Mindfulness Based Stress Reduction Programs – Correspondence of Eric K.P. Lee, AGASO School of Public Health and Primary Care, Faculty of Medicine, Room 402, School of Public Health Wales General Hospital, Shatin, Hong Kong. Email
From the AGASO School of Public Health and Primary Care, Faculty of Medicine (E.K.P.L., N.C.Y.Y., Z.X., D.Z., S.Y.S.W.), The Chinese University of Hong Kong.
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A mindfulness-based stress reduction (MBSR) program can lower or raise BP in patients with hypertension (BP). However, some important parameters (such as sleep BP) have not been investigated in previous reviews and there is no well-conducted meta-analysis. This meta-analysis examines the effect and acceptability of MBSR in patients with elevated BP or hypertension. Eligible articles were searched in multiple databases, including MEDLINE, EMBASE, and APA PsycInfo. The included studies were randomized controlled trials that included patients with elevated blood pressure, had a control group, and studied the effect of MBSR. Mean systolic and diastolic BP during and outside work (including 24-hour, daytime, and sleep), systolic and diastolic BP, psychological outcomes (depression/anxiety/stress), and fall rate were compared between the MBSR group and the control group using a random effects model. effects Quality assessment was performed according to the Cochrane Risk of Bias Tool. Twelve studies were included and only one trend was considered unsafe. The MBSR function reduced systolic and diastolic blood pressure by 6.64 and 2.47 mmHg. respectively after the intervention; the decrease in diastolic blood pressure was maintained for 3-6 months after recruitment. Our meta-analysis found no significant reduction in out-of-office BP after MBSR. MBSR reduced symptoms of depression, anxiety, and stress. The drop rate in the MBSR group was 15% and was similar to the control group. Current evidence is limited by a lack of high-quality and sufficiently powered studies with long-term follow-up. In addition, the Supreme Court’s office reported several lawsuits.
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Although the risk of these complications can be reduced by optimal blood pressure (BP) control with effective non-pharmacological treatments and medications, good BP control is achieved in only less than one-third and one-tenth of hypertensive patients in high-income and low-income countries. income level.
Therefore, an effective BP-lowering intervention is needed, and given the choice, many patients prefer non-pharmacological or lifestyle treatments.
Mindfulness-based MBIs may be a potential new non-pharmacological treatment for BP control in hypertensive patients. It teaches participants a mental faculty defined as the awareness that arises from the intention of the intention, this time not through the judgment of their own understanding, wisdom, and piety.
A widely used and well-established MBI is a mindfulness-based stress reduction (MBSR) program consisting of at least 8 weekly sessions and daily meditation practice of ≥30 minutes.
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MBIs can lower BP in several ways. Psychological stress and mood problems, which are associated with an increased risk of hypertension and cardiovascular disease, can be reduced with MBI.
In addition, by cultivating a non-judgmental attitude or acceptance of illness (including hypertension) and awareness of all available options, MBIs can enhance patients’ self-care capacity, such as adherence to hypertension strategies and lifestyles.
In addition, the most studied meditation, called transcendental meditation, has been shown to lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) by ≈4.5 and 3 mmHg. in accordance.
However, mindfulness meditation and transcendental meditation involve different meditation techniques. Additionally, while Transcendental Meditation is typically taught in individual formats, MBSR is taught in structured and group formats, which can reduce costs and be easily adapted for implementation in healthy health care systems.
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Although some systematic reviews and meta-analyses suggest that MBIs may lower BP, these meta-analyses included randomized controlled trials (RCTs) with predominantly normotensive participants (ie, BP <130/80 mmHg), RCTs that examined mindfulness programs of varying duration (ie, from a 1-day workshop to a 10-week program), included RCTs that used unconscious meditation techniques, and included non-RCTs; Therefore, many results were heterogeneous and difficult to interpret.
Furthermore, although sleep BP is a stronger predictor of cardiovascular events than awake BP, the effect of MBI on sleep BP has not been previously analyzed or discussed.
However, the results of several previous meta-analyses have been very heterogeneous; however, this has not been adequately investigated by subgroup analysis or meta-regression, and it is unclear whether MBIs are more effective in certain patient subgroups.
The most recent systematic review examining the effects of MBSR on BP included only 5 studies, and no meta-analysis was performed.
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This systematic review and meta-analysis examines whether MBSR (and its modified programs) (1) can reduce work and exclusion in RCTs that primarily include people with elevated BP or additional BP (mean BP ≥130/80 mmHg .). – work (24 hours, wakefulness, sleep) SAT/DAT; (2) reduce stress and mood symptoms that are independently associated with cardiovascular outcomes
; and (3) acceptable and safe for participants compared to active/accepted control groups. Subgroup and meta-regression analyzes were performed to determine the effect of MBSR on BP levels in different countries. Placement in population, intervention, comparator, outcome, study design format:
P: people with elevated office or office blood pressure (ie ≥130/80 mmHg); I: MBSR (and its modified programs); C: active or inactive control (eg, other lifestyle interventions or usual care); O: first release – office and non-office SBP/DBP; other outcomes include psychological outcomes (eg, depression/anxiety/stress) and acceptability (eg, dropout rate) and health status; S: randomized controlled trials.
Because the effect of MBI is enhanced in normotensive participants, limiting analysis to RCTs that include participants with elevated BP and standard dose MBI (MBSR only and MBSR-modified programs, see below), results may be more homogeneous than clinically meaningful. .
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Data supporting the findings of this study (including data from individual included studies) are available from the corresponding author upon reasonable request. The current review was conducted and reported according to the PRISMA index.
RCTs in which (1) participant mean SBP and DBP were ≥130 or ≥80 mmHg; (which corresponds to at least 1 stage of hypertension according to the American index and prehypertension according to most other international systems);
Admo; (2) an active or inactive control group was included; and (3) MBSR or modified MBSR were investigated. To be included in the review, modified programs had to include at least 8 weekly sessions (at least 1 hour) with a daily meditation practice. This is because MBSR has often been modified for different populations; for example, shorter lessons were taught to combat age-related fatigue in the elderly
; (4) reports on ATS and DAT; and (5) used either Chinese or English. Studies that included pregnant women ≤18 years of age and that allowed titration of antihypertensive medication during the MBSR intervention were excluded. Observational studies, animal studies, reviews and reviews were excluded.
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Databases including Ovid, MEDLINE, EMBASSY, APA PsycINFO, Allied and Complementary Medicine, CINAHL Complete, Cochrane Library, PubMed, Scopus, Internet of Science, and China Academic Journal Network Publishing Database were searched for articles up to June 9, 2020. Link. Search terms and topics used included “hypertension,” “lying,” “blood pressure,” and “controlled judgment.” Details of the study design are provided in Table S1 in the Data Supplement. The study was limited to studies involving adults, and the publication languages were only English and Chinese. Because many previous meta-analyses only included studies published in English, we intentionally included Chinese literature in the database search.
All studies in the search were included in the Covidence systematic review program (Covidence systematic review program, Truth Health Innovation, Melbourne, Australia; available at https://www.covidence.org). Two independent reviewers (E.K.P. Lee/N.C.Y. Yeung/Z. Xu) assessed studies for eligibility using title/abstract screening after full-text review in Covidence. Data were extracted independently by 2 reviewers (E.K.P. Lee/Z. Xu). Reviewers compared and resolved disagreements.
Data were extracted, including RCT details (eg sample size if only hypertensive patients and country information), participant details (eg cardiovascular/psychiatric co-morbidity and age/sex) and intervention/return details. group When office BP was reported, automated office BP (AOBP) was also used because AOBP (which automatically measures BP 3-5 times at 1-minute intervals in the absence of medical staff) has been shown to provide a closer mean BP to ABPM, than other office BPs.
Mean and SD measurement result of different types of BP data (from office BP [including awake/sleep BP] or included office BP) and depression/anxiety/stress/quality of life (QoL) scores immediately after the intervention, short -term post-intervention (<6 months post-enrolment) and long-term post-intervention (≥6 months post-enrollment). If multiple types of QOL were presented in the same RCT, physical QOL was removed. In addition, data on the number of participants with adverse outcomes and all-cause dropouts from the intervention/control were collected immediately after the intervention.
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; however, because blinding of the MBSR participants was not possible, only adequate blinding for the investigators was assessed. The quality of other blood pressure measurements was assessed. A study was low risk only when all questions were not statistically significant, while the rest of the studies were unknown risk/high risk. What assessments were conducted?
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