Reducing Blood Pressure

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Benson, H. (1977).  Systemic hypertension and the relaxation response.  New England Journal of Medicine, 296, 1152-1156.  This article reviews research on the relaxation response and blood pressure (BP).  In one of the studies reviewed, subjects were taught to elicit the relaxation response by meditation for 20 minutes twice/day.  After two weeks, BP's were measured every two weeks for 6 months (BP's never measured after meditation).  Among meditation subjects, there was an average drop in systolic BP (SBP) during the 6 months of 7 mmHG lower than at baseline and diastolic BP (DBP) was 4 mmHG lower than at baseline.  Subjects served as their own controls, with a 6-week run-in period when no BP changes were observed before start of study.  For subjects who "chose to stop meditation", both SBP and DBP by 14 mmHG in hypertensive patients treated with antihypertensive medication, compared with no statistically significant change in a matched control group.  A third study using control group and Buddhist meditation reported reductions of 15 mm SBP and 10 mm DBP in patients with hypertension (NEJM, 1976).  Other studies have also shown significant decreases in both SBP and DBP with the relaxation response in normotensive working populations.

Chesney, M.A., Agras, S., Benson, H., Blumenthal, J.A., Engel, B.T., Foreyt, J.P., Kaufmann, P.G., Levenson, R.M., Pickering, T.G., Randall, W.C., Schwartz, P.J. (1987).  Task Force 5: Nonpharmocologic approaches to the treatment of hypertension.  Circulation, 76 (Suppl I), 104-109.  This is a more recent review of the literature.  Authors conclude that since 20 million people in the U.S. alone have mild hypertension (HTN) and drug treatments for HTN have many potential negative side-effects, non-pharmacological treatments "must be explored vigorously" (p.104).  Suggests that for the standard care of hypertensive individuals that "Relaxation-based treatments should also be given early consideration in light of the evidence of their efficacy" (p.105).

Linden, W. & Chambers, L. (1994).  Clinical effectiveness of non-drug treatment for hypertension:  A meta-analysis.  Annals of Behavioral Medicine, 16, 35-45.  Perhaps one of the best reviews ever performed of mind-body medicine strategies for reducing blood pressure.  This review is unique in that the authors control for initial blood pressure levels.  In previous reviews, persons with normal blood pressure were included (in such populations it is difficult to demonstrate an effect for mind-body strategies on blood pressure because the blood pressure cannot be reduced much further.  The authors concluded that these approaches were equivalent to single drug therapy for hypertension.

Schneider, R.H., Staggers, F., Alexander, C., Sheppard, W., Rainforth, M., Kondwani, K., Smith, S., & King, C.G. (1995).  A randomized controlled trial of stress reduction for hypertension in older African Americans.  Hypertension, 26, 820-829.  Study involved 111 African Americans in Oakland, CA, ages 55-85 with baseline blood pressure < or = 179/104 mmHg (TM) compared with progressive muscle relaxation (PMR) and a life-style modification education control program.  TM and PMR sessions lasted 1.5 hours initially and 1.5 hours/month for 3 months; data collected every month.  Investigators found that TM had significantly greater effects on systolic blood pressure (p=.02) and diastolic blood pressure (p=.03) than PMR; SBP was reduced by 10.7 mmHg (p<.003) and DBP reduced by 6.4mm (p<.0001) for TM.  The investigators concluded that TM was twice as effective as PMR in reducing systolic and diastolic blood pressures.

Koenig, H.G., George, L.K., Cohen, H.J., Hays, J.C., Blazer, D.G., Larson, D.B. (1998).  The relationship between religious activities and blood pressure in older adults.  International Journal of Psychiatry in Medicine, 28, 189-213.  Epidemiological study of 4,000 randomly selected older adults in North Carolina (NIA-supported Establishment of Populations for Epidemiologic Studies of the Elderly (EPESE)).  Persons who both attended religious services regularly and who prayed/meditated regularly were 40% less likely to have diastolic hypertension than those who did not (p<.0001, after controlling for age, sex, race, education, smoking, physical functioning, and body mass index). Among black persons in the sample (54% of subjects), the effects on blood pressure were even greater.  Religious activities (especially regular prayer and scripture reading) at one wave predicted lower blood pressure levels three years later, after controlling for baseline blood pressure and other confounding variables.

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