Transcendental meditation in hypertension. Individual response patterns

Behavioral Treatment of Psychophysical Disorders

The behavioral treatment of psychophysiological disorders is reviewed with an emphasis on group outcome research and controlled, comparative group outcome studies. These behavioral treatments tend to fall into three categories: (I) biofeed-back training; (2) relaxation training; and (3) other behavioral techniques including assertiveness training and systematic desensitization.

Guided by two inclusion criteria-seriousness as defined in terms of prevalence and mortality and the existence of a large body of research-this review discusses the following disorders: essential hypertensions, migraine headaches, muscle contraction headaches, asthma, ulcers, and colitis.

Yoga as an Alternative and Complementary Treatment for Hypertensive Patients

Hypertension is a worldwide public health concern. It is a risk factor for heart disease and stroke. Pharmacological therapy is the most popular method to control hypertension, but yoga has been identified as a promising alternative and complementary therapy to costly drugs. A systematic review is presented below to determine the efficacy of yoga. The criteria for study to be included were as follows: ( a) published in the English language, ( b) between January 1972 and March 2012, ( c) included any form of yoga as an intervention (with or without pharmacological therapy), ( d) used any quantitative study design, and ( e) measured blood pressure as an outcome. A total of 19 studies met these criteria. Of the 19 studies systematically analyzed, 12 demonstrated a significant change in blood pressure using yoga as part of the intervention. Limitations include a lack of theory-based approach, self-reporting errors, and few randomized controlled trials.

QIGONG REDUCED BLOOD PRESSURE AND CATECHOLAMINE LEVELS OF PATIENTS WITH ESSENTIAL HYPERTENSION

This study was designed to investigate the efficacy of Qigong as a non-pharmacological treatment of hypertension and evaluate the contribution of Qigong in the blood pressure (BP) reduction of essential hypertension patients. Fifty-eight patients volunteered to participate in this study and were randomly divided into either a Qigong group (n = 29), or a wait list control group (n = 29). In response to 10 weeks of Qigong, systolic blood pressure (SBP), diastolic blood pressure (DBP), and rate pressure product (RPP) were decreased significantly. There was a significant reduction of norepinephrine, epinephrine, cortisol, and stress level by the Qigong. These results suggest that Qigong may reduce BP and catecholamines via stabilizing the sympathetic nervous system. Therefore, Qigong is an effective nonpharmacological modality to reduce BP in essential hypertensive patients.

The prevention of hypertension

Our way to prevention is to find a list of traits known to be predictors of elevated blood pressure. This list of predictors offers means for the early identification of susceptibile persons. Years of experience in preventive work indicate that such identification is always useful for developing preventive programmes, since it gives a focus for action (5). Most of the predictors show possible ways in which action could be directed towards prevention of hypertension and reduction of elevated blood pressure. We will focus on salt, control of obesity, physical exercise, and meditation. We would like to discuss preventive aspects of hypertension and the possibility of treating with other methods than drugs.

Relaxation therapies for the management of primary hypertension in adults

BACKGROUND

Lifestyle interventions are often recommended as initial treatment for mild hypertension, but the efficacy of relaxation therapies is unclear.

OBJECTIVES

To evaluate the effects of relaxation therapies on cardiovascular outcomes and blood pressure in people with elevated blood pressure.

SEARCH STRATEGY

We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review.

INCLUSION CRITERIA

RCTs of a parallel design comparing relaxation therapies with no active treatment, or sham therapy; follow-up >/=8 weeks; participants over 18 years, with raised systolic blood pressure (SBP) >/=140 mmHg or diastolic blood pressure (DBP) >/=85 mmHg); SBP and DBP reported at end of follow-up.

EXCLUSION CRITERIA

participants were pregnant; participants received antihypertensive medication which changed during the trial.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted.

MAIN RESULTS

29 RCTs, with eight weeks to five years follow-up, met our inclusion criteria; four were excluded from the primary meta-analysis because of inadequate outcome data. The remaining 25 trials assessed 1,198 participants, but adequate randomisation was confirmed in only seven trials and concealment of allocation in only one. Only one trial reported deaths, heart attacks and strokes (one of each). Meta-analysis indicated that relaxation resulted in small, statistically significant reductions in SBP (mean difference: -5.5 mmHg, 95% CI: -8.2 to -2.8, I2 =72%) and DBP (mean difference: -3.5 mmHg, 95% CI: -5.3 to -1.6, I2 =75%) compared to control. The substantial heterogeneity between trials was not explained by duration of follow-up, type of control, type of relaxation therapy or baseline blood pressure. The nine trials that reported blinding of outcome assessors found a non-significant net reduction in blood pressure (SBP mean difference: -3.2 mmHg, 95% CI: -7.7 to 1.4, I(2) =69%) associated with relaxation. The 15 trials comparing relaxation with sham therapy likewise found a non-significant reduction in blood pressure (SBP mean difference: -3.5 mmHg, 95% CI: -7.1 to 0.2, I(2) =63%).

AUTHORS' CONCLUSIONS

In view of the poor quality of included trials and unexplained variation between trials, the evidence in favour of causal association between relaxation and blood pressure reduction is weak. Some of the apparent benefit of relaxation was probably due to aspects of treatment unrelated to relaxation.

Determining the relationship of heart rate and blood pressure using voluntary cardio-respiratory synchronization (VCRS)

Voluntary cardio-respiratory synchronization (VCRS) was used to investigate heart rate and blood pressure changes in the supine position in 21 subjects. VCRS involves a breathing pattern that is synchronized with the cardiac cycle. The signals to inhale and exhale are derived from the ECG. In this study, the subjects inspired for four heart beats and expired for four heart beats for 35 cycles. This technique is designed to have the heart beat occur at exactly the same phase in the respiratory cycle and lends itself to the study of the influence of the respiration cycle on heart rate and blood pressure changes. The heart rate and blood pressure changed simultaneously in the same direction, with the largest significant positive change occurring on the second heart beat during inspiration. The authors discuss the potential of VCRS for research, and clinical applications as a respiration modulator for hypertension therapy or increased heart rate variability.

Claims about religious involvement and health outcomes

Claims about religion, spirituality, and health have recently appeared with increasing frequency, in both the popular media and professional journals. These claims have asserted that there are a great many studies in the literature that have examined relations between religious involvement and health outcomes and that the majority of them have shown that religious people are healthier. We examined the validity of these claims in two ways: (a) To determine the percentage of articles in the literature that were potentially relevant to such a claim, we identified all English-language articles with published abstracts identified by a Medline search using the search term religion in the year 2000, and (b) to examine the quality of the data in articles cited as providing supportfor such a claim, we examined all articles in the area of cardiovascular disease and hypertension cited by two comprehensive reviews of the literature. Of the 266 articles published in the year 2000 and identified by the Medline search, only 17% were relevant to claims of health benefits associated with religious involvement. About half of the articles cited in the comprehensive reviews were irrelevant to these claims. Of those that actually were relevant, many either had significant methodological flaws or were misrepresented, leaving only afew articles that could truly be described as demonstrating beneficial effects of religious involvement. We conclude that there is little empirical basis for assertions that religious involvement or activity is associated with beneficial health outcomes.

Mind-body therapy in the management and prevention of coronary disease

Conventional mind-body therapy has been proven a valuable noninvasive way to manage coronary disease. Yoga practice, especially, has been found to be valuable in preventing adverse outcomes of coronary disease by improving resistance to stress.

The effect of thermal biofeedback and progressive muscle relaxation training in reducing blood pressure of patients with essential hypertension

In order to assess the effectiveness of the thermal biofeedback training combined with the progressive muscle relaxation therapy in the treatment of patients with essential hypertension, blood pressure decline was measured on the treatment group who had the combined thermal biofeedback and progressive muscle relaxation training (N = 11), and on the control group who had only the progressive muscle relaxation training (N = 8). Baseline blood pressure was measured four times for two weeks on both groups. For the treatment group, blood pressure was measured twice before and after each of eight sessions of thermal biofeedback training for four weeks. For the control group, blood pressure was measured every two visits to a clinic for progressive muscle relaxation self-training twice before and after the self-training. A significant decline of the systolic blood pressure by 20.6 mmHg and of the diastolic blood pressure by 14.4 mmhg was observed in the treatment group. There was a tendency for both blood pressures to increase in the control group.

Hormonal and biochemical responses to transcendental meditation

This study was designed to assess whether transcendental meditation (TM) could influence various endocrine responses in 10 experienced male meditators. Nine matched subjects, uninformed of the TM procedure, acted as controls. Meditators successfully practised their technique for 40 min in the morning while controls relaxed for this period. No significant differences emerged between these 2 groups with respect to carbohydrate metabolism (plasma glucose, insulin and pancreatic glucagon concentrations), pituitary hormones (growth hormone and prolactin) or the 'stress' hormones, cortisol and total catecholamines-although meditators tended to have higher mean catecholamine levels. Plasma free fatty acids were significantly elevated in meditators 40 min after completing the period of TM. No clear evidence was thus obtained that any of the stress, or stress-related, hormones were suppressed during or after meditation in the particular setting examined.

Physiological responses during meditation and rest

Forty nonmeditators and 12 experienced transcendental meditators were randomly assigned to four experimental cells devised to control for order and expectation effects. All 52 (female) subjects were continuously monitored on seven physiological measures during both meditation and rest. Each subject was her own control in an abab experimental paradigm comparing meditation to rest. Analyses of variance on change scores calculated from both initial and running (intertrial) baselines revealed small but significant conditions effects for all variables except diastolic BP. The same subjects (both experienced meditators and those meditating for the first time) showed lower psychophysiological arousal during the meditation than during the rest condition for systolic BP, HR, SCL, digital BV, digital ST, and frontalis EMG. The experienced meditators showed only marginally more conditions effects than the novices practicing "noncultic" meditation. For the nonmeditators, deliberately fostering positive expectations of meditations was associated with lower physiological arousal in terms of diastolic BP, HR, and SCL. These findings suggest that both cultic and noncultic meditation are associated with lower physiological activation than eyes-closed rest. The meditators, however, tended to become more relaxed over meditation trials, whereas the nonmeditators showed the opposite trend.

Stress management training and relaxation imagery in the treatment of essential hypertension

The present study compared the effectiveness of three procedures in the treatment of 34 individuals with essential hypertension: (1) stress management training plus relaxation imagery, which consisted of an adaptation of existing stress management techniques in conjunction with extensive relaxation training using relaxation imagery; (2) relaxation imagery alone; and (3) weekly blood pressure checks. The relaxation imagery technique involved visualization of a relaxing image along with concentration on suggestions of relaxation, heaviness, and warmth. Treatment was individualized and lasted 8 weeks. Results indicated stress management plus relaxation imagery and relaxation imagery alone were significantly more effective than blood pressure checks in reducing systolic and diastolic blood pressures during treatment and in maintaining diastolic blood pressure reductions during follow-up. However, no significant differences were found between the two treatment procedures. Clinical implications of these findings are discussed.

Hypertension: comparison of drug and non-drug treatments

Thirty-seven reports of the treatment of hypertension by non-pharmacological means were compared with the results of treatment by standard drug regimens. Treatment by drugs produced the greatest lowering of blood pressure. Treatment by weight reduction, yoga, and muscle relaxation each produced smaller, but appreciable, changes in blood pressure biofeedback, and salt restriction were inferior to those of the other regimens and were not significantly different to the effects of placebo treatment. Large comparative trials of pharmacological and non-pharmacological treatments are needed before definite conclusions can be made.

Controlled trial of biofeedback-aided behavioural methods in reducing mild hypertension

Employees of a large industry were screened for the presence of coronary risk factors. A total of 204 employees, aged 35-64 years, with two or more such factors (serum cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), blood pressure greater than or equal to 140/90 mm Hg, and current cigarette consumption greater than or equal to 10 cigarettes a day) were randomly allocated to a biofeedback group receiving training in relaxation and management of stress or a control group. Both groups received simple health education literature. After eight weeks of training, and again eight months later, the biofeedback group showed a significantly greater fall in systolic and diastolic blood pressures than the control group (p less than 0.001). Plasma renin activity and plasma aldosterone concentration were measured in a subsample at entry to the study and again at eight weeks and eight months; both showed a greater reduction in the biofeedback compared with the control group at eight weeks' follow-up. The greater reduction in blood pressure in the subjects in the biofeedback group compared with the control group (11.0 mm Hg systolic and 8.8 mm Hg diastolic), persisting eight months after the training, suggests that relaxation-based behavioural methods might be offered as a first-time treatment to patients with mild hypertension.

Meditation training and essential hypertension: a methodological study

Meditation training appears to be a promising psychological approach to the control of hypertension. However, most studies to date have had serious deficiencies. This study attempted to correct many of these deficiencies. Forty-one unmedicated hypertensives referred by general practitioners were randomly allocated to three groups. The treatment group (SRELAX) underwent training procedures based on Transcendental Meditation; a placebo control group (NSRELAX) underwent identical training but withou a mantra. Both procedures were compared with a no-treatment control group. The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups, compared with the no-treatment controls, with diastolic percentage reductions reaching significance (p < 0.05). There was considerable subject variation in response, with overall a mean decline i diastolic blood presure of 8-10% on 3-month follow-up. Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed.

Sympathetic activity and transcendental meditation

Ten male advanced meditators and ten male long-term meditators subjected themselves four times to slight physical exercise following a period of rest, meditation or reading. Daily urine excretions of catecholamines and VMA were determined in both groups. On the experimental days 4-hour urine specimens, one before and one after the experiments, were again collected for analysis. During the experiments blood pressure and heart rate were measured continuously and blood samples were taken for plasma catecholamine levels immediately before and after the physical exercise. Daily catecholamine and VMA excretions showed to be higher in advanced meditators. During the experiments the pattern of noradrenaline, adrenaline and VMA excretions were different in both groups, long-term meditators showing a higher adrenaline excretion after exercise. After the resting period there was in both groups a similar increase of plasma catecholamine levels during exercise. However, after meditation the advanced meditators showed a significant increase in plasma noradrenaline and no further increase in plasma noradrenaline level during the following physical exercise. Also after the reading period differences between both groups in plasma catecholamine levels during exercise could be observed. In advanced meditators heart rate reduction after meditation was about 9% and diastolic blood pressure was slightly raised. The preceding conditions of rest, meditation or reading had a significant different influence on the behaviour of heart rate and blood pressure during the following physical exercise and this pattern was different for both groups.

Relaxation therapy for essential hypertension: a Veterans Administration Outpatient study

Twenty-nine patients who had been treated with antihypertensive medication for at least the preceding 6 months were randomly assigned to (1) therapist-conducted, face-to-face progressive, deep-muscle relaxation training for 10 weekly sessions, or (2) progressive deep-muscle relaxation therapy conducted mainly by home use of audio cassettes, or (3) nonspecific individual psychotherapy for 10 weekly sessions. No differences between the groups were found immediately after therapy; however, the therapist-conducted relaxation therapy group showed the greatest changes: -17.8 mm Hg systolic, -9.7 mm Hg diastolic at 6 months follow-up. Some significant trends in results among the three therapists were also found. No correlation existed between blood pressure changes and changes in dopamine-beta-hydroxylase (DbH) levels.

Daily relaxation response breaks in a working population: II. Effects on blood pressure

A 12-week randomized experiment investigated the effects of daily relaxation breaks on office workers with "normal" blood pressure. Blood pressures of 126 volunteers from the corporate offices of a manufacturing firm were measured biweekly. After four weeks of baseline monitoring,volunteers were divided randomly into three groups: Group A was taught a technique for producing the relaxation response; Group B was "taught" to sit quietly; and Group C was taught nothing. Groups A and B were asked to take two 15-minute relaxation breaks daily. During the baseline period, mean systolic blood pressures (SBP) were 119.7, 118.4, and 114.2 for Groups A, B and C respectively; mean diastolic pressures (DBP) were 78.7 and 75.7 Between the first and last measurements, mean changes in SBP were -11.6, -6.5, and +0.4 mm Hg in Groups A, B, and C; mean DBP decreased by 7.9, 3.1, and 0.3. Between the fourweek baseline period and last four weeks of the experimental period, mean SBP and DBP, mean changes in Group A were significantly greater than those in Group B (p < 0.05) and in Group C (p < 0.001). The same pattern of changes among the three groups was exhibited by both sexes, all ages, and at all initial levels of blood pressure. However, in general, within Group A, the higher the initial blood pressure, the greater the decrease. (Am. J. Public Health 67;954-959, 1977)

Limitations of transcendental meditation in the treatment of essential hypertension

20 hypertensive patients participating in a professionally supervised programme of transcendental meditation showed no significant change in blood-pressure after a 6-month study. Although there were small reductions in systolic blood-pressure and in pulse-rate early in the trial, these changes had disappeared by 6 months. At no time did the mean diastolic pressure fall significantly. Plasma-renin activity did not change during the study. It is concluded that while the general feeling of wellbeing experienced by most patients may provide a useful adjunct to conventional treatments, it is unlikely that transcendental meditation contributes directly towards the lowering of blood-pressure.