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Owolabi M, Olowoyo P, Mocumbi A, Ogah OS, Odili A, Wahab K, Ojji D, Adeoye AM, Akinyemi R, Akpalu A, Obiako R, Sarfo FS, Bavuma C, Beheiry HM, Ibrahim M, El Aroussy W, Parati G, Dzudie A, Singh S, Akpa O, Kengne AP, Okekunle AP, de Graft Aikins A, Agyemang C, Ogedegbe G, Ovbiagele B, Garg R, Campbell NRC, Lackland DT, Barango P, Slama S, Varghese CV, Whelton PK, Zhang XH. African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): novel strategies for accelerating hypertension control in Africa. J Hum Hypertens 2023:10.1038/s41371-023-00828-8. [PMID: 37076570 DOI: 10.1038/s41371-023-00828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023]
Abstract
Hypertension is a leading preventable and controllable risk factor for cardiovascular and cerebrovascular diseases and the leading preventable risk for death globally. With a prevalence of nearly 50% and 93% of cases uncontrolled, very little progress has been made in detecting, treating, and controlling hypertension in Africa over the past thirty years. We propose the African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE) to implement the HEARTS package for improved surveillance, prevention, treatment/acute care of hypertension, and rehabilitation of those with hypertension complications across the life course. The ecosystem will apply the principles of an iterative implementation cycle by developing and deploying pragmatic solutions through the contextualization of interventions tailored to navigate barriers and enhance facilitators to deliver maximum impact through effective communication and active participation of all stakeholders in the implementation environment. Ten key strategic actions are proposed for implementation to reduce the burden of hypertension in Africa.
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Affiliation(s)
- Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Department of Medicine, University College Hospital, Ibadan, Nigeria.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
- Lebanese American University of Beirut, Beirut, Lebanon.
| | - Paul Olowoyo
- Department of Medicine, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - Ana Mocumbi
- Departamento de Medicina, Universidade, Eduardo Mondlane, Maputo, Mozambique
| | - Okechukwu S Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/ University College Hospital, Ibadan, Nigeria
| | - Augustine Odili
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Dike Ojji
- Department of Medicine, University of Abuja, Abuja, Nigeria
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Abiodun M Adeoye
- Cardiovascular Genetics and Genomic Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
| | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charlotte Bavuma
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Hind Mamoun Beheiry
- Physiology Department, Faculty of Medicine, International University of Africa (IUA), Khartoum, Sudan
| | | | | | - Gianfranco Parati
- Department of Cardiovascular Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastase Dzudie
- Department of Internal Medicine and Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, Cameroon
| | - Sandhya Singh
- Non-Communicable Diseases, National Department of Health, Pretoria, South Africa
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Akinkunmi Paul Okekunle
- College of Medicine University of Ibadan, 200284, Ibadan, Nigeria
- Seoul National University, 08826, Seoul, Republic of Korea
| | - Ama de Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, San Francisco, CA, USA
| | - Renu Garg
- Resolve To Save Lives, New York, NY, USA
| | - Norman R C Campbell
- Department of Medicine, Physiology, and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Prebo Barango
- World Health Organization, Inter-Country Support Team, Eastern and Southern Africa, Harare, Zimbabwe
| | - Slim Slama
- Department of Healthier Populations and Non-Communicable Disease, World Health Organization, South East Asia Regional Office, New Delhi, India
| | - Cherian V Varghese
- Department of Healthier Populations and Non-Communicable Disease, World Health Organization, South East Asia Regional Office, New Delhi, India
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LO, USA
| | - Xin-Hua Zhang
- Beijing Hypertension League Institute, Beijing, China
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Elucidation of Anti-Hypertensive Mechanism by a Novel Lactobacillus rhamnosus AC1 Fermented Soymilk in the Deoxycorticosterone Acetate-Salt Hypertensive Rats. Nutrients 2022; 14:nu14153174. [PMID: 35956350 PMCID: PMC9370603 DOI: 10.3390/nu14153174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/13/2022] Open
Abstract
Dietary intake of fermented soymilk is associated with hypotensive effects, but the mechanisms involved have not been fully elucidated. We investigated the anti-hypertensive effects of soymilk fermented by L. rhamnosus AC1 on DOCA-salt hypertension from the point of view of oxidative stress, inflammatory response and alteration of the gut microbiome. The antioxidant assays in vitro indicated the ethanol extract (EE) of L. rhamnosus AC1 fermented soymilk showed better antioxidative effects than the water extract (WE). Those extracts displayed a hypotensive effect using a tail-cuff approach to measuring blood pressure and improved nitric oxide (NO), angiotensin II (Ang II), tumor necrosis factor-α (TNF-α) and interleukin factor-6 (IL-6) on DOCA-salt hypertensive rats. Furthermore, cardiac and renal fibrosis were attenuated by those extracts. The gut microbiota analysis revealed that they significantly reduced the abundance of phylum Proteobacteria, its family Enterobacteriaceae and genus Escherichia-Shigella. Moreover, metabolomic profiling revealed several potential gut microbiota-related metabolites which appeared to involve in the development and recovery of hypertension. In conclusion, fermented soymilk is a promising nutritional intervention strategy to improve hypertension via reducing inflammation and reverting dysbiotic microbiota.
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Wilcox BK, Henley MR, Navaneethabalakrishnan S, Martinez KA, Pournouri A, Goodlett BL, Lopez AH, Allbee ML, Pickup EJ, Bayless KJ, Chakraborty S, Mitchell BM. Hypertensive Stimuli Indirectly Stimulate Lymphangiogenesis through Immune Cell Secreted Factors. Cells 2022; 11:2139. [PMID: 35883582 PMCID: PMC9315625 DOI: 10.3390/cells11142139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Renal immune cells and lymphatic vessel (LV) density have been reported previously to be increased in multiple mouse models of hypertension (HTN). However, whether interstitial levels of HTN stimuli such as angiotensin II, salt, or asymmetric dimethylarginine have a direct or indirect effect on lymphangiogenesis is unknown. We hypothesized that these 3 HTN stimuli directly increase lymphatic endothelial cell (LEC) proliferation, LEC 3-D matrix invasion and vessel formation, and sprouting of mouse mesometrial LVs. (2) Methods: Human LECs (hLECs) and mouse LECs (mLECs) were treated with HTN stimuli while explanted mouse mesometrial LVs were treated with either the same HTN stimuli or with HTN stimuli-conditioned media. Conditioned media was prepared by treating murine splenocytes with HTN stimuli. (3) Results: HTN stimuli had no direct effect on hLEC or mLEC proliferation. Treatment of hLECs with HTN stimuli increased the number of lumen-forming structures and invasion distance (both p < 0.05) in the 3-D matrix but decreased the average lumen diameter and the number of cells per invading structure (both p < 0.05). Conditioned media from HTN-stimuli-treated splenocytes significantly attenuated the decrease in sprout number (aside from salt) and sprout length of mouse mesometrial LVs that is found in the HTN stimuli alone. (4) Conclusions: These data indicate that HTN stimuli indirectly prevent a decrease in lymphangiogenesis through secreted factors from HTN-stimuli-treated immune cells.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sanjukta Chakraborty
- College of Medicine, Texas A&M University, Bryan, TX 77807, USA; (B.K.W.); (M.R.H.); (S.N.); (K.A.M.); (A.P.); (B.L.G.); (A.H.L.); (M.L.A.); (E.J.P.); (K.J.B.)
| | - Brett M. Mitchell
- College of Medicine, Texas A&M University, Bryan, TX 77807, USA; (B.K.W.); (M.R.H.); (S.N.); (K.A.M.); (A.P.); (B.L.G.); (A.H.L.); (M.L.A.); (E.J.P.); (K.J.B.)
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Wu H, Lam TYC, Shum TF, Tsai TY, Chiou J. Hypotensive effect of captopril on deoxycorticosterone acetate-salt-induced hypertensive rat is associated with gut microbiota alteration. Hypertens Res 2022; 45:270-282. [PMID: 34857899 PMCID: PMC8766282 DOI: 10.1038/s41440-021-00796-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 12/11/2022]
Abstract
The role of the gut microbiota in various metabolic diseases has been widely studied. This study aims to test the hypothesis that gut microbiota dysbiosis is associated with DOCA-salt-induced hypertension, while captopril, an antihypertensive drug, is able to rebalance the gut microbiota alterations caused by hypertension. Treatment with captopril resulted in an approximate 32 mmHg reduction in systolic blood pressure (162.57 vs. 194.61 mmHg) in DOCA-salt-induced hypertensive rats, although it was significantly higher than that in SHAM rats (136.10 mmHg). Moreover, the nitric oxide (NO) level was significantly increased (20.60 vs. 6.42 µM) while the angiotensin II (Ang II) content (42.40 vs. 59.47 pg/ml) was attenuated nonsignificantly by captopril treatment in comparison to those of DOCA-salt-induced hypertensive rats. The introduction of captopril significantly decreased the levels of tumor necrosis factor-α (TNF-ɑ) and interleukin-6 (IL-6). Hypertrophy and fibrosis in kidneys and hearts were also significantly attenuated by captopril. Furthermore, gut microbiota dysbiosis was observed in DOCA-salt-induced hypertensive rats. The abundances of several phyla and genera, including Proteobacteria, Cyanobacteria, Escherichia-Shigella, Eubacterium nodatum and Ruminococcus, were higher in DOCA-salt-induced hypertensive rats than in SHAM rats, while these changes were reversed by captopril treatment. Of particular interest, the genera Bifidobacterium and Akkermansia, reported as beneficial bacteria in the gut, were abundant in only hypertensive rats treated with captopril. These results provide evidence that captopril has the potential to rebalance the dysbiotic gut microbiota of DOCA-salt-induced hypertensive rats, suggesting that the alteration of the gut flora by captopril may contribute to the hypotensive effect of this drug.
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Affiliation(s)
- Haicui Wu
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Theo Y C Lam
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Tim-Fat Shum
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Tsung-Yu Tsai
- Department of Food Science, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
| | - Jiachi Chiou
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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Ihm SH, Kim KI, Lee KJ, Won JW, Na JO, Rha SW, Kim HL, Kim SH, Shin J. Interventions for Adherence Improvement in the Primary Prevention of Cardiovascular Diseases: Expert Consensus Statement. Korean Circ J 2022; 52:1-33. [PMID: 34989192 PMCID: PMC8738714 DOI: 10.4070/kcj.2021.0226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/05/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023] Open
Abstract
Over the last 2 decades, the management of chronic disease in Korea has been improved, but it has gradually stagnated. In order to improve care and reduce cardiovascular morbidity and mortality, it is crucial to improve primary prevention of cardiovascular diseases. In recent international guidelines for hypertension, diabetes, hyperlipidemia, obesity, and other conditions, adherence issues have become more frequently addressed. However, in terms of implementation in practice, separate approaches by dozens of related academic specialties need to be integrated into a systematic approach including clinician’s perspectives such as the science behind adherence, clinical skills, and interaction within team approach. In primary prevention for cardiovascular diseases, there are significant barriers to adherence including freedom from symptoms, long latency for therapeutic benefits, life-long duration of treatment, and need for combined lifestyle changes. However, to implement more systematic approaches, the focus on adherence improvement needs to be shifted away from patient factors to the effects of the treatment team and healthcare system. In addition to conventional educational approaches, more patient-oriented approaches such as patient-centered clinical communication skills, counseling using motivational strategies, decision-making by patient empowerment, and a multi-disciplinary team approach should be developed and implemented. Patients should be involved in a program of self-monitoring, self-management, and active counseling. Because most effective interventions on adherence improvement demand greater resources, the health care system and educational or training system of physicians and healthcare staff need to be supported for systematic improvement.
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Affiliation(s)
- Sang Hyun Ihm
- Division of Cardiology, Department of Internal Medicine and Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Kondo K, Noonan KM, Freeman M, Ayers C, Morasco BJ, Kansagara D. Efficacy of Biofeedback for Medical Conditions: an Evidence Map. J Gen Intern Med 2019; 34:2883-2893. [PMID: 31414354 PMCID: PMC6854143 DOI: 10.1007/s11606-019-05215-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/12/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Biofeedback is increasingly used to treat clinical conditions in a wide range of settings; however, evidence supporting its use remains unclear. The purpose of this evidence map is to illustrate the conditions supported by controlled trials, those that are not, and those in need of more research. METHODS We searched multiple data sources (MEDLINE, PsycINFO, CINAHL, Epistemonikos, and EBM Reviews through September 2018) for good-quality systematic reviews examining biofeedback for clinical conditions. We included the highest quality, most recent review representing each condition and included only controlled trials from those reviews. We relied on quality ratings reported in included reviews. Outcomes of interest were condition-specific, secondary, and global health outcomes, and harms. For each review, we computed confidence ratings and categorized reported findings as no effect, unclear, or insufficient; evidence of a potential positive effect; or evidence of a positive effect. We present our findings in the form of evidence maps. RESULTS We included 16 good-quality systematic reviews examining biofeedback alone or as an adjunctive intervention. We found clear, consistent evidence across a large number of trials that biofeedback can reduce headache pain and can provide benefit as adjunctive therapy to men experiencing urinary incontinence after a prostatectomy. Consistent evidence across fewer trials suggests biofeedback may improve fecal incontinence and stroke recovery. There is insufficient evidence to draw conclusions about effects for most conditions including bruxism, labor pain, and Raynaud's. Biofeedback was not beneficial for urinary incontinence in women, nor for hypertension management, but these conclusions are limited by small sample sizes and methodologic limitations of these studies. DISCUSSION Available evidence suggests that biofeedback is effective for improving urinary incontinence after prostatectomy and headache, and may provide benefit for fecal incontinence and balance and stroke recovery. Further controlled trials across a wide range of conditions are indicated.
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Affiliation(s)
- Karli Kondo
- Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239-2999, USA.
- Research Integrity Office, Oregon Health & Science University, Portland, OR, USA.
| | - Katherine M Noonan
- Physical Medicine and Rehabilitation, VA Portland Health Care System, Portland, OR, USA
| | - Michele Freeman
- Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239-2999, USA
| | - Chelsea Ayers
- Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239-2999, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Devan Kansagara
- Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239-2999, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Niu JF, Zhao XF, Hu HT, Wang JJ, Liu YL, Lu DH. Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure?: Recommendations based on high-quality systematic reviews. Complement Ther Med 2018; 42:322-331. [PMID: 30670261 DOI: 10.1016/j.ctim.2018.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review aims to rate the quality of evidence and the strength of recommendations in high-quality systematic reviews of non-drug therapies. Hypertensive patients who are resistant or non-adherent to antihypertensive drugs may be easier to manage if they choose alternative non-drug therapies for hypertension, based on this review. METHODS P: Adults (>18 years), except pregnant women, with essential hypertension. I: Cupping, moxibustion, acupuncture, acupoint stimulation, yoga, meditation, tai chi, Qi gong, Chinese massage, massage, spinal manipulation, biofeedback, device-guided breathing therapy, aromatherapy, music therapy, and relaxation approaches. C: 1. No treatment. 2. Sham therapy. 3. Conventional treatment, including antihypertensive drugs and lifestyle modification (e.g., exercise). O: 1. Change in the incidence of cardiovascular death. 2. Change in the incidence of myocardial infarction. 3. Change in the incidence of stroke. 4. Change in blood pressure (BP). 5. Efficacy rate of BP lowering. 6. Adverse effects (review specific). S: Systematic reviews of randomized controlled trials, including meta-analyses and assessments of the methodological quality/risk of bias. INFORMATION SOURCES Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane library, PubMed, Web of Science, China National Knowledge Infrastructure, and Chinese Scientific Journal Database were searched. The bibliographies of the included articles were also searched for relevant systematic reviews. GRADE criteria were used to rate the quality of evidence in systematic reviews considering 6 factors, including risk of bias. RESULTS This review ultimately included 13 systematic reviews of 14 non-drug therapies (acupuncture, wet cupping, Baduanjin, blood letting, auricular acupuncture, music, massage, Qi gong, moxibustion, relaxation therapies, biofeedback, device-guided breathing, yoga and tai chi) based on the inclusion criteria. The quality of evidence was generally low, and weak recommendations were given for most therapies except massage and acupuncture plus antihypertensive drug. Based on the analyzed evidence, massage and acupuncture plus antihypertensive drug could benefit people who want to lower their BP and do not have contraindications for massage and acupuncture plus antihypertensive drug. DISCUSSION/STRENGTH The GRADE approach makes this review a unique reference for people who are considering the grade of quality of evidence in systematic reviews, the balance of desirable and undesirable consequences and the strength of recommendations to decide which intervention should be used to reduce BP. LIMITATIONS Many non-drug therapies were excluded due to the low methodological quality of their systematic reviews, and only 14 therapies were evaluated in this review. As no patient-important outcomes were reviewed, surrogate outcomes were used to rate the strength of recommendations. This approach may cause a decrease in evidence quality according to GRADE, but we argue that this is appropriate in the context of this review.
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Affiliation(s)
- Jian-Fei Niu
- VIP Ward of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-Feng Zhao
- VIP Ward of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Han-Tong Hu
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejing Province, China
| | - Jia-Jie Wang
- Department of Traditional Chinese Medicine, Peoples' Hospital of Shuozhou, Shanxi Province, China
| | - Yan-Ling Liu
- The Affiliated Hospital of Shandong University of TCM, Shandong Province, China
| | - De-Hua Lu
- The Second hospital of Dalian Medical University, Liaoning Province, China
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Clemow LP, Pickering TG, Davidson KW, Schwartz JE, Williams VP, Shaffer JA, Williams RB, Gerin W. Stress management in the workplace for employees with hypertension: a randomized controlled trial. Transl Behav Med 2018; 8:761-770. [PMID: 30202927 PMCID: PMC6128963 DOI: 10.1093/tbm/iby018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could benefit remains difficult. Workplace programs have potential as dissemination vehicles. The objective is to evaluate the effectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hypertension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduction and physician referral. Intervention group participants' systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0-152.1) to 140.0 (95% CI: 134.7-145.2), p < .001. The differential change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = -2.05; p = .04). Diastolic BP reductions were not significantly different. Scores on measures of emotional exhaustion and depressive rumination showed significant improvements and correlated with reductions in SBP. There was no significant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension.
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Affiliation(s)
- Lynn P Clemow
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
- Department of Family and Community Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas G Pickering
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Karina W Davidson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Joseph E Schwartz
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | | | - Jonathan A Shaffer
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Redford B Williams
- Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA
| | - William Gerin
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
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Ramey SL, Perkhounkova Y, Hein M, Bohr NL, Anderson AA. Testing a Resilience Training Program in Police Recruits: A Pilot Study. Biol Res Nurs 2017; 19:440-449. [DOI: 10.1177/1099800417699879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Stress from multiple sources is inherent in law enforcement. However, it is possible to modify responses to stress with resilience training that includes teaching techniques to modify emotional and physical responses to stress, interface with mental health professionals, and practice sessions to improve self-regulation of responses to stress including coherence, a measure of heart rate variability. A gap exists in the research, however, regarding evaluation of the duration of effects after the initial resilience training. Method: Subjects included ( N = 34) recruits enrolled in summer 2015 at the Milwaukee Police Academy. An experimental design was used to compare recruits who received resilience training to recruits in the control group. Results: No statistically significant differences between the groups were found for self-reported measures of stress and resilience. For the treatment group ( n = 17), change in coherence was significant ( p < .001) and improvement in the Personal Organizational Quality Assessment Emotional Buoyancy subscale correlated significantly with the number of practice sessions ( r = .63, p = .01) and marginally with change in coherence ( r = .47, p = .07). Conclusion: Results confirm several significant effects of resilience training with recruits.
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Affiliation(s)
| | | | - Maria Hein
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Nicole L. Bohr
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Amanda A. Anderson
- College of Nursing, University of Iowa, Iowa City, IA, USA
- Department of Kinesiology, Iowa State University, Ames, IA, USA
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Le HM, Carbutti G, Ilisei D, Bouccin E, Vandemergel X. Pseudopheochromocytoma Associated with Domestic Assault. Case Rep Cardiol 2016; 2016:6580215. [PMID: 27738531 PMCID: PMC5050350 DOI: 10.1155/2016/6580215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/28/2016] [Indexed: 01/19/2023] Open
Abstract
Pseudopheochromocytoma has a clinical presentation that is similar to pheochromocytoma. It manifests itself with paroxysmal hypertension crises, associated with various symptoms such as headaches, chest pain, nausea, palpitations, and dizziness. Patients are usually asymptomatic in between the crises. Unlike pheochromocytoma, there is no catecholamines overproduction in this pathology: hypertensive peaks are caused by a hyperactivation of the sympathetic nervous system, which is often triggered by a psychological trauma in the past. Treatment of pseudopheochromocytoma can be challenging due to normal blood pressure values in between the hypertensive peaks; it includes alpha- and beta-blockers for moderate crises and prevention and must be combined with psychopharmacologic agents such as anxiolytics or antidepressant drugs. Psychotherapy and dietetic treatment are also crucial in pseudopheochromocytoma management.
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Affiliation(s)
- H. M. Le
- Department of General Internal Medicine, Centres Hospitaliers Jolimont, Nivelles, Belgium
| | - G. Carbutti
- Intensive Care Unit, Centres Hospitaliers Jolimont, Nivelles, Belgium
| | - D. Ilisei
- Department of General Internal Medicine, Centres Hospitaliers Jolimont, Nivelles, Belgium
| | - E. Bouccin
- Intensive Care Unit, Centres Hospitaliers Jolimont, Nivelles, Belgium
| | - X. Vandemergel
- Intensive Care Unit, Centres Hospitaliers Jolimont, Nivelles, Belgium
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Uddin AA, Morita PP, Tallevi K, Armour K, Li J, Nolan RP, Cafazzo JA. Development of a Wearable Cardiac Monitoring System for Behavioral Neurocardiac Training: A Usability Study. JMIR Mhealth Uhealth 2016; 4:e45. [PMID: 27106171 PMCID: PMC4859872 DOI: 10.2196/mhealth.5288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/27/2015] [Accepted: 01/03/2016] [Indexed: 11/13/2022] Open
Abstract
Background Elevated blood pressure is one of the main risk factors for death globally. Behavioral neurocardiac training (BNT) is a complementary approach to blood pressure and stress management that is intended to exercise the autonomic reflexes, improve stress recovery, and lower blood pressure. BNT involves cognitive-behavioral therapy with a paced breathing technique and heart rate variability biofeedback. BNT is limited to in-clinic delivery and faces an accessibility barrier because of the need for clinical oversight and the use of complex monitoring tools. Objective The objective of this project was to design, develop, and evaluate a wearable electrocardiographic (ECG) sensor system for the delivery of BNT in a home setting. Methods The wearable sensor system,
Beat, consists of an ECG sensor and a mobile app. It was developed iteratively using the principles of test-driven Agile development and user-centered design. A usability study was conducted at Toronto General Hospital to evaluate feasibility and user experience and identify areas of improvement. Results The
Beatsensor was designed as a modular patch to be worn on the user’s chest and uses standard ECG electrodes. It streams a single-lead ECG wirelessly to a mobile phone using Bluetooth Low Energy. The use of small, low-power electronics, a low device profile, and a tapered enclosure allowed for a device that can be unobtrusively worn under clothing. The sensor was designed to operate with a mobile app that guides users through the BNT exercises to train them to a slow-paced breathing technique for stress recovery. The BNT app uses the ECG captured by the sensor to provide heart rate variability biofeedback in the form of a real-time heart rate waveform to complement and reinforce the impact of the training. Usability testing (n=6) indicated that the overall response to the design and user experience of the system was perceived positively. All participants indicated that the system had a positive effect on stress management and that they would use it at home. Areas of improvement were identified, which focused primarily on the delivery of training and education on BNT through the app. Conclusions The outcome of this project was a wearable sensor system to deliver BNT at home. The system has the potential to offer a complementary approach to blood pressure and stress management at home and reduce current accessibility barriers.
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Affiliation(s)
- Akib A Uddin
- Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Low stress resilience in late adolescence and risk of hypertension in adulthood. Heart 2016; 102:541-7. [PMID: 26830662 DOI: 10.1136/heartjnl-2015-308597] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/17/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Greater blood pressure reactivity to psychological stress has been associated with higher risk of developing hypertension. We hypothesised that low stress resilience based on psychological assessment early in life is associated with hypertension in adulthood. METHODS National cohort study of 1,547,182 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males) without prior history of hypertension, who underwent standardised psychological assessment by trained psychologists for stress resilience (1-9 scale), and were followed up for hypertension identified from outpatient and inpatient diagnoses during 1969-2012 (maximum age 62). RESULTS 93,028 men were diagnosed with hypertension in 39.4 million person-years of follow-up. Adjusting for body mass index (BMI), family history and socioeconomic factors, low stress resilience at age 18 was associated with increased risk of hypertension in adulthood (lowest vs highest quintile: HR 1.43; 95% CI 1.40 to 1.46; p < 0.001; incidence rates, 278.7 vs 180.0 per 100,000 person-years), including a strong linear trend across the full range of stress resilience (p(trend) < 0.0001). We also found a positive additive interaction between stress resilience and BMI (p < 0.001), indicating that low stress resilience accounted for more hypertension cases among those with high BMI. Men with a combination of low stress resilience and high BMI had a more than threefold risk of hypertension. CONCLUSIONS These findings suggest that low stress resilience may contribute to etiological pathways for hypertension and accounts for more cases among those with high BMI. If confirmed, this knowledge may help inform better preventive interventions by addressing psychosocial risk factors and stress management across the lifespan.
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Affiliation(s)
- Casey Crump
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University, Stanford, California, USA
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Garcha AS, Cohen DL. Catecholamine excess: pseudopheochromocytoma and beyond. Adv Chronic Kidney Dis 2015; 22:218-23. [PMID: 25908471 DOI: 10.1053/j.ackd.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/02/2014] [Accepted: 11/03/2014] [Indexed: 12/21/2022]
Abstract
Symptoms of catecholamine excess or pseudopheochromocytoma can be clinically indistinguishable from pheochromocytoma. Patients usually present with paroxysmal or episodic hypertension and have a negative evaluation for pheochromocytoma. It is important to exclude other causes of catecholamine excess that can be induced by stress, autonomic dysfunction due to baroreflex failure, medications, and drugs. Patients with pseudopheochromocytoma appear to have an amplified cardiovascular responsiveness to catecholamines with enhanced sympathetic nervous stimulation. The exact mechanism is not well understood and increased secretion of dopamine, epinephrine, and norepinephrine, and their metabolites have been identified as potentiating this clinical scenario leading to differing hemodynamic presentations depending on which catecholamine is elevated. Management of this condition is often difficult and frustrating for both the physician and the patient. Most patients respond reasonably well to medications that reduce sympathetic nervous system activity. Anxiolytics, antidepressants, and psychotherapy also play an important role in managing these patients' symptoms.
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Commentary on "Effect of Feedback Signal on Blood Pressure Self-regulation Capability in Individuals With Prehypertension or Stage I Hypertension: A Randomized Controlled Study". J Cardiovasc Nurs 2015; 31:173-4. [PMID: 25774847 DOI: 10.1097/jcn.0000000000000240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ladwig KH, Lederbogen F, Albus C, Angermann C, Borggrefe M, Fischer D, Fritzsche K, Haass M, Jordan J, Jünger J, Kindermann I, Köllner V, Kuhn B, Scherer M, Seyfarth M, Völler H, Waller C, Herrmann-Lingen C. Position paper on the importance of psychosocial factors in cardiology: Update 2013. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc09. [PMID: 24808816 PMCID: PMC4012565 DOI: 10.3205/000194] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered. Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.
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Affiliation(s)
- Karl-Heinz Ladwig
- Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Epidemiologie-2, Helmholtz-Zentrum München, Neuherberg, Germany ; Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Rechts der Isar der TU München, Germany
| | - Florian Lederbogen
- Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Medizinische Fakultät Mannheim, Germany
| | - Christian Albus
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln, Germany
| | | | - Martin Borggrefe
- I. Medizinische Klinik für Kardiologie, Angiologie, Pneumologie, Internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim, Germany
| | - Denise Fischer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Kurt Fritzsche
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Germany
| | - Markus Haass
- Innere Medizin II: Kardiologie, Angiologie und Internistische Intensivmedizin, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany
| | - Jochen Jordan
- Herz-, Thorax- und Rheumazentrum, Abteilung für Psychokardiologie, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Jana Jünger
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg, Germany
| | - Ingrid Kindermann
- Innere Medizin III (Kardiologie/Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Volker Köllner
- Medizinische Fakultät, Universität des Saarlandes, Blieskastel, Germany
| | - Bernhard Kuhn
- Fachpraxis für Innere Medizin, Kardiologie, Angiologie und Notfallmedizin, Heidelberg, Germany
| | - Martin Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Melchior Seyfarth
- Medizinische Klinik 3 (Kardiologie), Helios-Klinikum Wuppertal-Herzzentrum, Universität Witten/Herdecke, Wuppertal, Germany
| | - Heinz Völler
- Fachklinik für Innere Medizin, Abteilung Kardiologie, Klinik am See, Rüdersdorf, Germany
| | - Christiane Waller
- Abteilung Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Germany
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An exploratory analysis of the utility of adding cardiorespiratory biofeedback in the standard care of pregnancy-induced hypertension. Appl Psychophysiol Biofeedback 2014; 38:161-70. [PMID: 23613006 DOI: 10.1007/s10484-013-9219-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study examined the efficacy of a cardiorespiratory biofeedback intervention compared to bed rest in the treatment of 47 women diagnosed with pregnancy-induced hypertension (PIH). The investigation consisted of a historical control group with 31 PIH subjects receiving treatment as usual (TAU), bed rest and antihypertensive medications, and an experimental group with 16 PIH subjects receiving TAU and instruction on using a portable respiratory sinus arrhythmia (RSA) biofeedback device once daily until delivery. Results indicated that systolic and diastolic blood pressure levels were unchanged for either group. Failing to find the intended main effects, a series of exploratory analyses were performed. Findings of associated hypotheses revealed that the RSA BF group had a 35 % higher birth weight than the TAU group. The gestational age at delivery was 10 % greater in the RSA BF group than in the TAU group. A significant relationship was found between the StressEraser Total and the 1-min Apgar score. Eighty-one percent of the subjects stated that the device was relaxing. Fifty percent of the subjects believed that the device helped them fall asleep. Overall, these results suggest that portable RSA biofeedback may be effective in reducing stress during pregnancy and improving perinatal outcomes.
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Manchanda SC, Madan K. Yoga and meditation in cardiovascular disease. Clin Res Cardiol 2014; 103:675-80. [PMID: 24464106 DOI: 10.1007/s00392-014-0663-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/03/2014] [Indexed: 02/07/2023]
Abstract
Yoga is a holistic mind-body intervention aimed at physical, mental, emotional and spiritual well being. Several studies have shown that yoga and/or meditation can control risk factors for cardiovascular disease like hypertension, type II diabetes and insulin resistance, obesity, lipid profile, psychosocial stress and smoking. Some randomized studies suggest that yoga/meditation could retard or even regress early and advanced coronary atherosclerosis. A recent study suggests that transcendental meditation may be extremely useful in secondary prevention of coronary heart disease and may reduce cardiovascular events by 48% over a 5-year period. Another small study suggests that yoga may be helpful in prevention of atrial fibrillation. However, most studies have several limitations like lack of adequate controls, small sample size, inconsistencies in baseline and different methodologies, etc. and therefore large trials with improved methodologies are required to confirm these findings. However, in view of the existing knowledge and yoga being a cost-effective technique without side effects, it appears appropriate to incorporate yoga/meditation for primary and secondary prevention of cardiovascular disease.
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Affiliation(s)
- S C Manchanda
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, 110060, India,
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Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach. PSYCHOLOGICAL INJURY & LAW 2013. [DOI: 10.1007/s12207-013-9165-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Heart rate variability biofeedback has enjoyed increased popularity in recent years. In this review, empirical evidence from multiple sources is presented from the point of view of possible mechanisms of effect. While more research is clearly needed, the data thus far are certainly promising.
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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; 61:1360-83. [PMID: 23608661 DOI: 10.1161/hyp.0b013e318293645f] [Citation(s) in RCA: 362] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioral therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than acupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), and isometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate. A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level of evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for future research priorities are outlined.
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Park C. Mind-body CAM interventions: current status and considerations for integration into clinical health psychology. J Clin Psychol 2012; 69:45-63. [PMID: 22936306 DOI: 10.1002/jclp.21910] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Complementary and alternative medicine (CAM) is increasingly used for treating myriad health conditions and for maintaining general health. The present article provides an overview of current CAM use with a specific focus on mind-body CAM and its efficacy in treating health conditions. METHOD Characteristics of CAM users are presented, and then evidence regarding the efficacy of mind-body treatments (biofeedback, meditation, guided imagery, progressive muscle relaxation, deep breathing, hypnosis, yoga, tai chi, and qi gong) is reviewed. RESULTS Demographics associated with CAM use are fairly well-established, but less is known about their psychological characteristics. Although the efficacy of mind-body CAM modalities for health conditions is receiving a great deal of research attention, studies have thus far produced a weak base of evidence. Methodological limitations of current research are reviewed. Suggestions are made for future research that will provide more conclusive knowledge regarding efficacy and, ultimately, effectiveness of mind-body CAM. Considerations for clinical applications, including training and competence, ethics, treatment tailoring, prevention efforts, and diversity, conclude the article. CONCLUSIONS Integration of CAM modalities into clinical health psychology can be useful for researchers taking a broader perspective on stress and coping processes, illness behaviors, and culture; for practitioners seeking to incorporate CAM perspectives into their work; and for policy makers in directing healthcare resources wisely.
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Real-time fMRI and its application to neurofeedback. Neuroimage 2012; 62:682-92. [DOI: 10.1016/j.neuroimage.2011.10.009] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 10/06/2011] [Indexed: 11/20/2022] Open
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Lin G, Xiang Q, Fu X, Wang S, Wang S, Chen S, Shao L, Zhao Y, Wang T. Heart rate variability biofeedback decreases blood pressure in prehypertensive subjects by improving autonomic function and baroreflex. J Altern Complement Med 2012; 18:143-52. [PMID: 22339103 DOI: 10.1089/acm.2010.0607] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Individuals with prehypertension are at risk of hypertension and cardiovascular diseases, and yet efficient interventions are lagging behind. Studies indicate that heart rate variability-biofeedback (HRV-BF) increases HRV and baroreflex sensitivity (BRS) as well as reduces related pathological symptoms, suggesting potentially beneficial effects of HRV-BF on prehypertension, but little is known about these effects. In this study, these effects were investigated and their mechanisms were explored. OBJECTIVES The effect of HRV-BF on prehypertension in young adults and its potential mechanism were explored. DESIGN Forty-three (43) individuals with prehypertension were recruited and classified into three categories: HRV-BF group, slow abdominal breathing group, and control group. All groups were assessed with measurements of noninvasive blood pressure (BP), BRS, respiration, and galvanic skin response (GSR) at pre-intervention, in the entire process of each session, at postintervention, as well as at a 3-month follow-up. INTERVENTIONS Subjects participated in a 10-session HRV-BF protocol or simple slow abdominal breathing protocol conducted over 5 weeks. A 3-month follow-up was also performed on these individuals. RESULTS The incidence of prehypertension was as high as 14.5% in young college students. Individuals with prehypertension were lower in BRS (7.5±5.2 ms/mm Hg) and HRV (log10-transformed of the standard deviation of normal-to-normal beats [SDNN]=1.62±0.13 ms, lgTotal power of spectral density in the range of frequencies between 0 and 0.4Hz (TP)=8.02±0.55 ms2) than those with normal blood pressure (BRS=18.4±7.4 ms/mm Hg, lgSDNN=1.79±0.10 ms, lgTP=8.68±0.85 ms2). HRV-BF reduced blood pressure (from 131.7±8.7/79.3±4.7 mm Hg to 118.9±7.3 mm Hg/71.9±4.9 mm Hg, p<0.01), increased BRS (from 7.0±5.9 ms/mm Hg to 15.8±5.3 ms/mm Hg, p<0.01) and increased HRV (lgSDNN from 1.61±0.11 to 1.75±0.05 ms, and lgTP from 8.07±0.54 to 9.08±0.41 ms2, p<0.01). These effects were more obvious than those of the slow-breathing group, and remained for at least 3 months. HRV-BF also significantly increased vagus-associated HRV indices and decreased GSR (indices of sympathetic tone). CONCLUSIONS These effects suggest that HRV-BF, a novel behavioral neurocardiac intervention, could enhance BRS, improve the cardiac autonomic tone, and facilitate BP adjustment for individuals with prehypertension.
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Affiliation(s)
- Guiping Lin
- Department of Physiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
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Factores psicosociales implicados en el control de la hipertensión arterial. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Blom K, How M, Dai M, Baker B, Irvine J, Abbey S, Abramson BL, Myers M, Perkins N, Tobe SW. Hypertension Analysis of stress Reduction using Mindfulness meditatiON and Yoga (The HARMONY Study): study protocol of a randomised control trial. BMJ Open 2012; 2:e000848. [PMID: 22396225 PMCID: PMC3298834 DOI: 10.1136/bmjopen-2012-000848] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypertension (HTN) is a leading risk factor for preventable cardiovascular disease, with over one in five adults affected worldwide. Lifestyle modification is a key strategy for the prevention and treatment of HTN. Stress has been associated with greater cardiovascular risk, and stress management is a recommended intervention for hypertensives. Stress reduction through relaxation therapies has been shown to have an effect on human physiology, including lowering blood pressure (BP). However, individualised behavioural interventions are resource intensive, and group stress management approaches have not been validated for reducing HTN. The HARMONY Study is a pilot randomised controlled trial designed to determine if mindfulness-based stress reduction (MBSR), a standardised group therapy, is an effective intervention for lowering BP in stage 1 unmedicated hypertensives. METHODS AND ANALYSIS Men and women unmedicated for HTN with mean daytime ambulatory blood pressure (ABP) ≥135/85 mm Hg or 24 h ABP ≥130/80 mm Hg are included in the study. Subjects are randomised to receive MBSR immediately or after a wait-list control period. The primary outcome measure is mean awake and 24 h ABP. The primary objective of the HARMONY Study is to compare ABP between the treatment and wait-list control arm at the 12-week primary assessment period. Results from this study will determine if MBSR is an effective intervention for lowering BP in early unmedicated hypertensives. ETHICS AND DISSEMINATION This research project was approved by the Sunnybrook Research Ethics Board and the University Health Network Research Ethics Board (Toronto, Canada). Planned analyses are in full compliance with the principles of the Declaration of Helsinki. Data collection will be completed by early spring 2012. Primary and secondary analysis will commence immediately after data monitoring is completed; dissemination plans include preparing publications for submission during the summer of 2012. TRIAL REGISTRATION NUMBER This study is registered with http://clinicaltrials.gov (NCT00825526).
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Affiliation(s)
- Kimberly Blom
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maxine How
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monica Dai
- Queen's University, Kingston, Ontario, Canada
| | - Brian Baker
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Jane Irvine
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Susan Abbey
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Beth L Abramson
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Martin Myers
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nancy Perkins
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sheldon W Tobe
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Vandana B, Saraswathy L, Pillai GKS, Sunadaram KR, Kumar H. Meditation induces a positive response during stress events in young Indian adults. Int J Yoga 2011; 4:64-70. [PMID: 22022124 PMCID: PMC3193656 DOI: 10.4103/0973-6131.85487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Relaxation techniques like meditation have been found to be beneficial in reducing stress. Aim: The aim was to find out the effect of the Integrated Amrita Meditation (IAM) technique on the response to life changes. Materials and Methods: The IAM technique, progressive muscle relaxation (PMR) technique, and the Life Changes Questionnaire (LCQ) were used. LCQ was culturally adapted to the Indian population. One hundred and fifty subjects were randomized into IAM, PMR, and Control groups. LCQ scores were documented in all groups at 0 h, 48 h, 2 months, and 8 months after the training. Statistics Analysis: Within groups, comparison was done by the paired t-test and between groups by ANCOVA. Results: The new LCQ was analyzed using split-half reliability and was found to be having a correlation coefficient 0.96. On within group analysis, the IAM group showed a significant decrease in LCQ scores (P = 0.004) in the second visit which was maintained in the third (P = 0.003) and fourth visits (P = 0.001). Within the PMR group, there was a significant decrease (P = 0.006) in the third visit and fourth visits (P = 0.001). No significant change was seen within the control group in any of the visits. The decrease in LCQ scores in the IAM group was significant at the end of 8 months when compared to the Control group (P < 0.05) whereas the decrease in the PMR group was not significant in comparison with the control group. Conclusion: The IAM technique is an efficient tool in reducing stress as measured by LCQ.
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Affiliation(s)
- Balakrishnan Vandana
- Department of Physiology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
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Wang SZ, Li S, Xu XY, Lin GP, Shao L, Zhao Y, Wang TH. Effect of slow abdominal breathing combined with biofeedback on blood pressure and heart rate variability in prehypertension. J Altern Complement Med 2011; 16:1039-45. [PMID: 20954960 DOI: 10.1089/acm.2009.0577] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Prehypertension is a new category designated by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) in 2003. Managing prehypertension with nonpharmacological intervention is possibly beneficial to the prevention of hypertension. In this study, we observed the effect of slow abdominal breathing combined with electromyographic (EMG) biofeedback training on blood pressure (BP) in prehypertensives and assessed the changes of heart rate variability (HRV) in order to find an optional intervention to prevent hypertension and acquire some experimental data to clarify the underlying neural mechanism. METHODS Twenty-two (22) postmenopausal women with prehypertension were randomly assigned to either the experiment group or the control group. The experiment group performed 10 sessions of slow abdominal breathing (six cycles/min) combined with frontal electromyographic (EMG) biofeedback training and daily home practice, while the control group only performed slow abdominal breathing and daily home practice. BP and HRV (including R-R interval and standard deviation of the normal-normal intervals [SDNN]) were measured. RESULTS Participants with prehypertension could lower their systolic blood pressure (SBP) 8.4 mm Hg (p < 0.001) and diastolic blood pressure (DBP) 3.9 mm Hg (p < 0.05) using slow abdominal breathing combined with EMG biofeedback. The slow abdominal breathing also significantly decreased the SBP 4.3 mm Hg (p < 0.05), while it had no effect on the DBP (p > 0.05). Repeated-measures analyses showed that the biofeedback group + abdominal respiratory group (AB+BF) training was more effective in lowering the BP than the slow breathing (p < 0.05). Compared with the control group, the R-R interval increased significantly during the training in the AB+BF group (p < 0.05). The SDNN increased remarkably in both groups during the training (p < 0.05). CONCLUSIONS Slow abdominal breathing combined with EMG biofeedback is an effective intervention to manage prehypertension. The possible mechanism is that slow abdominal breathing combined with EMG biofeedback could reduce sympathetic activity and meanwhile could enhance vagal activity.
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Affiliation(s)
- Shu-Zhen Wang
- Department of Physiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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Emmons KM, Geller AC, Puleo E, Savadatti SS, Hu SW, Gorham S, Werchniak AE. Skin cancer education and early detection at the beach: a randomized trial of dermatologist examination and biometric feedback. J Am Acad Dermatol 2011; 64:282-9. [PMID: 21163550 PMCID: PMC3158610 DOI: 10.1016/j.jaad.2010.01.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 12/29/2009] [Accepted: 01/06/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are limited data on the effectiveness of skin cancer prevention education and early detection programs at beaches. OBJECTIVES We evaluate 4 strategies for addressing skin cancer prevention in beach settings. METHODS This prospective study at 4 beaches included 4 intervention conditions: (1) education only; (2) education plus biometric feedback; (3) education plus dermatologist skin examination; or (4) education plus biometric feedback and dermatologist skin examination. Outcomes included sun protection behaviors, sunburns, and skin self-examinations. RESULTS There was a significant increase in hat wearing, sunscreen use, and a reduction in sunburns in the education plus biometric feedback group (odds ratio = 1.97, 1.94, and 1.07, respectively), and greater improvements in knowing what to look for in skin-self examinations (odds ratio = 1.13); there were no differences in frequency of self-examinations. Skin examinations plus biometric feedback led to greater reductions in sunburns. The dermatologist examinations identified atypical moles in 28% of participants. LIMITATIONS Inclusion of only one beach per condition, use of self-report data, and a limited intervention period are limitations. CONCLUSIONS Education and biometric feedback may be more effective than education alone for impacting sun protective attitudes and behaviors in beachgoing, high-risk populations.
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Olsson EMG, El Alaoui S, Carlberg B, Carlbring P, Ghaderi A. Internet-Based Biofeedback-Assisted Relaxation Training in the Treatment of Hypertension: A Pilot Study. Appl Psychophysiol Biofeedback 2009; 35:163-70. [DOI: 10.1007/s10484-009-9126-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gasperin D, Netuveli G, Dias-da-Costa JS, Pattussi MP. Effect of psychological stress on blood pressure increase: a meta-analysis of cohort studies. CAD SAUDE PUBLICA 2009; 25:715-26. [PMID: 19347197 DOI: 10.1590/s0102-311x2009000400002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 10/14/2008] [Indexed: 11/22/2022] Open
Abstract
Studies have suggested that chronic exposure to stress may have an influence on increased blood pressure. A systematic review followed by a meta-analysis was conducted aiming to assess the effect of psychological stress on blood pressure increase. Research was mainly conducted in Ingenta, Psycinfo, PubMed, Scopus and Web of Science. Inclusion criteria were: published in any language; from January 1970 to December 2006; prospective cohort design; adults; main exposure psychological/emotional stress; outcome arterial hypertension or blood pressure increase > 3.5mmHg. A total of 2,043 studies were found, of which 110 were cohort studies. Of these, six were eligible and yielded 23 comparison groups and 34,556 subjects. Median follow-up time and loss to follow-up were 11.5 years and 21%. Results showed individuals who had stronger responses to stressor tasks were 21% more likely to develop blood pressure increase when compared to those with less strong responses (OR: 1.21; 95%CI: 1.14-1.28; p < 0.001). Although the magnitude of effect was relatively small, results suggest the relevance of the control of psychological stress to the non-therapeutic management of high blood pressure.
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Rainforth MV, Schneider RH, Nidich SI, Gaylord-King C, Salerno JW, Anderson JW. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep 2008; 9:520-8. [PMID: 18350109 DOI: 10.1007/s11906-007-0094-3] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Maxwell V Rainforth
- Institute for Natural Medicine and Prevention, Maharishi University of Management, 2100 Mansion Drive, Suite 211, Maharishi Vedic City, IA 52556, USA.
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Abstract
To secure the role of behavioral medicine in health care, researchers continue to improve the quality of their outcome studies. Despite the availability of guidelines for designing high quality clinical trials, however, we have noted two, unfortunately common, flaws in behavioral medicine outcome research that undermine these efforts. The first issue is that researchers recruit medical patients whose scores on psychological target measures are not elevated at pretest. Data are presented from quantitative reviews of cardiovascular and cancer populations to illustrate the impact of this protocol decision. It is demonstrated how magnitude of change and corresponding statistical power are greatly reduced when patients with few problems are enrolled. The second issue pertains to the failure of researchers to measure psychological change when the actual model to be tested is a mediational model such that successful treatment of psychological distress is presumed to account for good long-term health outcomes. Such lack of attention to protocol design can result in misinterpretation of obtained effects and can lead to premature dismissal of psychological treatment opportunities for physical disease. We suggest how these flaws can be avoided in the protocol design stage.
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Tsai PS, Chang NC, Chang WY, Lee PH, Wang MY. Blood Pressure Biofeedback Exerts Intermediate-Term Effects on Blood Pressure and Pressure Reactivity in Individuals with Mild Hypertension: A Randomized Controlled Study. J Altern Complement Med 2007; 13:547-54. [PMID: 17604559 DOI: 10.1089/acm.2007.6289] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This randomized controlled study examined whether a 4-week blood pressure (BP) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension. METHODS Participants in the active biofeedback group (n=20) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals, whereas participants in the sham biofeedback group (n=18) were told to manipulate their BP without feedback signals. BP, skin temperature, skin conductance, BP reactivity to stress, body weight, and state anxiety were assessed before training and repeated at the eighth week after the training. RESULTS The decreases in systolic (12.6 +/- 8.8 versus 4.1 +/- 5.7) and mean BP (8.2 +/- 6.9 versus 3.3 +/- 4.9) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group (p=0.001 and 0.017, respectively). Results from analysis of covariance with the follow-up systolic blood pressure (SBP) (or mean arterial pressure [MAP]) as the dependent variable, baseline SBP (or MAP) as the covariate, and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP (p=0.013 and 0.026, respectively). The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group (p=0.005 and 0.01, respectively), but not for the control group. For the sample as a whole and for the biofeedback group, the state anxiety score and body weight remained unchanged. CONCLUSIONS BP biofeedback exerts a specific treatment effect in reducing BP in individuals with mild hypertension, possibly through reducing pressor reactivity to stress.
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Affiliation(s)
- Pei-Shan Tsai
- College of Nursing, Taipei Medical University, Taipei, Taiwan.
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Xu XY, Gao J, Ling D, Wang TH. Biofeedback treatment of prehypertension: analyses of efficacy, heart rate variability and EEG approximate entropy. J Hum Hypertens 2007; 21:973-5. [PMID: 17541386 DOI: 10.1038/sj.jhh.1002237] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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