Randomized controlled trial of mindfulness-based stress reduction for prehypertension
Open accessAbstract
OBJECTIVE: Mindfulness-based stress reduction (MBSR) is an increasingly popular practice demonstrated to alleviate stress and treat certain health conditions. MBSR may reduce elevated blood pressure (BP). Treatment guidelines recommend life-style modifications for BP in the prehypertensive range (systolic BP [SBP] 120-139 mm Hg or diastolic BP [DBP] 80-89 mm Hg), followed by antihypertensives if BP reaches hypertensive levels. MBSR has not been thoroughly evaluated as a treatment of prehypertension. A randomized clinical trial of MBSR for high BP was conducted to determine whether BP reductions associated with MBSR exceed those observed for an active control condition consisting of progressive muscle relaxation (PMR) training. METHODS: Fifty-six men (43%) and women (57%) averaging (standard deviation) 50.3 (6.5) years of age (91% white) with unmedicated BP in the prehypertensive range were randomized to 8 weeks of MBSR or PMR delivered in a group format. Treatment sessions were administered by one treatment provider and lasted approximately 2.5 hours each week. Clinic BP was the primary outcome measure. Ambulatory BP was a secondary outcome measure. RESULTS: Analyses were based on intent to treat. Patients randomized to MBSR exhibited a 4.8-mm Hg reduction in clinic SBP, which was larger than the 0.7-mm Hg reduction observed for PMR (p = .016). Those randomized to MBSR exhibited a 1.9-mm Hg reduction in DBP compared with a 1.2-mm Hg increase for PMR (p = .008). MBSR did not result in larger decreases in ambulatory BP than in PMR. CONCLUSIONS: MBSR resulted in a reduction in clinic SBP and DBP compared with PMR. Trial Registration ClinicalTrials.gov identifier: NCT00440596.
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MBI reduces systolic blood pressure with a large effect size (g = 1.12, 95% CI 0.40-1.84, p = 0.002, I2 = 89.1%, τ2 = 0.56) in CVD patients.
“There was a large reduction in systolic blood pressure (g = 1.12, 95% CI: 0.40; 1.84, p = 0.002, I2 = 89.1%, τ2 = 0.56)”
From Mindfulness-based interventions for physical and psychological wellbeing in cardiovascular diseases: A systematic review and meta-analysis (2021) · cites this paper as [26]
The Results (Clinic Blood Pressure; page unavailable) report that MBSR reduced clinic systolic blood pressure more than the active control in people with prehypertension. The paper does not report the claimed effect size, confidence interval, p value, or heterogeneity statistics, and its findings do not establish that result for CVD patients. (LLM, conf=0.90)
Experimental — accuracy not yet measuredMBI does not significantly reduce diastolic blood pressure after correction (g = 0.66, 95% CI −0.04-1.36, p = 0.043, I2 = 89.3%, τ2 = 0.54).
“diastolic blood pressure was not significant after correction (g = 0.66, 95% CI: −0.04; 1.36, p = 0.043, I2 = 89.3%, τ2 = 0.54)”
From Mindfulness-based interventions for physical and psychological wellbeing in cardiovascular diseases: A systematic review and meta-analysis (2021) · cites this paper as [26]
The Results (Ambulatory Blood Pressure; page unavailable) report no significant treatment effect on daytime or sleeping ambulatory diastolic blood pressure. However, the Results (Clinic Blood Pressure; page unavailable) report a significant reduction in clinic diastolic blood pressure (p = 0.008). The paper does not report the claimed corrected effect size, confidence interval, heterogeneity statistics, or p = 0.043; its Methods say analyses were not corrected for multiple comparisons. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn some studies, the training was led by a certified trainer, while in others it was not; this aspect may have affected the impact of training on physical and psychological outcomes.
“Moreover, in some studies, the training was led by a certified trainer [10,21,26,28,31], while in others, it was not [9,13,17,22,23,24,25,27,29,30,32,33]. Therefore, this aspect may have affected the impact of training on physical and psychological outcomes.”
From Mindfulness-based interventions for physical and psychological wellbeing in cardiovascular diseases: A systematic review and meta-analysis (2021) · cites this paper as [26]
The Results section (‘Treatment adherence and fidelity’; page not provided) says the intervention was delivered by a licensed clinical psychologist who had received formal MBSR training. It does not say the trainer was certified. The sentence’s suggestion that trainer status may have affected outcomes is the citing authors’ inference, not a finding attributed to this trial. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSome RCTs reported adequate random sequence generation and allocation concealment and adequate blinding of participants' personnel and outcome assessment.
“Some RCTs reported adequate random sequence generation and allocation concealment and adequate blinding of participants’ personnel and outcome assessment [26].”
From Mindfulness-based interventions for physical and psychological wellbeing in cardiovascular diseases: A systematic review and meta-analysis (2021) · cites this paper as [26]
The Methods > Procedure section reports a random-number assignment sequence, and Methods > Blinding describes allocation concealment and effective blinding of the research assistants who assessed outcomes (page numbers not supplied). The paper does not report that participants or treatment-delivery personnel were blinded to which intervention they received or delivered; describing PMR as a credible placebo does not establish that blinding. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPart of the discrepancy reported in this systematic re-examination may be dependent on factors such as different duration of MBI intervention, the psychological battery, high dropout rates, and the administration system.
“Part of the discrepancy reported in this systematic re-examination of literature may be dependent on some factors, such as (a) the different duration of MBI intervention (from 1 day to 12 weeks) [17,22], (b) the psychological battery, (c) the high dropout rates [10,17,26], and (d) the administration system.”
From Mindfulness-based interventions for physical and psychological wellbeing in cardiovascular diseases: A systematic review and meta-analysis (2021) · cites this paper as [26]
Baseline imbalances of office DBP and ABPM BP between the 2 arms were reported by Palta et al and Hughes et al.
“Finally, the baseline imbalances of office DBP and ABPM BP between the 2 arms were reported by Palta et al 45 and Hughes et al. 37”
From Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials (2020) · cites this paper as [37]
The Methods (Data analysis; page unavailable) say the authors controlled for pre-intervention blood pressure, and the Results (Clinic Blood Pressure and Ambulatory Blood Pressure; pages unavailable) report changes after treatment. Neither those passages nor searches for baseline differences report an imbalance in office DBP or ambulatory BP between the two arms. (LLM, conf=0.72)
Experimental — accuracy not yet measuredIn a pilot randomized controlled trial with 56 participants, most of whom were white, an eight-week Mindfulness-Based Stress Reduction program reduced clinic blood pressure significantly more than Progressive Muscle Relaxation.
“This actively controlled pilot RCT (n=56, 91% white) found that the standard, 8-week Mindfulness-Based Stress Reduction (MBSR) program significantly lowered clinic BP more than Progressive Muscle Relaxation (PMR), an established relaxation technique.”
From Mindfulness and physical disease: a concise review (2019) · cites this paper as [13]
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- Authors
- Hughes, J. W., Fresco, D. M., Myerscough, R., H. M. van Dulmen, M., Carlson, L. E., & Josephson, R.
- Affiliations
- Summa Health System (US)
- Corresponding author
- Hughes, Joel W.
- Venue
- Psychosomatic Medicine
- Published
- 2013-10
- Volume
- 75
- Issue
- 8
- Pages
- 721-728
- ISSN
- 0033-3174 (ISSN-L)
- PMC
- PMC3834730
- OpenAlex
- W1991191692
- Cited by
- 142
- References
- 31
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 8 · 2023: 3 · 2022: 12 · 2021: 13 · 2020: 15 · 2019: 11 · 2018: 20 · 2017: 10 · 2016: 13 · 2015: 18 · 2014: 9 · 2013: 2 · 2012: 2
- FWCI
- 15.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Complementary and Integrative Health (R21AT002698)
- 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, prehypertension, blood pressure reduction, progressive muscle relaxation, ambulatory blood pressure, lifestyle modification, hypertension prevention, group intervention
- MeSH terms
- Adult, Analysis of Variance, Blood Pressure, Female, Humans, Male, Middle Aged, Patient Dropouts, Relaxation Therapy, Stress, Psychological, Linear Models, Outcome Assessment, Health Care, Practice Guidelines as Topic, Blood Pressure Monitoring, Ambulatory, Intention to Treat Analysis, Prehypertension, Mindfulness
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