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Contemplative meditation reduces ambulatory blood pressure and stress-induced hypertension: A randomized pilot trial

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Abstract

A total of 52 pharmacologically untreated subjects with essential hypertension were randomly allocated to either 8 weeks of contemplative meditation combined with breathing techniques (CMBT) or no intervention in this observer-blind controlled pilot trial. CMBT induced clinically relevant and consistent decreases in heart rate, systolic and diastolic blood pressure if measured during office readings, 24-h ambulatory monitoring and mental stress test. Longer-term studies should evaluate CMBT as an antihypertensive strategy.
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RESEARCH LETTER
Contemplative meditation reduces
ambulatory blood pressure and
stress-induced hypertension:
a randomized pilot trial
Journal of Human Hypertension (2008) 22, 138–140;
doi:10.1038/sj.jhh.1002275; published online 6 September
2007
A total of 52 pharmacologically untreated subjects
with essential hypertension were randomly allo-
cated to either 8 weeks of contemplative meditation
combined with breathing techniques (CMBT) or no
intervention in this observer-blind controlled pilot
trial. CMBT induced clinically relevant and con-
sistent decreases in heart rate, systolic and diastolic
blood pressure if measured during office readings,
24-h ambulatory monitoring and mental stress test.
Longer-term studies should evaluate CMBT as an
antihypertensive strategy.
Emotional and psychological stress is an acknowl-
edged risk factor and mediator of hypertension,
1,2
but
it is still unknown whether stress-reducing techni-
ques may effectively control essential hypertension.
3–5
Numerous stress-reducing techniques have been
investigated, as physical techniques (for example,
progressive muscle relaxation, breathing exercises,
yoga), cognitive and behavioural therapies (for exam-
ple, talk therapies, meditation, guided imagery), stress
management (for example, autogenic training) and
biofeedback.
5
Some of these techniques share com-
mon features (for example, breathing control) but may
exert their effects via different underlying mechan-
isms. Contemplative meditation as a stress-reducing
technique has been widely studied with divergent
results. A recent systematic review of randomized
clinical trials summarized that, at present, there is
insufficient evidence to conclude whether or not
meditation has a cumulative positive effect on blood
pressure (BP).
3
We therefore aimed to determine in a
randomized controlled observer-blind pilot trial the
differential effects of contemplative meditation com-
bined with breathing techniques (CMBT) on BP at
rest, ambulatory and during mental stress.
Meditation-naı
¨
ve subjects with pharmacologically
untreated BP were sought by newspaper advertise-
ments (n ¼ 81). They qualified for screening (n ¼ 64)
in our cardiovascular outpatient department if their
sitting BP after 5 min of rest was 4140 mm Hg
systolic and/or 485 mm Hg diastolic on each of three
occasions within 4 weeks. Important exclusion
criteria were BP levels 4180 mm Hg systolic and/or
110 mm Hg diastolic and secondary hypertension.
A total of 52 subjects were randomized 1:1 into 8
weeks of CMBT or no intervention. All subjects
received the lifestyle counselling recommended by
current guidelines on one occasion.
1,2
In the CMBT
group, two 40-min sessions were held in the early
morning and the evening. The first phase (10–12 min)
prepared the participants for the session and
focussed on breathing exercises, that is, slow abdom-
inal breathing to achieve a general muscle tension
release.
6,7
The second phase (30 min) dealt with
exercising meditation techniques based on the
Christian tradition.
8,9
Eight weeks after randomiza-
tion, all baseline examinations were repeated at the
same time of the day in a single participant. At the
day of baseline and follow-up examination, study
participants refrained from coffee, smoking and
physical exercise. Office BP was measured four times
each 5 min apart on the left upper arm with an
oscillometric-automated device (DINAMAP 8100,
Critikon) after 10 min rest in the sitting position,
and the mean of the last three measurements was
calculated. Twenty-four hours BP recording was
performed using calibrated devices (Custo Screen
100, custo med GmbH, Ottobrunn, Germany). Day
and night time was specified by the subject on a diary
sheet. A standardized computerized version (devel-
oped by Stefan Bedel) of the concentration test
Konzentrations–Leistungs-Test (KLT) according to
Du
¨
ker was used. Participants were seated in a quiet
air-conditioned room using ear plugs to minimize
distraction. All tests were performed between 1400
and 1600 hours. The KLT consists of 250 analogously
built simple arithmetic procedures mimicking con-
ditions of office work stress. The impossibility to
accomplish all procedures within the available time
frame generates a high and reproducible level of
stress. Heart rate and BP were measured every 5 min
during the mental stress test (duration 30 min) and
for 20 min before and after completion. To compare
the effects between groups and mental stress test
periods, the averages of three time points before,
seven time points during and four time points after
the test completion were used. The primary end
point of the trial was prespecified as the comparison
between groups of the median change from baseline
to follow up in systolic BP during mental stress (that
is, the average of the seven measurement points).
Sample size analysis suggested that 26 participants
Journal of Human Hypertension (2008) 22, 138–140
&
2008 Nature Publishing Group All rights reserved 0950-9240/08
$30.00
www.nature.com/jhh
were needed to show a difference between groups
with a power of 0.90, alpha of 0.05 and a drop-out
rate of three subjects per group. Non-parametric tests
were used to compare groups.
Groups were not different regarding the baseline
characteristics shown in Supplementary Table 1. No
subject in the CMBT group but three controls (two
females) dropped out. Adherence to the study
protocol in the CMBT group was 490% of all
sessions. With CMBT, the median (%) change in
resting office systolic BP after 8 weeks of meditation
was 15 mm Hg (11%) vs 3 mm Hg (0%) in controls
(Po0.0001; Supplementary Table 2). Further, a
significant reduction of diastolic BP (13 vs 2%)
and a trend for heart rate (13 vs 0%) was observed.
At follow-up, 75% of the subjects in the CMBT group
but none of the controls had office BP levels
o130 mm Hg systolic/o80 mm Hg diastolic. Consis-
tently, in the CMBT group, ambulatory BP recordings
showed absolute median reductions of 4–7 mm Hg
for systolic and diastolic BP values for day and night
time periods (all Pp0.005 for comparison of change
between groups; Supplementary Table 2). At follow-
up, 50% of subjects in the CMBT group, but none of
the controls, had total mean BP levels o125 mm Hg
systolic/75 mm Hg diastolic. Mental stress test
induced an immediate sympathetic activation indi-
cated by a sustained rise of systolic BP in both groups
during the 30-min test period (Supplementary Table
2 and Figure 1a). At follow-up, this increase was still
evident in both groups, but the averaged BP during
mental stress was 11 mm Hg lower in the CMBT
group compared with controls: median (%) change
18 mmHg (12%) vs 7mmHg (5%; P ¼ 0.002),
respectively. The raw data and the result of the
primary end point are shown in Figures 1b and c.
This pilot trial indicates that CMBT may effectively
lower BP levels in essential hypertension under
resting conditions and during mental stress. The
observed antihypertensive effects of CMBT were
substantial, of similar magnitude compared with
pharmacotherapeutic trials,
10
sustained during day
PostPre Mental Stress Test Pre
-5 0 5 10 15 20 25
130
140
150
160
170
180
-5 0 5 10 15 20 25 30 35 40 45 50 30 35 40 45 50min
24
∆ systolic, BP, %
diastolic, BP, %
P =0.002
P =0.771
80
90
100
110
Diastolic BP, mm Hg
Systolic BP, mm Hg
Systolic BP, mm Hg
120
130
P =0.002
Follow-up
Meditation
Meditation
P <0.000
120
130
140
150
160
170
180
190
200
21
10
0
10
0
-10
-20
-30
-10
-20
-30
0
Control
Control
P =0.001
PostMental Stress Test
0 5 10 15
24
∆
∆
Change in BP
P =0.002
P =0.771
P =0.002
Baseline
Baseline
Follow-up
Follow-up
Control
Meditation
Baseline
P <0.000P =0.001
P <0.001
a
b
c
Figure 1 (a) The time course of systolic BP behaviour at baseline and follow-up during mental stress test in the intervention and control
group. Boxes (baseline) and circles (follow-up) indicate means with standard errors. (b) Effect of meditation combined with breathing
techniques on BP during mental stress test (that is, average of 7 BP measurements). The panels show individual systolic (top) and
diastolic (bottom) BP levels at baseline and follow-up. Large square boxes indicate means7s.e.m. P-value for within-group comparison
(Wilcoxon’s test). (c) The change of systolic (top) and diastolic (bottom) BP levels between baseline and follow-up within each study
group. Square boxes indicate box and whisker plots. P-value for between-group comparison of median BP changes from baseline to
follow-up (Mann–Whitney U-test). BP, blood pressure.
Research Letter
139
Journal of Human Hypertension
and night and were achieved in the majority of
meditating subjects. A median difference in office BP
between the intervention and the control group of
18 mm Hg was found. This is compatible with a
potentially pronounced risk reduction for stroke and
myocardial infarction, because an increment of
20 mm Hg in systolic BP office readings in middle-
aged persons is associated with a twofold increase in
cardiovascular mortality.
11
In both groups, BP values
during mental stress at follow-up were lower, either
because the participants became accustomed to the
stress situation or due to effects of regression towards
the mean. The absolute increase in systolic/diastolic
BP during mental stress was in the same order of
magnitude as observed previously in healthy con-
trols. However, at follow-up, meditating subjects
started from a lower pre-test BP and maintained
lower BP levels throughout the stress and post-test
period. Both meditation and breathing techniques are
thought to shift the sympathetic/vagal balance to-
wards a vagal stimulation. Our trial design did not
allow studying the differential effects of medita-
tion
8,9,12
and breathing.
6,7
It is possible that the BP-
lowering effect of meditation may attenuate or
dissipate if the intensity or frequency of meditation
sessions decreases. Any meditation technique is
likely to have a substantial placebo effect. Since no
validated ‘sham meditation technique’ is available,
this feature was not included into the study design.
However, we aimed to avoid the previously identi-
fied methodological shortcomings of meditation
research.
3
The beneficial effects of CMBT may be
achievable with less intense protocols and may also
induce indirect effects as better compliance with
pharmacotherapy. Future studies should address the
long-term effects of CMBT on BP as a stand-alone
treatment or as adjunct to pharmacological therapy.
JP Manikonda
1,4
, S Sto
¨
rk
1,4
,STo
¨
gel
1
, A Lobmu
¨
ller
1
,
I Gru
¨
nberg
2
, S Bedel
3
, F Schardt
3
, CE Angermann
1
,
R Jahns
1
and W Voelker
1
1
Department of Internal Medicine I, Center of
Cardiovascular Medicine, University of Wu¨rzburg,
Wu¨rzburg, Germany;
2
Center for Contemplative Meditation, Wu¨rzburg,
Germany and
3
Department of Medicine I, Betriebsa
¨
rztliche
Untersuchungsstelle, University of Wu¨rzburg,
Wu¨rzburg, Germany
4
These authors share the authorship of this
paper equally.
E-mail: stoerk_s@klinik.uni-wuerzburg.de
Published online 6 September 2007
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Supplementary Information accompanies the paper on the Journal of Human Hypertension website (http://
www.nature.com/jhh).
What is known about the topic
K Stress reduction has been regarded as an important
component of the lifestyle changes that might support control
of elevated BP in hypertensives.
K There is inconclusive evidence whether or not meditation as a
stress reduction technique has a positive effect on BP reduction.
What this study adds
K This randomized pilot trial shows that BP in early-stage
hypertension may safely and effectively be lowered by
contemplative meditation combined with breathing techniques.
K Although encouraging, our findings need to be replicated in
different settings before wider recommendations can be made.
Abbreviation: BP, blood pressure.
Research Letter
140
Journal of Human Hypertension
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Article
  • Oct 2020
Hypertension affects approximately one third of the world’s adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.
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... 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 ...
Meditation and Cardiovascular Health: What is the Link?
Article
Full-text available
  • Dec 2019
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.
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... He found decrease in heart rate and decrease in systolic and diastolic blood pressure of the study subjects. (12) Raj yoga meditation Yoga is a Sanskrit word which literally means "link" or "Union". The word Raja means "King", "Sovereign" or "Supreme". ...
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Autonomic Modulation with Mindfulness-Based Stress Reduction in Chronic Kidney Disease: A Randomized Controlled Trial
Preprint
Full-text available
  • Apr 2024
Background: Chronic kidney disease (CKD) is characterized by overactivation of the sympathetic nervous system (SNS) that leads to increased cardiovascular disease risk. Despite the deleterious consequences of SNS overactivity, there are very few therapeutic options available to combat sympathetic overactivity. Aim: To evaluate the effects of Mindfulness-Based Stress Reduction (MBSR) on SNS activity in CKD patients. Method: Participants with CKD stages III-IV were randomized to an 8-week MBSR program or Health Education Program (HEP; a structurally parallel, active control group). Primary outcomes were direct intraneural measures of SNS activity directed to muscle (MSNA) via microneurography at rest and during stress maneuvers. Results: 28 participants (63 ±9 years; 86% males) completed the intervention with 16 in MBSR and 12 in HEP. There was a significant Group (MBSR vs. HEP) by Time (baseline vs. post-intervention) interaction in the change in MSNA reactivity to mental stress (p=0.026), with a significant reduction in the mean change in MSNA over 3 minutes of mental arithmetic at post-intervention (10.6 ± 7.1 to 5.0 ± 5.7 bursts/min, p<0.001), while no change was observed within the HEP group (p=0.773). Conclusions: In this randomized controlled trial, patients with CKD had an amelioration of sympathetic reactivity during mental stress following 8-weeks of MBSR but not after HEP. Our findings demonstrate that mindfulness training is feasible and may have clinically beneficial effects on autonomic function in CKD.
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Meditation for the primary and secondary prevention of cardiovascular disease
Article
  • Feb 2024
Background: Interventions incorporating meditation to address stress, anxiety, and depression, and improve self-management, are becoming popular for many health conditions. Stress is a risk factor for cardiovascular disease (CVD) and clusters with other modifiable behavioural risk factors, such as smoking. Meditation may therefore be a useful CVD prevention strategy. Objectives: To determine the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD. Search methods: We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. Selection criteria: We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators. Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence. Main results: We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates. Authors' conclusions: Despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.
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Unpredictable Chronic Mild Stress-Induced Depressive-Like Behaviors in Spontaneously Hypertensive Rats
Article
Full-text available
  • Oct 2021
Objective The objective is to explore whether hypertension influences unpredictable chronic mild stress (UCMS)-induced depressive-like behaviors and the potential therapeutic effect of Guan-Xin-Shu-Tong capsules (GXST) in controlling hypertension and depressive-like behaviors. Materials and Methods Fifteen spontaneously hypertensive rats (SHR) and 15 wistar rats were divided into three groups respectively ( n = 5, in each group), including control, UCMS, and UCMS + GXST groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at the end of the experiment. Rats were subjected to seven kinds of UCMS over 4 weeks. GXST treatments were administrated (2.8 g/kg) by intragastric gavage once a day over 4 consecutive weeks during UCMS treatment. Sucrose-preference and open-field tests were used to detect depressive-like behaviors. Results SHR exposed to 4-week UCMS treatment had lower HR when compared with control and UCMS + GXST groups ( P < 0.05); Wister rats receiving UCMS or UCMS + GXST had lower SBP ( P < 0.05), lower DBP ( P < 0.05) and lower MAP ( P < 0.05) than controls. Compared with the controls, UCMS reduced the sucrose preference of Wistar rats, UCMS and UCMS + GXST decreased both grid-crossings and the number of upright postures measured in Wistar rats ( P < 0.05). SHR showed lower sucrose consumption, less sucrose preference, and fewer grid-crossings after UCMS than control SHR. However, the lower incidence of upright postures in SHR was prevented by GXST treatment ( P < 0.05). Linear correlation showed that grid-crossings or upright postures were negatively related to the values of SBP, DBP, or MAP, presenting the positive relationship between depressive-like behaviors and SBP, DBP, or MAP reduction in Wistar rats; there was a negative correlation between grid-crossings and DBP responses, and MAP responses in SHR, and a positive correlation between depressive-like behaviors and DBP and MAP response elevation in SHR. Conclusions UCMS-induced depressive-like behaviors in Wistar and SHR, accompanied by a blood pressure decrease in Wistar rats but not in SHR. While GXST exhibited effective relief of depressive-like behaviors in SHR without influencing their blood pressure.
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Treating hypertension with a device that slows and regularises breathing: A randomised, double-blind controlled study
Article
Full-text available
  • May 2001
  • J Hum Hypertens
To examine the efficacy of a new device, which slows and regularises breathing, as a non-pharmacological treatment of hypertension and thus to evaluate the contribution of breathing modulation in the blood pressure (BP) reduction. Randomised, double-blind controlled study, carried out in three urban family practice clinics in Israel. Sixty-five male and female hypertensives, either receiving antihypertensive drug therapy or unmedicated. Four patients dropped out at the beginning of the study. Self treatment at home, 10 minutes daily for 8 consecutive weeks, using either the device (n = 32), which guides the user towards slow and regular breathing using musical sound patterns, or a Walkman, with which patients listened to quiet music (n = 29). Medication was unchanged 2 months prior to and during the study period. Systolic BP, diastolic BP and mean arterial pressure (MAP) changes from baseline. BP reduction in the device group was significantly greater than a predetermined 'clinically meaningful threshold' of 10.0, 5.0 and 6.7 mm Hg for the systolic BP, diastolic BP and MAP respectively (P = 0.035, P = 0.0002 and P = 0.001). Treatment with the device reduced systolic BP, diastolic BP and MAP by 15.2, 10.0 and 11.7 mm Hg respectively, as compared to 11.3, 5.6 and 7.5 mm Hg (P = 0.14, P = 0.008, P = 0.03) with the Walkman. Six months after treatment had stopped, diastolic BP reduction in the device group remained greater than the 'threshold' (P < 0.02) and also greater than in the walkman group (P = 0.001). The device was found to be efficacious in reducing high BP during 2 months of self-treatment by patients at home. Breathing pattern modification appears to be an important component in this reduction.
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Is There a Role for Prayer and Spirituality in Health Care?
Article
Full-text available
  • Feb 2002
  • MED CLIN N AM
While most people will turn to prayer during serious illness or impending death, our healthcare system has tended to relegate prayer and spirituality to the periphery of medical care, if it is tolerated at all. Despite recent research that seemingly demonstrates a relationship between prayerful practices and health benefits, the integration of spirituality into the practice of medicine remains elusive. The research that purports to demonstrate the link between prayer and health is examined in an exploration of the place prayer and spirituality might have in the health care system.
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The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report
Article
Full-text available
  • May 2003
"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.
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Value of low dose combination treatment with blood pressure lowering drugs: Analysis of 354 randomised trials
Article
Full-text available
  • Jul 2003
  • Br Med J
To determine the average reduction in blood pressure, prevalence of adverse effects, and reduction in risk of stroke and ischaemic heart disease events produced by the five main categories of blood pressure lowering drugs according to dose, singly and in combination. Meta-analysis of 354 randomised double blind placebo controlled trials of thiazides, beta blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, and calcium channel blockers in fixed dose. 40,000 treated patients and 16,000 patients given placebo. Placebo adjusted reductions in systolic and diastolic blood pressure and prevalence of adverse effects, according to dose expressed as a multiple of the standard (recommended) doses of the drugs. All five categories of drug produced similar reductions in blood pressure. The average reduction was 9.1 mm Hg systolic and 5.5 mm Hg diastolic at standard dose and 7.1 mm Hg systolic and 4.4 mm Hg diastolic (20% lower) at half standard dose. The drugs reduced blood pressure from all pretreatment levels, more so from higher levels; for a 10 mm Hg higher blood pressure the reduction was 1.0 mm Hg systolic and 1.1 mm Hg diastolic greater. The blood pressure lowering effects of different categories of drugs were additive. Symptoms attributable to thiazides, beta blockers, and calcium channel blockers were strongly dose related; symptoms caused by ACE inhibitors (mainly cough) were not dose related. Angiotensin II receptor antagonists caused no excess of symptoms. The prevalence of symptoms with two drugs in combination was less than additive. Adverse metabolic effects (such as changes in cholesterol or potassium) were negligible at half standard dose. Combination low dose drug treatment increases efficacy and reduces adverse effects. From the average blood pressure in people who have strokes (150/90 mm Hg) three drugs at half standard dose are estimated to lower blood pressure by 20 mm Hg systolic and 11 mm Hg diastolic and thereby reduce the risk of stroke by 63% and ischaemic heart disease events by 46% at age 60-69.
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The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Article
Full-text available
  • Dec 2003
  • Hypertension
The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.
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Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
Article
  • Jan 2002
The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Methods Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56 000 vascular deaths (12 000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66 000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Findings Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at,ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Interpretation Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
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Prayer and health outcomes in Church members
Article
  • Aug 2000
  • Alternative Ther Health Med
This study adds to the existing research on religion and health by focusing on the specific practice of prayer and its relationship to health outcomes. The purpose of this survey is to examine the relationship of frequency of prayer to 8 categories of physical and mental health. The Presbyterian Church, USA, performed data collection as part of an ongoing research program. Members of the Presbyterian Church were randomly selected from the national population and surveyed by mail on their frequency of prayer and their health status, as measured by the Medical Outcomes Study Short-form 36 Health Survey. Self-reports of health indicated a high level of functioning overall for all 8 categories of physical and mental health. People who prayed more often scored lower in their physical functioning and their ability to carry out role activities, and higher in their reports of physical pain. However, people who prayed more often also had significantly higher mental health scores than did those who prayed less frequently, despite their physical health problems. This study supports the relationship of a high frequency of prayer with a more positive mental health. Various explanations of the results are explored.
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Lewington S, Clarke R, Qizilbash N, Peto R, Collins R and Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet 2002; 360: 1903-1913
Article
  • Jan 2003
The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56000 vascular deaths (12000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
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