Advertisement

Stress reduction programs in patients with elevated blood pressure: A systematic review and meta-analysis

  • Maxwell V. Rainforth
  • Robert H. Schneider
  • Sanford I. Nidich
  • Carolyn Gaylord-King
  • John W. Salerno
  • James W. Anderson
Article
First Online:

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 Previous meta-analyses of stress reduction and high blood pressure (BP) were outdated and/or methodologically limited.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.

Keywords

Blood Pressure Reduction Stress Reduction Blood Pressure Change Meditation Practice Relaxation Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

References and Recommended Reading

  1. 1.
    Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC VII report. JAMA 2003, 289:2560–2572.PubMedCrossRefGoogle Scholar
  2. 2.
    Kaplan M, Nunes A: The psychosocial determinants of hypertension. Nutr Metab Cardiovasc Dis 2003, 13:52–59.PubMedCrossRefGoogle Scholar
  3. 3.
    Khan N, Hemmelgarn B, Padwal R, et al.: The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2—therapy. Can J Cardiol 2007, 23:539–550.PubMedGoogle Scholar
  4. 4.
    Rozanski A, Blumenthal JA, Davidson KW, et al.: The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005, 45:637–651.PubMedCrossRefGoogle Scholar
  5. 5.
    Steptoe A, Brydon L, Kunz-Ebrecht S: Changes in financial strain over three years, ambulatory blood pressure, and cortisol responses to awakening. Psychosom Med 2005, 67:281–287.PubMedCrossRefGoogle Scholar
  6. 6.
    Yan LL, Liu K, Matthews KA, et al.: Psychosocial factors and risk of hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) study. JAMA 2003, 290:2138–2148.PubMedCrossRefGoogle Scholar
  7. 7.
    Rosengren A, Hawken S, Ounpuu S, et al.: Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (INTERHEART study): case-control study. Lancet 2004, 364:953–962.PubMedCrossRefGoogle Scholar
  8. 8.
    Moseley JV, Linden W: Predicting blood pressure and heart rate change with cardiovascular reactivity and recovery: results from 3-year and 10-year follow up. Psychosom Med 2006, 68:833–843.PubMedCrossRefGoogle Scholar
  9. 9.
    McEwen BS: Protective and damaging effects of stress mediators: central role of the brain. Dialogues Clin Neurosci 2006, 8:367–381.PubMedGoogle Scholar
  10. 10.
    Linden W, Moseley JV: The efficacy of behavioral treatments for hypertension. Appl Psychophysiol Biofeedback 2006, 31:51–63.PubMedCrossRefGoogle Scholar
  11. 11.
    Chesney MA, Black GW, Swan GE, et al.: Relaxation training for essential hypertension at the worksite: I. the untreated mild hypertensive. Psychosom Med 1987, 49:250–263.PubMedGoogle Scholar
  12. 12.
    Stetter F, Kupper S: Autogenic training: a meta-analysis of clinical outcome studies. Appl Psychophysiol Biofeedback 2002, 27:45–98.PubMedCrossRefGoogle Scholar
  13. 13.
    Ospina MB, Bond TK, Karkhaneh M, et al.: Meditation Practices for Health: State of the Research. Rockville, MD: Agency for Healthcare Research and Quality; 2007. [Evidence report/technology assessment no. 155.]Google Scholar
  14. 14.
    Wallace RK, Orme-Johnson DW, Dillbeck MC, eds: Scientific Research on Maharishi’s Transcendental Meditation and TM-Sidhi Program: Collected Papers, vol 5. Fairfield, IA: Maharishi International University Press; 1990.Google Scholar
  15. 15.
    Maharishi Mahesh Yogi: The Science of Being and Art of Living. New York: New American Library; 1963.Google Scholar
  16. 16.
    Roth R: Maharishi Mahesh Yogi’s Transcendental Meditation. Washington, DC: Primus; 2002.Google Scholar
  17. 17.
    Eppley K, Abrams AI, Shear J: Differential effects of relaxation techniques on trait anxiety: a meta-analysis. J Clin Psychol 1989, 45:957–974.PubMedCrossRefGoogle Scholar
  18. 18.
    Dickinson HO, Mason JM, Nicolson DJ, et al.: Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006, 24:215–233.PubMedCrossRefGoogle Scholar
  19. 19.
    Nakao M, Yano E, Nomura S, et al.: Blood pressure-lowering effects of biofeedback treatment in hypertension: a meta-analysis of randomized controlled trials. Hypertens Res 2003, 26:37–46.PubMedCrossRefGoogle Scholar
  20. 20.
    Eisenberg DM, Delbanco TL, Berkey CS, et al.: Cognitive behavioral techniques for hypertension: are they effective? Ann Intern Med 1993, 118:964–972.PubMedGoogle Scholar
  21. 21.
    Jacob RG, Chesney MA, Williams DM, et al.: Relaxation therapy for hypertension: design effects and treatment effects. Ann Behav Med 1991, 13:5–17.Google Scholar
  22. 22.
    Linden W, Chambers L: Clinical effectiveness of non-drug treatment for hypertension: a meta-analysis. Ann Behav Med 1994, 16:35–45.Google Scholar
  23. 23.
    Devine E, Reifschneider E: A meta-analysis of the effects of psychoeducational care in adults with hypertension. Nurs Res 1995, 44:237–245.PubMedCrossRefGoogle Scholar
  24. 24.
    Yucha C, Clark L, Smith M, et al.: The effect of biofeedback in hypertension. Appl Nurs Res 2001, 14:29–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Institute for Natural Medicine and Prevention: Research reviews. Available at: http://www.mum.edu/inmp/researchreviews.html. Accessed August, 2007.
  26. 26.
    Schneider RH, Staggers F, Alexander C, et al.: A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension 1995, 26:820–827.PubMedGoogle Scholar
  27. 27.
    Schneider R, Alexander C, Staggers F, et al.: A randomized controlled trial of stress reduction in the treatment of hypertension in African Americans during one year. Am J Hypertens 2005, 18:88–98.PubMedCrossRefGoogle Scholar
  28. 28.
    Castillo-Richmond A, Schneider R, Alexander C, et al.: Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000, 31:568–573.PubMedGoogle Scholar
  29. 29.
    Paul-Labrador M, Polk D, Dwyer JH, et al.: Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med 2006, 166:1218–1224.PubMedCrossRefGoogle Scholar
  30. 30.
    Blanchard EB, Miller ST, Abel GG, et al.: Evaluation of biofeedback in the treatment of borderline essential hypertension. J Appl Behav Anal 1979, 12:99–109.PubMedCrossRefGoogle Scholar
  31. 31.
    Blanchard EB, Khramelashvili VV, McCoy GC, et al.: The USA-USSR collaborative cross-cultural comparison of autogenic training and thermal biofeedback in the treatment of mild hypertension. Health Psychol 1988, 7(Suppl):175–192.PubMedCrossRefGoogle Scholar
  32. 32.
    Blanchard EB, Eisele G, Gordon MA, et al.: Thermal biofeedback as an effective substitute for sympatholytic medication in moderate hypertension: a failure to replicate. Biofeedback Self Regul 1993, 18:237–253.PubMedCrossRefGoogle Scholar
  33. 33.
    Blanchard EB, Eisele G, Vollmer A, et al.: Controlled evaluation of thermal biofeedback in treatment of elevated blood pressure in unmedicated mild hypertension. Biofeedback Self Regul 1996, 21:167–190.PubMedCrossRefGoogle Scholar
  34. 34.
    Barnes VA, Treiber FA, Davis H: Impact of Transcendental Meditation on cardiovascular function at rest and during acute stress in adolescents with high normal blood pressure. J Psychosom Res 2001, 51:597–605.PubMedCrossRefGoogle Scholar
  35. 35.
    Barnes VA, Treiber FA, Johnson MH: Impact of stress reduction on ambulatory blood pressure in African American adolescents. Am J Hypertens 2004, 17:366–369.PubMedCrossRefGoogle Scholar
  36. 36.
    Seer P, Raeburn JM: Meditation training and essential hypertension: a methodological study. J Behav Med 1980, 3:59–71.PubMedCrossRefGoogle Scholar
  37. 37.
    Frankel BL, Patel DJ, Horwitz D, et al.: Treatment of hypertension with biofeedback and relaxation techniques. Psychosom Med 1978, 40:276–293.PubMedGoogle Scholar
  38. 38.
    Jacob RG, Shapiro AP, O’Hara, P, et al.: Relaxation therapy for hypertension: setting-specific effects. Psychosom Med 1992, 54:87–101.PubMedGoogle Scholar
  39. 39.
    McGrady A, Turner JW, Fine TH, et al.: Effects of biobehaviorally-assisted relaxation training on blood pressure, plasma renin, and aldosterone levels in borderline hypertension. Clin Biofeedback Health 1987, 10:16–25.Google Scholar
  40. 40.
    Amigo I, Gonzalez A, Herrera J: Comparison of physical exercise and muscle relaxation training in the treatment of mild essential hypertension. Stress Med 1997, 13:59–65.CrossRefGoogle Scholar
  41. 41.
    Irvine MJ, Johnston DW, Jenner DA, et al.: Relaxation and stress management in the treatment of essential hypertension. J Psychosom Res 1986, 30:437–450.PubMedCrossRefGoogle Scholar
  42. 42.
    Johnston DW, Gold A, Kentish J, et al.: Effect of stress management on blood pressure in mild primary hypertension. Br Med J 1993, 306:963–965.Google Scholar
  43. 43.
    Bali LR: Long-term effect of relaxation on blood pressure and anxiety levels of essential hpertensive males: a controlled study. Psychosom Med 1979, 41:637–646.PubMedGoogle Scholar
  44. 44.
    van Montrans GA, Karemaker JM, Wieling W, et al.: Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study. BMJ 1990, 300:1368–1372.CrossRefGoogle Scholar
  45. 45.
    Orme-Johnson D, Walton K: All approaches to preventing or reversing effects of stress are not the same. Am J Health Promot 1998, 12:297–299.PubMedGoogle Scholar
  46. 46.
    Alexander CN, Robinson P, Rainforth M: Treating alcohol, nicotine and drug abuse through Transcendental Meditation: a review and statistical meta-analysis. Alcohol Treat Q 1994, 11:13–87.CrossRefGoogle Scholar
  47. 47.
    Zamarra JW, Schneider RH, Besseghini I, et al.: Usefulness of the Transcendental Meditation program in the treatment of patients with coronary artery disease. Am J Cardiol 1996, 78:77–80.Google Scholar
  48. 48.
    Schneider RH, Alexander CN, Staggers F, et al.: Long-term effects of stress reduction on mortality in persons > 55 years of age with systemic hypertension. Am J Cardiol 2005, 95:1060–1064.PubMedCrossRefGoogle Scholar
  49. 49.
    Schneider RH, Walton KG, Salerno JW, Nidich SI: Cardiovascular disease prevention and health promotion with the Transcendental Meditation program and Maharishi consciousness-based health care. Ethn Dis 2006, 16:S4-15–S4-26.Google Scholar
  50. 50.
    Travis F, Wallace RK: Autonomic and EEG patterns during eyes-closed rest and transcendental meditation (TM) practice: the basis for a neural model of TM practice. Conscious Cognition 1999, 8:302–318.CrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  • Maxwell V. Rainforth
    • 1
  • Robert H. Schneider
  • Sanford I. Nidich
  • Carolyn Gaylord-King
  • John W. Salerno
  • James W. Anderson
  1. 1.Institute for Natural Medicine and PreventionMaharishi University of ManagementMaharishi Vedic CityUSA

Personalised recommendations