EFFECT AND ACCEPTABILITY OF MINDFULNESS-BASED STRESS REDUCTION PROGRAM ON PATIENTS WITH ELEVATED BLOOD PRESSURE OR HYPERTENSION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Objective: Mindfulness-based stress reduction program (MBSR) may reduce blood pressure (BP) in patients with hypertension (HT) or elevated BP. However, some important parameters including asleep BP were not investigated in previous reviews and a well-conducted meta-analysis is lacking. This meta-analysis investigated the effect and acceptability of MBSR, when compared to active and inactive controls, on patients with elevated BP and HT. Design and method: Multiple databases including MEDLINE, EMBASE, APA PsycInfo etc were searched. Included studies were randomized-controlled trials that included patients with elevated BP, have a control group and investigated effect of MBSR. The mean office and out-of-office (including 24-hour, daytime, and asleep) systolic BP (SBP) and diastolic BP (DBP), psychological outcomes (depression/anxiety/stress) and dropout rate were compared between the MBSR arm and the control arm by random effect model. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Results: 12 studies were included and only one was considered at low risk of bias. MBSR decreased office SBP and DBP by 6.64mmHg (95% confidence interval (CI): 1.53–11.74mmHg; I2:86.7%) and by 2.47mmHg (95%CI: 0.89–4.06mmHg, I2:14.8%) at post-intervention; the reduction in DBP was sustained at 3–6 months after recruitment. Although one study suggested reduced 24-h SBP and DBP by MBSR at 1 year, our meta-analyses did not find significant reduction of out-of-office BP by MBSR at post-intervention. MBSR reduced depressive, anxiety and stress symptoms. The drop-out rate from MBSR arm was 15% (95%:9–22%), which was not different from that of control arm. Conclusions: MBSR is acceptable to patients and can reduce office BP and mood symptoms. The current evidence is limited by lack of high-quality and adequately powered trials with long-term follow-up. Furthermore, out-of-office BP was only reported by few trials.