Mindfulness may offer an ‘appealing approach’ to lower blood pressure
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CHICAGO — A mindfulness-based program adapted for individuals with elevated BP showed “potentially clinically relevant” reductions in systolic BP 6 months after participation, researchers reported.
At 6 months’ follow-up, participants of the mindfulness-based program had a mean reduction in systolic BP of nearly 6 mm Hg, Eric B. Loucks, PhD, associate professor of epidemiology and director of the Mindfulness Center at Brown University, said during a presentation at the American Heart Association Scientific Sessions.
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The Mindfulness-Based Blood Pressure Reduction (MB-BP) program focuses on training participants in skills such as attention control, self-awareness and emotion regulation. That training is then applied to health behavior change. This could be a novel strategy to improve BP control, according to Loucks.
Mindfulness training
Researchers recruited more than 200 adults from the Providence, Rhode Island, area who had elevated BP (> 120/80 mm Hg). Participants were mostly women (59%), the mean age was 59 years, 81% were white and 73% had a college education.
Half of participants were randomly assigned to enhanced usual care, which comprised a home BP monitor and training, BP education materials from the AHA and facilitated access to a physician, if needed. The other half were randomly assigned to the MB-BP program, which consisted of an in-person group orientation session, eight 2.5-hour weekly group sessions and a 7.5-hour group retreat. Participants were also recommended to follow a home mindfulness practice of at least 45 minutes per day 6 days per week.
“Mindfulness training trains us in attention control so that we can place our mind where we choose to place it, through practice on the breath or meditating on other parts of the body. ... There’s some self-awareness that arises in terms of how we feel the next day after a lot of alcohol consumption, for example, or a lack of physical activity or actually a good amount of physical activity ... [and] then you might get some insights that arise with the enhanced attention control [and] can act on it. That’s the framework we developed and are testing in this program,” Loucks said during a press conference.
Reduction in systolic BP
The primary outcome was change in unattended office systolic BP at 6 months.
Results showed a 5.9 mm Hg reduction in unattended office systolic BP at 6 months’ follow-up in the mindfulness-based program group compared with a 1.4 mm Hg reduction in the enhanced usual care group. The between-group difference was 4.5 mm Hg (P = .045), Loucks reported.
There were no notable changes in diastolic BP in either group.
The researchers then looked at examples of plausible mechanisms. Participants in the mindfulness-based program group were more likely to have a higher Dietary Approaches to Stop Hypertension (DASH) diet score, improved perceived stress and levels of mindfulness, less sedentary time and higher levels of physical activity.
Implications and future directions
Loucks noted several limitations of the current study, including its limited duration of follow-up and inclusion of mainly college-educated white adults, which limits the generalizability of the findings. He said the researchers recently received a grant to adapt MB-BP with the Mohegan Native American tribal nation.
“I’d like to see this [study] replicated by groups other than us ... and with longer follow-up time and more generalizable participant samples. If that were to happen and the results held, it could be an appealing approach to help control the blood pressure of about half of Americans who have hypertension, of which of them only about half are controlled,” Loucks said.
Loucks referenced data from the Blood Pressure Lowering Treatment Trialists’ Collaboration published in The Lancet in 2021. In the meta-analysis of nearly 345,000 participants, a 5 mm Hg reduction in systolic BP translated into a 10% reduction risk for major CV events.
“With our 5.9 mm Hg drop [in systolic BP] from baseline [and] between-group difference of 4.5 mm Hg, this could be clinically relevant,” Loucks said.
The researchers are evaluating three different primary outcomes. The other two will be in a paper submitted soon, Loucks said.
Reference:
- Mindfulness shows promise as an effective intervention to lower blood pressure. https://newsroom.heart.org/news/mindfulness-shows-promise-as-an-effective-intervention-to-lower-blood-pressure. Published Nov. 6, 2022. Accessed Nov. 6, 2022.
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Dipti Itchhaporia, MD, MACC, FESC, FAHA
This study looked at about 200 patients; 100 in a usual care arm and the other 100 received mindfulness training to see if this could help reduce their BP. Interesting, it decreased the systolic BP about 5.9 mm Hg. We know that a 5 mm Hg decrease in BP can translate into about a 10% decrease in CV events.
This is a quite interesting study. It suggests that maybe mindfulness can be used in patients in lieu of another antihypertensive medication or in addition to other antihypertensive medications. It was a small study of only 6 months’ duration so we don’t know the durability of these results. It was predominantly done in a white, highly educated population. So I think we have to wait to see if the results are generalizable.
It’s a provocative study, but I think we need more data.
Director of disease management
Jeffrey M. Carlton Heart and Vascular Institute
Hoag Memorial Hospital, Newport Beach, California
Associate clinical professor of medicine
University of California, Irvine
Immediate past president, American College of Cardiology
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Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA
The mindfulness approach to BP reduction, where someone divorces him/herself from everyday stresses, was interesting and is going to get a lot of press. The approach is related to meditation but it is deeper than that, including embracing a healthy lifestyle and encouraging medication adherence.
However, there are several problems with this study in terms of applying it across wide populations. It was conducted mainly in educated self-identified white participants (about 80%) and the proportion of college graduates was approximately 75%. It will be hard for patients who are disadvantaged and live in a very stressful socioeconomic environment to undergo the training and practice mindfulness.
Also, an unintended consequence of the public embracing a superficial approach to mindfulness is that some patients may consider that BP medicines are bad and a novel means of treating hypertension that does not involve medications is better. The use of antihypertensive medications has had a linear, direct, proven benefit at reducing CVD, CV mortality and overall mortality. The BP Behavioralist Trialists’ Collaboration out of the U.K. has a regression line that shows that with each of the new studies, ending with SPRINT, where the goal was systolic BP < 120 mm Hg, lower is better, and it’s mainly done through medication.
Mindfulness may have some benefit in helping patients escape some of the ravages of daily stress, but most middle-aged and older persons are going to need two or more medicines. Although antihypertensive drug use was encouraged, I never want to send a message that medications are harmful and should be avoided.
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Loucks EB, et al. LBS.04. Late-Breaking Science: Mindful Disruption of Chronic Hypertension Management. Presented at: American Heart Association Scientific Sessions; Nov. 5-7, 2022; Chicago (hybrid meeting).
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