Stress reduction programs in patients with elevated blood pressure: A systematic review and meta-analysis

Abstract

Substantial evidence indicates that psychosocial stress contributes to hypertension and cardiovascular disease (CVD). Previous meta-analyses of stress reduction and high blood pressure (BP) were outdated and/or methodologically limited. Therefore, we conducted an updated systematic review of the published literature and identified 107 studies on stress reduction and BP. Seventeen trials with 23 treatment comparisons and 960 participants with elevated BP met criteria for well-designed randomized controlled trials and were replicated within intervention categories. Meta-analysis was used to calculate BP changes for biofeedback, -0.8/-2.0 mm Hg (P = NS); relaxation-assisted biofeedback, +4.3/+2.4 mm Hg (P = NS); progressive muscle relaxation, -1.9/-1.4 mm Hg (P = NS); stress management training, -2.3/-1.3 mm (P = NS); and the Transcendental Meditation program, -5.0/-2.8 mm Hg (P = 0.002/0.02). Available evidence indicates that among stress reduction approaches, the Transcendental Meditation program is associated with significant reductions in BP. Related data suggest improvements in other CVD risk factors and clinical outcomes.

Formative evaluation on cultural tailoring breathing awareness meditation smartphone apps to reduce stress and blood pressure

“…These maladaptive coping styles have long been noted in stress research to further contribute to perceived stress, as well as development or exacerbation of various chronic diseases (e.g., EH, obesity, CVD, stroke, certain cancers, etc.) (3,17). There were, however some positive coping strategies noted including taking a "time out," relaxing and exercising.…”

“…Meta-analytic reviews have shown BAM reduces self-reported stress, anxiety, worry and their associated detrimental physiological effects including elevated blood pressure (BP) (17,18). A number of randomized clinical trials have been conducted using BAM and have indicated high acceptability, usability, and beneficial effects on stress levels, physiological functioning, and reduced casual and ambulatory BP (17,18). Our prior research has also found BAM highly acceptable, easy to learn and has resulted in reductions of stress, hostility, resting and ambulatory BP and improved sodium handling (19)(20)(21)(22)(23).…”

“…BAM research also has lacked efficacious objective measure of adherence to BAM practice sessions outside of the classroom or clinic, effecting the true reported dosage conditions (17,(24)(25)(26). The actual amount of BAM dosage is unknown in many studies and may partially contribute to the substantial heterogeneity in individuals' BP changes observed within and across trials.…”

The sympathetic nervous system and blood pressure in humans: implications for hypertension

“…In a recent meta-analysis, transcendental meditation was reported to effectively lower blood pressure in patients with hypertension, whereas psychological approaches to stress management were deemed ineffective. 89 Intriguingly, the results of several studies indicate that device-guided, home-based training with slow, deep breathing can effectively reduce blood pressure in patients with hypertension, [90][91][92] although this has not been a universal finding. 93 These findings are particularly intriguing given the recent identification of an amplified bursting of SNA related to the respiratory cycle that appears to contribute to the progression and maintenance of hypertension in rats, 7 and the alterations in respiratory-sympathetic coupling recently reported in human hypertension.…”

From Retreat Center to Clinic to Boardroom? Perils and Promises of the Modern Mindfulness Movement

“…Buoyed by the Maharishi's rise to Western fame in the late 1960's, the transcendental meditation (TM) movement predates the mindfulness movement by several decades, and appears to promote a range of health benefits ranging from lowering blood pressure to improving cognitive flexibility [16]. TM is perhaps best known in the research literature for its ability to promote relaxation and reverse physiological markers of chronic stress [17], outperforming related practices in promoting relaxation [18]. MSMT differs from TM by de-emphasizing relaxed, focus attention as a proximal goal, emphasizing instead the cultivation of awareness leading to insight into the nature of reality and one's conditioning within it [19].…”