Meditation may lower blood pressure: but which type should we choose?

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Different meditation practices shown to reduce blood pressure

Many studies have researched meditation’s effects on blood pressure and indications are that some types of meditation have modest but significant potential to reduce it.  Of the different types, Transcendental Meditation (TM) has seen the most prolific research over the years. In April this year, the American Heart Foundation included TM as one of the alternative approaches it recommends to be considered in clinical practice for the prevention and treatment of hypertension[1] (another term for high blood pressure).

Now another practice with a basis in mindfulness meditation, has been shown to reduce blood pressure for individuals with prehypertension (meaning their blood pressure is higher than desirable, but lower than the levels of hypertension, which requires medication). In this month’s issue of Psychosomatic Medicine, a new study shows that non-medicated individuals with prehypertension have significantly lower blood pressure following an 8-week Mindfulness-Based Stress Reduction (MBSR) course, compared to the active control group, who received standard relaxation training in the form of Progressive Muscle Relaxation (PMR)[2].

The authors of the MBSR study conclude: “Our results provide evidence that MBSR, when added to lifestyle modification advice, may be an appropriate complementary treatment for BP (blood pressure) in the prehypertensive range,”[3]

As reported in ScienceDaily, “Although the blood pressure reductions associated with mindfulness-based interventions are modest, they are similar to many drug interventions and potentially large enough to lead to reductions in the risk of heart attack or stroke.”

So which meditation should we choose?

If people are to consider meditation as an add-on to the lifestyle modifications that are generally recommended by doctors to lower blood pressure, one wouldn’t blame them for being confused about which type to choose. The two that have been most researched are very different techniques.

MBSR is an 8-week programme delivered in a group setting consisting of 2.5 hour sessions each week, where participants are guided through a combination of mindfulness meditation and stress relief techniques. An overview of mindfulness meditation is given here, but in essence it is about paying attention with openness and attention to the present moment – including all thoughts, feelings, sensations as they arise. We are encouraged to observe all such phenomena but instead of getting carried away by them we bring our attention back to a single point of focus, usually the breath.

Transcendental Meditation is a mantra-based meditation, taught in person and individually by a TM teacher (click here for overview). A 2012 meta-analysis[4] comparing meditation studies for blood pressure summarises the claimed effects of TM nicely: In the TM technique, the mantras, which are used for sound value rather than meaning, become increasingly secondary in experience and eventually disappear, while self-awareness becomes primary in experience as the practitioner transcends to a state of pure consciousness”.[5]

Both have been shown to reduce stress, which then leads to reduction in blood pressure. Authors of the MBSR study claim that reductions in blood pressure are comparable across both practices. TM however is solely meditation, whereas MBSR combines 3 techniques: mindfulness meditation, body scan, and non-strenuous yoga.

Both have barriers to adoption. One has to find a convenient time and location to attend 8 weekly sessions for the group-based MBSR, which will probably have to be privately funded, and as is instruction in TM.

What is interesting is that both these meditative practices are more effective than standard relaxation techniques for reducing blood pressure: “Overall, relaxation techniques, the most common being progressive muscle relaxation (PMR), are not considered effective methods for treating hypertension”.[6]

Ultimately the choice will come down to availability, affordability, and a preference for style. If time and money are issues for someone interested in the benefits of these practices, a place to start might be to try simple meditation techniques for free, at a time convenient to thee (for recommendations of easy guided apps see “Who is bringing meditation to the masses?”). Although the research has so far studied strict protocols in the form of TM and MBSR, it wouldn’t be unreasonable to start the habit with something more accessible.

 

UPDATE TO POST

Since this was posted another article was published – it showed like Brook et al that MBSR doesn’t reduce ambulatory blood pressure (Hughes et al study showed it to reduce only clinic BP, not ambulatory BP), and therefore concluded that MBSR has no significant effect on BP. Joel Hughes, co-author of the article reviewed in this post, comments on this. See comments below,

 


[1] Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S. Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure: A Scientific Statement From the American Heart Association. Hypertension 2013;61:1368Y83.

[2] J. W. Hughes, D. M. Fresco, R. Myerscough, M. H. M. van Dulmen, L. E. Carlson, R. Josephson. Randomized Controlled Trial of Mindfulness-Based Stress Reduction for Prehypertension. Psychosomatic Medicine, 2013; 75 (8): 721 DOI: 10.1097/%u200BPSY.0b013e3182a3e4e5

[4] “Meta-analysis is a statistical procedure that integrates the results of several independent studies considered to be ‘combinable.’” http://www.bmj.com/content/315/7121/1533

[5] Carly M. Goldstein, Richard Josephson, Susan Xie, and Joel W. Hughes, “Current Perspectives on the Use of Meditation to Reduce Blood Pressure,” International Journal of Hypertension, vol. 2012, Article ID 578397, 11 pages, 2012. doi:10.1155/2012/578397

[6] See footnote 4

5 Comments on “Meditation may lower blood pressure: but which type should we choose?

  1. See also the article by Blom et al in A J Hypertension here: http://ajh.oxfordjournals.org/content/early/2013/09/13/ajh.hpt134.abstract

    In both Hughes et al and Blom et al mindfulness meditation did not reduce ambulatory blood pressure (BP). In Hughes et al meditation reduced “clinic” BP. They are consistent in their findings, but Blom et al did not focus on clinic BP.

    We must consider the differences between clinic and ambulatory BP to understand this apparent discrepancy. Clinic BP is measured in a controlled setting; seated, after a rest, arm supported at heart level, etc.–just like the AHA says to measure BP. Most clinical decisions in the management of BP are based on clinic BP. Ambulatory BP is measured by a BP machine people wear as they go about their daily life.

    So it is possible that the effects of meditation are most apparent in a controlled situation with less “noise.” There are many factors that affect BP during the day and night; posture, activity, recent intake (e.g., nicotine, caffeine), mental stress, sleep, and so on. However, BP during daily life is the BP that people “really have,” as clinic BP is an artificial situation in a way. Ambulatory BP is more related to the deleterious effects of high BP on body organs than clinic BP.

    One could argue that ambulatory BP is more important, and that changes in BP of the magnitude necessary to be reflected in the somewhat noisier measurements would be ideal. One could also argue that clinic BP gave people the chance to use their new skills; either meditating or relaxing (in Hughes et al) right before the BP was taken. If meditation only reduces BP right when someone is meditating, that is less exciting than if meditation has prolonged effects on BP. On the other hand, one could argue that the effects of most interventions are easiest to see in a carefully controlled environment, which is why we fast before a cholesterol test, etc.

    Ultimately, only TM has enough research for a conclusion at this point. More research on mindfulness meditation is necessary to fully understand whether or not it reliably reduces BP.

  2. Joel – thanks very much for responding to my query on that article. Once I read that it says “MBSR research shows it doesn’t lower blood pressure” I realised that they studied specifically ambulatory BP – while yours studied both, and your found it lowered clinic BP – so wanted to know which type of BP – ambulatory or clinic is more important.
    Your response makes sense – more research needed to see the effects of MBSR on BP.
    Thanks!
    Adiba

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