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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.
RESEARCH LETTER
Contemplative meditation reduces
ambulatory blood pressure and
stress-induced hypertension:
a randomized pilot trial
Journal of Human Hypertension (2008) 22, 138140;
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, 138140
&
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$30.00
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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
... Therefore, meditation may lead to & Amy R. Borchardt borchardt_ar@mercer.edu quicker BP and HR recovery from stress compared to simple distractions. Indeed, meditation studies examining physiological activity during meditation, at rest or across the day (while not meditating) show that meditation leads to immediate and long-term decreases in BP and HR (Barnes et al., 1999;Benson et al., 1974bBenson et al., , 1974cCauthen & Prymak, 1977;Cuthbert et al., 1981;Ditto et al., 2006;English & Baker, 1983;Holmes et al., 1983;Manikonda et al., 2008;Peters et al., 1977;Solberg et al., 2004;Rainforth et al., 2007). However, currently there is only one dissertation study (Key, 2010) regarding the cardiovascular effects of meditating during recovery from stress; Key (2010) found no differences in BP and HR when comparing a mindfulness meditation group to a distraction group during recovery from stress. ...
... Indeed, research shows that when expert meditators practice meditation in the laboratory (Holmes et al., 1983;Solberg et al., 2004) or novices are used in within-subjects designs (Ditto et al., 2006) it does not always lead to greater decreases in BP compared to control groups. However, studies that have used naturalistic settings or multiple collection days have been more likely to show that meditation produces decreased BP (Benson et al., 1974b(Benson et al., , 1974cPeters et al., 1977;Manikonda et al., 2008;Stuart et al., 1987;Wenneberg et al., 1997). ...
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Identifying strategies that aid in recovery from stress may benefit cardiovascular health. Ninety-nine undergraduate meditation novices were randomly assigned to meditate, listen to an audio book, or sit quietly after a standardized stressor. During recovery, meditators’ heart rate variability and skin conductance levels returned to baseline, whereas only heart rate variability returned to baseline for the audio book and control groups. Positive and negative affect were no different than baseline following meditation, whereas, both audio book and control groups had lower positive affect and higher negative affect following the intervention. Findings suggest that the sympathetic nervous system is uniquely affected by meditation, and novices may benefit emotionally from meditating after a stressor. Further research is needed to determine meditation’s utility in recovering from stress.
... Studies of meditation and ABPM, such as those by Barnes [14] and Manikonda [15], demonstrate the superiority of meditation over other techniques in reducing BP in intervention groups compared to control groups. In contrast, in the study by Blom [12], no significant reduction in BP was observed for meditation for ABPM in patients with untreated grade 1 AHT. ...
... The questionnaire is composed of three subscales with seven items each: depression, anxiety and stress. We used the Spanish version of this questionnaire, as validated by Bados et al. [15], with Cronbach alpha values between 0.7 and 0.84. ...
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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.
... Estas mudanças inter-relacionadas são experimentadas como sentimentos e podem interromper o comportamento em curso ou ainda levar a processos mentais. 33 Em indivíduos que, normalmente no dia a dia, tendem a reagir positivamente e sem respostas associadas ao stress, a atividade elétrica de base do cérebro deve-se à maior ativação anterior do lado esquerdo [atividade gamma-band (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)]. 34 A relação entre afetividade positiva e atividade anterior das áreas do cérebro é fortemente apoiada, como avaliado por Craig, 32 pela conectividade anatómica entre o sistema nervoso autónomo e as áreas do cérebro anterior. ...
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Background. Some studies published previously have shown a strong correlation between hypertension and psychological nature including impulsion emotion or mindfulness and relaxation temperament, among which mindfulness and relaxation temperament might have a benign influence on blood pressure, ameliorating the hypertension. However, the conclusion was not confirmed. Objective. The meta-analysis was performed to investigate the influence of mindfulness and relaxation on essential hypertension interventions and confirm the effects. Methods. Systematic searches were conducted in common English and Chinese electronic databases (i.e., PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and Chinese Biomedical Literature Database) from 1980 to 2020. A meta-analysis including 5 studies was performed using Rev Man 5.4.1 software to estimate the influence of mindfulness and relaxation on blood pressure, ameliorating the hypertension. Publication bias and heterogeneity of samples were tested using a funnel plot. Studies were analyzed using either a random-effect model or a fixed-effect model. Results. All the 5 studies investigated the influence of mindfulness and relaxation on diastolic and systolic blood pressure, with total 205 participants in the control group and 204 in the intervention group. The random-effects model (REM) was used to calculate the pooled effect for mindfulness and relaxation on diastolic blood pressure (I² = 0%, t² = 0.000, ). The random pooled effect size (MD) was 0.30 (95% CI = −0.81–1.42, ). REM was used to calculate the pooled effect for mindfulness and relaxation on systolic blood pressure (I² = 49%, t² = 3.05, ). The random pooled effect size (MD) was −1.05 (95% CI = −3.29–1.18, ). The results of this meta-analysis were influenced by publication bias to some degree. Conclusion. All the results showed less influence of mindfulness and relaxation might act on diastolic or systolic blood pressure, when mindfulness and relaxation are used to intervene in treating CVD and hypertension. 1. Introduction The primary aim of hypertension therapy is to condense the mortality and elude the diseases related to it, such as the strokes, cerebral hemorrhage, dementia, and metabolic syndrome, by practicing blood pressure management. The patients suffering from hypertension need to incorporate some lifestyle modifications where they follow certain diet and weight regulation programs before the initiation of the relative drug therapy [1, 2]. According to the worldwide stats, approximately 1 billion of the population is affected by hypertension which causes around 7.1 million deaths per year. It was predicted that eradication of hypertension has an immense effect on the mortality associated with cardiovascular disease (CVD) than the eviction of any other CVD-based risk elements in the females and any in case of males except for smoking [3]. Despite multiple proven methods to treat hypertension, blood pressure is still counted as uncontrolled among the hypertensive patients. The elevated blood pressure is considered to be the “silent killer” because of no specific symptoms associated with it, and thus, people are not aware of it until regular monitoring of blood pressure is maintained. According to a consensus theoretical foundation in 2015, it was proposed that mindfulness can have a major impact on the cardiovascular disease in purpose to the blood pressure [4]. Thus, after reaching the realistic limits of confining the treatment of hypertension only to the medicines, the recent research studies have proven to integrate the treatment with dietary practice, exercises, and meditation [5]. The origin of mindfulness therapy has its roots from the Buddhist meditation traditional techniques fused with meditation. Mindfulness is the self-regulation of attentiveness to the conscious awareness of experiences in present moment with an attitude of acceptance, curiosity, and openness [6]. Mindfulness training is aimed at strengthening of individuals’ intrinsic ability to be conscious of what is happening inside and outside with curious and nonjudgmental viewpoint [7]. In the recent years, meditation techniques have proven to be considered under the clinical treatments of stress, where mindfulness-based stress reduction therapy (MBSR) is most popular. A clinically proven MBSR is an 8-week designed standard program founded by Brook et al. [8]. It highlights on practicing intentionally focusing towards the consciousness on one’s experiences about the present instance without judgment. The main focus of this program is to concentrate towards enthusiasm, acceptance, and openness towards the present moment which is supported by a set of formal and informal practices where the former consists of body scan meditation and walking meditation and the latter follows emotional connections, interpersonal communications, awareness, and experience towards daily events [9]. The regular practice of MBSR is considered to diminish BP in multiple ways including reduction of psychological stress and mood switching that are linked with hypertension and CVD [10–13]. A wider understanding towards the analysis of anxiety issues comprises of multiple elements like the biological, psychological, and social enticement, where different risk and protective factors are the mediators [14]. There has been a separate clinical community formed to focus on anxiety issues and to investigate the benefits of combined and tailored somatic and psychological therapies [15]. There has been an enormous advancement made towards nonpharmacological treatment of anxiety issues [16]. Thus, relaxation approaches are one of the widely discussed techniques which represent anxiety management program at global level [17–20]. Although there are wide range of relaxation approaches which have been recognized scientifically, but can still be defined worldwide as a cognitive/behavioral method to highlight the formation of a relaxation reaction to prevent the stress response of anxiety. Therefore, the relaxation reaction is determined as a group of integrated physiological approaches and “adjustments” which are engaging the subject in a mundane mental or physical task and ignoring the distracting thoughts. 2. Methodology 2.1. Search Strategy Based on the guidelines [21] of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, studies were searched using PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Chinese Biomedical Literature Databases. 2.2. Data Extraction The data were recorded from each study on basis of hypertension baseline, systolic and diastolic blood pressure (control and intervention group), mean age, sample size, study duration, mean changes in blood pressure levels, standard deviation (SD), standard error (SE), estimated mean, and 95% CI. In total, 6 studies were considered for meta-analysis. 2.3. Exclusion Criteria Studies were excluded on the following basis: (1) dissertations were excluded from the study, (2) studies lacking intervention groups, (3) lack of protocols in the study, (4) lack of clinical context, (5) incomplete publishing of data, (6) data without statistical analysis, and (7) incompletely reported data. 2.4. Inclusion Criteria Studies were included on the following basis: (1) human participants in study, (2) type of intervention, (3) subjects in the study, (4) control groups inclusions, (5) baseline of systolic and diastolic values, (6) patients with prehypertension or hypertension, (7) mindfulness therapy and relaxation therapy as interventions, (8) studies published in English studies, and (9) statistics. 2.5. Data Analysis Meta-analysis was performed using RevMan 5.4.1. The variables were analyzed as continuous via mean ± SD. The mean difference was evaluated with 95% CI (Figure 1).
... In addition to psychological and psychosocial stressors, the presence of comorbidities associated with CKD, such as hypertension, is very prevalent in people with CKD 52 . Previous studies found significant results, like those reported by Park et al. (2014) 39 on the effects of mindfulness meditations on the physical measures of blood pressure, heart rate, and respiratory rate [53][54][55][56] . One of the potential mechanisms behind these results may be the fact that MBIs are associated with a reduction in sympathetic activity via an inflammatory decrease, mainly acting on markers such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin 8 (IL-8) described in previous studies 57, 58 . ...
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Introduction: Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies. Methods: We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936). Results: Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1). Conclusions: MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.
... In this context, a single session of mindfulness meditation can acutely decrease SNS activity and SBP and DBP in patients with hypertension and chronic kidney disease 360 . These findings are consistent with the benefits of regular meditation (up to 16 weeks) for improving autonomic balance (as assessed with heart rate variability) 351 and BP in patients with pre-hypertension or hypertension 361,362 or with coronary heart disease 351 , and even for decreasing mortality (over a mean follow-up of 7.6 years) in patients aged ≥55 years with hypertension 363 . ...
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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.
... 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 ...
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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.
... 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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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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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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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" 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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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 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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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.
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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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.