the premise of this review that meditation in general, and KK specifically, along with other modalities such as dietary modification, physical exercise, mental stimulation, and socialization, may be beneficial as part of an AD prevention program.
    Full-text · Article · Oct 2015 · Journal of Alzheimer's disease: JAD
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    • "Relaxation techniques can be divided into two categories: (1) The first includes techniques that focus on muscles to mind techniques, including breathing exercises and Jacobson's progressive muscular relaxation falls in this category; (2) The second category involves techniques that work from mind to muscle, including meditation, autogenic and imagery approaches, each of which is unique, but have the same effect on physiological variables in the body. Procedures like progressive muscular relaxation techniques, autogenic, imagery and meditation will decrease oxygen consumption, heart rate and respiration (Stefano et al., 2001; Cox, 2007; Dusek et al., 2008). "

    Full-text · Article · Jan 2013
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    • "Previous studies have investigated pathways for explaining the health effects of the RR. The physiological effects associated with the RR, such as reduced oxygen consumption , heart and respiratory rates, increased exhaled nitric oxide and lowered blood pressure, have been proposed as possible mechanisms for the beneficial effects [7] [8] [9]. Our study team has also been exploring the pathway through genomic alterations and recently reported that RR practice elicits specific gene expression changes [10]. "
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    ABSTRACT: Studies have shown beneficial effects from practicing the relaxation response (RR). Various pathways for these effects have been investigated. Previous small studies suggest that spirituality might be a pathway for the health effects of the RR. In this study, we tested the hypothesis that increased spiritual well-being by eliciting the RR is one pathway resulting in improved psychological outcomes. This observational study included 845 outpatients who completed a 13-week mind/body Cardiac Rehabilitation Program. Patients self-reported RR practice time in a questionnaire before and after the 13-week program. Similarly, data on spiritual well-being, measured by the subscale of Spiritual Growth of the Health-Promoting Lifestyle Profile II, were collected. The psychological distress levels were measured by the Symptom Checklist-90-Revised. We tested the mediation effect of spiritual well-being using regression analyses. Significant increases in RR practice time (75 min/week, effect size/ES=1.05) and spiritual well-being scores (ES=0.71) were observed after participants completed the program (P<.0001). Patients also improved on measures of depression, anxiety, hostility and the global severity index with medium effect sizes (0.25 to 0.48, P<.0001). Greater increases in RR practice time were associated with enhanced spiritual well-being (beta=.08, P=.01); and enhanced spiritual well-being was associated with improvements in psychological outcomes (beta=-0.14 to -0.22, P<.0001). Our data demonstrated a possible dose-response relationship among RR practice, spiritual and psychological well-being. Furthermore, the data support the hypothesis that spiritual well-being may serve as a pathway of how RR elicitation improves psychological outcomes. These findings might contribute to improved psychological care of cardiac patients.
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