Hypertension Analysis of Stress Reduction Using Mindfulness Meditation and Yoga: Results From the Harmony Randomized Controlled Trial
Abstract
BACKGROUND: The HARMONY study was a randomized, controlled trial examining the efficacy of an 8-week mindfulness-based stress reduction (MBSR) program for blood pressure (BP) lowering among unmedicated stage 1 hypertensive participants. METHODS: Participants diagnosed with stage 1 hypertension based on ambulatory BP were randomized to either immediate treatment of MBSR for 8 weeks or wait-list control. Primary outcome analysis evaluated whether change in awake and 24-hour ambulatory BP from baseline to week 12 was significantly different between the 2 groups. A within-group before and after MBSR analysis was also performed. RESULTS: The study enrolled 101 adults (38% male) with baseline average 24-hour ambulatory BP of 135±7.9/82±5.8mm Hg and daytime ambulatory BP of 140±7.7/87±6.3 mmHg. At week 12, the change from baseline in 24-hour ambulatory BP was 0.4±6.7/0.0±4.9mm Hg for the immediate intervention and 0.4±7.8/-0.4±4.6mm Hg for the wait-list control. There were no significant differences between intervention and wait-list control for all ambulatory BP parameters. The secondary within-group analysis found a small reduction in BP after MBSR compared with baseline, a finding limited to female subjects in a sex analysis. CONCLUSIONS: MBSR did not lower ambulatory BP by a statistically or clinically significant amount in untreated, stage 1 hypertensive patients when compared with a wait-list control group. It leaves untested whether MBSR might be useful for lowering BP by improving adherence in treated hypertensive participants. CLINICAL TRIALS REGISTRATION: NCT00825526.
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One study did not report the standard deviation of blood pressure measured using ambulatory blood pressure monitoring at end points, and the end-point standard deviation was substituted with that study's corresponding baseline standard deviation.
“One study did not report the SD of BP measured using ABPM at end points; the SD at the end points was substituted with the corresponding baseline SD of that study. 34”
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“The frequency in BP measurements may have contributed to higher BP readings.(32) We chose the out-of-office home BP monitoring for participants' convenience and comfort and believe that it provides a more realistic BP reading.”
BackgroundMethodResultInfluentialFernandes, A. C., McIntyre, T. M., Coelho, R. C., Prata, J., & Maciel, M. J. (2019) · Revista Portuguesa de Cardiologia · doi:10.1016/j.repc.2018.09.009 · Cited by 23 · see citing works
“The detrimental effects of high cholesterol and salt intake and hypertension on the severity of coronary atherosclerosis are well known.(27,28)”
BackgroundCohen, D. L., Boudhar, S., Bowler, A., & Townsend, R. R. (2016) · Journal of Clinical Hypertension · doi:10.1111/jch.12772 · Cited by 20 · see citing works
Srisoongnern, S., Pajareya, K., Sriboon, R., Thanakiatpinyo, T., Chirakarnjanakorn, S., & Thirapatarapong, W. (2021) · Heart & Lung · doi:10.1016/j.hrtlng.2021.02.005 · Cited by 18 · see citing works
Contemplative Practices: A Strategy to Improve Health and Reduce Disparities
Bruce, M. A., Jeffers, K. S., Robinson, J. K., & Norris, K. C. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15102253 · Cited by 18 · see citing works
“Contemplative practices can also foster an opportunity to raise one’s awareness about stressful, underlying issues [30,31].”
BackgroundMeditation for the primary and secondary prevention of cardiovascular disease
Rees, K., Takeda, A., Court, R. A., Kudrna, L., Hartley, L., & Ernst, E. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013358.pub2 · Cited by 18 · see citing works
Brems, C. (2020) · Springer eBooks · doi:10.1007/978-3-030-30892-6_10 · Cited by 17 · see citing works
Faasse, K., & Petrie, K. J. (2015) · Elsevier eBooks · doi:10.1016/b978-0-08-097086-8.14133-9 · Cited by 14 · see citing works
Cognitive-behavioral therapy for treating hypertension: a systematic review and meta-analysis
Walker, M. S., Figueiredo, N. R., Machado, W. D. L., Costa, C. A. D., & Feóli, A. M. P. (2023) · Psychology Health & Medicine · doi:10.1080/13548506.2023.2282958 · Cited by 11 · see citing works
“…but which did not present data that was included in the meta-analysis, those conducted by Southgate et al. (Southgate et al., 2017), Blom et al. (Blom et al., 2014), Loucks et al. (Loucks et al., 2019), Tanaka e Nolan (Tanaka & Nolan, 2018), Clemow et al. (Clemow et al., 2018) and Sung et al.…”
BackgroundInfluentialSangprasert, P., Palangrit, S., Tiyoa, N., & Pattaraarchachai, J. (2019) · Journal of Health Research · doi:10.1108/jhr-07-2018-0059 · Cited by 10 · see citing works
Cohen, D. L. (2013) · Journal of Yoga & Physical Therapy · doi:10.4172/2157-7595.1000144 · Cited by 11 · see citing works
“There are only 9 randomized controlled trials [RCT] of any form of yoga for hypertension [11,13,15-21,23].”
BackgroundChen, Z., Li, Q., Xu, T., Zhou, X., Shu, Y., Guo, T., & Liang, F. (2024) · Systematic Reviews · doi:10.1186/s13643-024-02744-5 · Cited by 10 · see citing works
Zhang, H., Jiang, X., Da, H., Dai, R., Zhao, N., Pan, W., & Fan, J. (2020) · Medicine · doi:10.1097/md.0000000000021451 · Cited by 10 · see citing works
“Mindfulness-based cognitive therapy is mainly use to explore the effectiveness of treatment of hypertension with anxiety and depression, reducing stress through mindfulness, and adjusting the psychology to achieve the effect of reducing blood pressure.([16,17]) Cognitive behavioral therapy (CBT) is widely used in trea…”
BackgroundWankhar, D., Kumar, A., Vijayakumar, V., Arumugam, V., Balakrishnan, A., Ravi, P., Bhandari, R. B., & Kuppusamy, M. (2024) · Cureus · doi:10.7759/cureus.58434 · Cited by 12 · see citing works
“…the current meta-analysis and all the trials were done between the years 2000 to 2020, out of which five studies were done in the USA [17-20], two studies in Iran [21,22], and the rest in Brazil [23], Los Angeles [24], Portugal [25], Iowa [26], India [27], Spain [28], Italy [29], and Canada [30].”
BackgroundInfluence of Mindfulness and Relaxation on Treatment of Essential Hypertension: Meta-Analysis
Zhang, F., Zhang, Y., Jiang, N., Zhai, Q., Hu, J., & Feng, J. B. (2021) · Journal of Healthcare Engineering · doi:10.1155/2021/2272469 · Cited by 9 · see citing works
RetractedPsychological methods in treatment of essential hypertension
Larionow, P. (2021) · Arterial Hypertension · doi:10.5603/ah.a2021.0002 · Cited by 8 · see citing works
“pl/arterial_hypertension observed that MBSR does not result in the reduction of blood pressure in people with EH [48].”
BackgroundMir, I. A., John, A. T., Humayra, S., Khan, Q. I., Chong, T. F., & Manan, H. A. (2024) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2024.103084 · Cited by 8 · see citing works
Tedder, M. L., Shi, L., Si, M., Franco, R., & Chen, L. (2015) · Medicines · doi:10.3390/medicines2040298 · Cited by 8 · see citing works
“group [1,21–25].”
Meditation and Cardiovascular Health: What is the Link?
Schnaubelt, S., Hammer, A., Koller, L., Niederdöckl, J. D., Kazem, N., Spiel, A. O., Niessner, A., & Sulzgruber, P. (2019) · European Cardiology Review · doi:10.15420/ecr.2019.21.2 · Cited by 8 · see citing works
Meditation in Prevention and Treatment of Cardiovascular Disease: An Evidence-Based Review
Schneider, R. H., Marwaha, K., & Salerno, J. W. (2022) · Springer eBooks · doi:10.1007/978-981-16-6913-2_24 · Cited by 8 · see citing works
Spiritually Based Interventions for High Blood Pressure: A Systematic Review and Meta-analysis
Khabiri, R., Jahangiry, L., Abbasian, M., Majidi, F., Farhangi, M. A., Sadeghi‐Bazargani, H., & Ponnet, K. S. (2024) · Journal of Religion and Health · doi:10.1007/s10943-024-02034-3 · Cited by 9 · see citing works
“Ultimately, 23 studies were deemed eligible for inclusion in the meta-analysis (Alexander et al., 1989; An et al., 2021; Blom et al., 2014; Castillo-Richmond et al., 2000; Chandler et al., 2020; Cohen et al., 2011; Fiedler et al., 1989; Hagins et al., 2014; Hughes et al., 2013; Kaleeswari et al.,…”
InfluentialMcDonagh, S. T. J., Reburn, C., Smith, J. R., & Clark, C. E. (2024) · British Journal of General Practice · doi:10.3399/bjgp.2023.0585 · Cited by 9 · see citing works
Takotsubo Syndrome: The Enigma of Women’s Depressed Heart – A State-of-the-Art Review
Lisci, F. M., Mazza, M., Brisi, C., Gaetani, E., Pola, R., Romagnoli, E., Biondi‐Zoccai, G., & Marano, G. (2025) · Heart and Mind · doi:10.4103/hm.hm-d-24-00081 · Cited by 5 · see citing works
Nisshash: Design of An IoT-based Smart T-Shirt for Guided Breathing Exercises
Rumon, M. A. A., Veeturi, S., Seckin, M., Solanki, D., & Mankodiya, K. (2023) · IEEE International Conference on Smart Computing · doi:10.1109/smartcomp58114.2023.00019 · Cited by 5 · see citing works
“Existing methods for practicing GBE, including meditation, yoga, physiological training, and wearable devices, have demonstrated potentials to improve relaxation [7], [8].”
MethodManchanda, S. C., & Madan, K. (2015) · Hypertension Journal · doi:10.5005/jp-journals-10043-0005 · Cited by 5 · see citing works
Meditation for the primary and secondary prevention of cardiovascular disease
Rees, K., Court, R. A., Takeda, A., & Ernst, E. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013358 · Cited by 4 · see citing works
Yong-yao, W., Xia, Q., Gao, Y., Zhang, C., Xu, P., Zhang, H., Chao, G., Yu, R., & Liu, J. (2025) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2025.103245 · Cited by 3 · see citing works
Sabetfar, N., Meschi, F., & Taghvaei, M. H. (2021) · Quarterly of Horizon of Medical Sciences · doi:10.32598/hms.27.2.3502.1 · Cited by 3 · see citing works
Effect of Different Modalities of Mindfulness-Based Interventions on Blood Pressure
AlKhabbaz, A., Almusa, B. M., & Estrella, E. D. (2022) · Jurnal Keperawatan Padjadjaran · doi:10.24198/jkp.v10i1.1946 · Cited by 4 · see citing works
“This effect was largely confined to female subjects” (Blom et al., 2014).”
BackgroundИгоревич, Н. Д., Solovieva, M., & Александрович, З. К. (2022) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2022-5189 · Cited by 3 · see citing works
Hypertension and meditation: can meditation be useful in preventing hypertension?
Khobragade, Y., Khobragade, S., & Abbas, A. (2016) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20162030 · Cited by 2 · see citing works
Ogiri, S., Agoha, B. E., Akindele, Z., & Ogiri, S. (2020) · Nigerian Postgraduate Medical Journal · doi:10.4103/npmj.npmj_199_19 · Cited by 2 · see citing works
Mindfulness-Based Interventions in the Treatment of Physical Conditions
Goyal, M., & Rusch, H. L. (2020) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780198808640.013.34 · Cited by 2 · see citing works
Capnometric feedback training decreases 24-h blood pressure in hypertensive postmenopausal women
Anderson, D. E., Reeves, A. N., Mehling, W. E., & Chesney, M. A. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-02240-x · Cited by 2 · see citing works
“Other research on breathing interventions in hypertension have provided comparable findings involving hypertensive control groups that had shown no significant changes in 24-h mean BP following the wait list period [41, 42].”
ResultThe Effectiveness Of Mindfulness On Blood Pressure And Brain Wave Of Elderly People
Almosawy, M. S. A. W. (2022) · Journal of Pharmaceutical Negative Results · doi:10.47750/pnr.2022.13.s07.91 · Cited by 1 · see citing works
Rabipour, F., Hosseininasab, S. D., & Salari, A. (2024) · American Journal of Health Education · doi:10.1080/19325037.2023.2297281 · Cited by 1 · see citing works
“Also, in the results of studies conducted by Blom et al. 28 and Campbell et al., 29 there was no significant reduction in BP resulting from MBSR.”
ResultEstrategia de prevención comunitaria enfocada en la detección de pacientes con hipertensión arterial
Aroca, K. M. V., & Zumárraga, D. P. (2024) · Mediciencias UTA (Impresa)/Mediciencias UTA (En línea) · doi:10.31243/mdc.uta.v8i1.2346.2024 · Cited by 1 · see citing works
Cardona, E. Y. B. (2018) · Psicología y Salud · doi:10.25009/pys.v29i1.2569 · Cited by 2 · see citing works
Yoga in the Management of Arterial Hypertension
Roche, L. T., Menon, P., & Tiwari, S. (2022) · Springer eBooks · doi:10.1007/978-981-16-6913-2_23 · Cited by 1 · see citing works
Relações entre Estresse, Distorções Cognitivas e Otimismo em Pacientes com Hipertensão
Pacheco, D. D. S. G., & Malagris, L. E. N. (2020) · Psicologia Ciência e Profissão · doi:10.1590/1982-3703003186605 · Cited by 1 · see citing works
A meditação como prática complementar em saúde para hipertensos
Barbosa, J. D. S., da Costa, L. B. D., Camacho, A. C. L. F., & Correia, D. M. D. S. (2020) · Research Society and Development · doi:10.33448/rsd-v9i11.9549 · Cited by 1 · see citing works
Fernandes, A. C., McIntyre, T. M., Coelho, R., Prata, J., & Maciel, M. J. (2019) · Revista Portuguesa de Cardiologia (English Edition) · doi:10.1016/j.repce.2018.09.011 · Cited by 1 · see citing works
“Kajian” Efektivitas Pengurangan Stres Berbasis Kesadaran terhadap Respons Psikologis Mahasiswa
Usman, S. (2022) · Buletin Psikologi · doi:10.22146/buletinpsikologi.53229 · Cited by 1 · see citing works
“Program meditasi mulai dikembangkan di sebuah klinik penanganan stres di Universitas Massachusetts bagian pusat pelayanan medis (Blom et al., 2013).”
BackgroundIntegrative medicine in the care of the elderly
Gaylord, S. A. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781107294967.052
Mind–Body Practices for the Prevention and Treatment of Cardiovascular Disease
Newberg, A. B., & Olex, S. (2016) · Springer eBooks · doi:10.1007/978-3-319-33214-7_12
Alternative Approaches for Lowering Blood Pressure
Byrd, J. B., & Brook, R. D. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-42973-3.00029-9
How to Maximise Individual Propensity for Active Committed Enthusiasm
Scott‐Jackson, W., & Mayo, A. (2017) · Springer eBooks · doi:10.1007/978-3-319-56145-5_4
Mindfulness-Based Therapy and Heart Health
Ismond, K. P., Bukutu, C., & Vohra, S. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811279-3.00023-9
Integrative Approach in Cardiovascular Disease
Dhindsa, D. S., Shen, J., Sandesara, P. B., & Sperling, L. S. (2020) · Springer eBooks · doi:10.1007/978-3-030-30892-6_17
Plotnikoff, G. A., & Dusek, J. A. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-35868-2.00024-4
The Potential Health Benefits of Meditation
Allen, C. (2020) · ACSMʼs Health & Fitness Journal · doi:10.1249/fit.0000000000000624
“The HARMONY study used a randomized controlled trial to examine the effectiveness of an 8-week MBSR program on blood pressure (BP) measurements among unmedicated, stage 1 hypertensive participants (15).”
MethodGaylord, S. A., Kadro, Z. O., & Toche, J. (2022) · Cambridge University Press eBooks · doi:10.1017/9781108942751.056
Integrative Approach in Cardiovascular Disease
Shen, J. (2025) · Nutrition and health · doi:10.1007/978-3-031-87441-3_21
Kalinowski, J., Anderson, R., Uzoigwe, N., Chagomerana, C., Loucks, E. B., Pagoto, S., Newton, R. L., Mama, S. K., & Johnson, B. T. (2025) · Physical Activity and Health · doi:10.5334/paah.435
Luo, Y., Zhang, Y., Zhai, Y., Lu, Z., Shou, L., Hu, L., He, W., Qin, Y., Anwar, N., Zhong-fu, Z., et al. (2025) · Digital Health · doi:10.1177/20552076251388138
“49,50 The intervention used in this study was a one-time, brief mind-fulness meditation practice.”
Effects of a Tai Chi dance intervention on the autonomic nervous system in university students
Zhao, R., An, M., Li, J., Ding, H., & Wang, J. (2025) · Medicine · doi:10.1097/md.0000000000044930
“[2,3] Extensive research has established a strong link between autonomic nervous system (ANS) disorders and ventricular arrhythmias.”
InfluentialIntegrative approach to cardio-oncology
Huston, A. J., & Dent, S. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-30194-0.00061-8
Wang, S., Ng, S. N., Sit, R. W. S., Ying, C. C. T., Leung, S. Y., Han, J., Choi, Y. K., Chow, K. F., Chung, W. H., Yip, B. H. K., et al. (2026) · Clinical Hypertension · doi:10.5646/ch.2026.32.e34
“https://clinicalhypertension.org only 2 RCTs including a total of 129 participants reported the effect of MBSR on nocturnal BP; the results were conflicting with 1 RCT reported a significant reduction of asleep SBP of 6mmHg ( n = 42) [19,20].”
Influential
- Authors
- Blom, K., Baker, B., How, M., Dai, M., Irvine, J., Abbey, S., Abramson, B. L., Myers, M. G., Kiss, A., Perkins, N. J., & Tobe, S. W.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- University Health Network (CA)
- York University (CA)
- University of Toronto (CA)
- Institute for Clinical Evaluative Sciences (CA)
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-09-14
- Volume
- 27
- Issue
- 1
- Pages
- 122-129
- ISSN
- 0895-7061 (ISSN-L)
- 1941-7225
- OpenAlex
- W2014081470
- Cited by
- 101
- References
- 43
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 10 · 2023: 2 · 2022: 12 · 2021: 9 · 2020: 13 · 2019: 10 · 2018: 9 · 2017: 10 · 2016: 5 · 2015: 8 · 2014: 3 · 2013: 1
- FWCI
- 6.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- mindfulness-based stress reduction, hypertension, stage 1 hypertension, ambulatory blood pressure, yoga, blood pressure reduction, waitlist control, sex differences
- MeSH terms
- Adult, Aged, Blood Pressure, Female, Humans, Hypertension, Male, Middle Aged, Stress, Psychological, Time Factors, Yoga, Treatment Outcome, Blood Pressure Monitoring, Ambulatory, Meditation, Mindfulness
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