Mindfulness Could Combat Uncontrolled Hypertension: MB-BP

CHICAGO, IL—A mindfulness intervention designed for those with uncontrolled hypertension has the potential to reduce systolic blood pressure by clinically-meaningful amounts, according to data from the MB-BP randomized study.

Prior research has shown that activities like yoga can aid in post-MI cardiac rehab programs and also has demonstrated a direct link between stress and hypertension.

“We know how to bring blood pressure down for just about everybody through, for example, physical activity, diet, and antihypertensive medication,” said Eric Loucks, PhD (Brown University, Providence, RI), who presented the findings during a late-breaking clinical trial session at the American Heart Association (AHA) 2022 Scientific Sessions.

Mindfulness—with its core tenets of being nonjudgmental, curious, and accepting—is starting to come in as a way to potentially improve outcomes for the “about half of Americans with hypertension, of which about 50-75% are uncontrolled,” he said.

Commenting on the findings for TCTMD, AHA President Michelle Albert, MD, MPH (University of California, San Francisco), said mindfulness goes deeper than mere exercise. “What things like mindfulness and yoga do,” she explained, “is that they give you space to think about yourself, think about your life, and think about things that may matter to you, inside and outside the context of the session, because they help regulate the way you perceive things and how you think in general.”

Mindfulness vs Enhanced Care

For the MB-BP trial, Loucks and colleagues developed a mindfulness-based BP-reduction program around the premises of emotion regulation, attention control, and self-awareness that would help address determinants of blood pressure, including physical activity, diet, obesity, alcohol use, stress, and antihypertensive medication use. It included coaching on various mindfulness skills, such as body scan exercises, meditation, and yoga.

The researchers randomized 201 patients (mean age 59; 41% men) with elevated unattended office BP at baseline (≥ 120 mm Hg systolic or ≥ 80 mm Hg diastolic) to the 8-week intervention or enhanced usual care. Those in the intervention arm met once a week for 2.5 hours and attended a 1-day retreat, while controls received health education material. Both groups received home BP monitors. Notably, 81% of study participants were white, and 73% had a college education.

At 6 months, those in the mindfulness group saw a mean 5.9-mm Hg reduction in the primary endpoint of unattended office systolic BP, which was 4.5 mm Hg more than among controls (P = 0.045).

In post hoc analyses that adjusted for baseline blood pressure and sex, there was a between-group difference of 4.3 mm Hg in mean systolic BP reduction at 6 months (P = 0.056). Another sensitivity analysis that accounted for the fact that several patients were unavailable for follow-up due to the COVID-19 pandemic showed a smaller between-group effect size (P = 0.26), and there were no differences observed in diastolic BP between the groups.

Interestingly, those in the intervention arm reported significantly less sedentary activity (P = 0.02) than controls, with a trend toward more physical activity (P = 0.12). Patients who went through the mindfulness program also scored higher on the Five Facet Mindfulness Questionnaire (P < 0.001) and there was a trend toward a higher DASH diet score (P = 0.08).

There were four serious adverse events reported in each group over the course of the study, but none were found to be related to involvement in the study.

More Study in Different Populations Needed

Loucks acknowledged several limitations of their study. First, the limited 6-month follow-up time leaves open the question of whether their mindfulness program has durable effects. “And then we've got a fairly high proportion of well-educated white participants in the study, which reduces the generalizability to other racial and ethnic groups and other socioeconomic groups,” he said. “And so we're working hard on that piece.”

Loucks said his team plans to start working on a study with the Mohegan Tribe, “weaving in their culture and traditions,” to reproduce this trial.

Albert, too, picked up on the need for better generalizability. “I worry about the participants being self-selected to be part of this project,” she said. “Already they’re primed to have the intervention work, which means it might not work in other groups. Perhaps they are more self-aware of their stress levels, and that might mean that their stress levels are lower than the average person.”

She advised recreating this study in a population that would be more likely to benefit from an intervention. For example, Albert said, “I would focus on doing it in a population that is stressed out, has medical issues like a heart failure population, or Takotsubo cardiomyopathy. If you can truly get benefit in those higher-risk populations, then you can figure out if something works or not.”

On a broader scale, Albert said that mindfulness and yoga offerings are generally prominent in affluent neighborhoods, but not as much for patients at the other end of the socioeconomic scale.