Is Mindfulness-Based Stress Reduction Effective for People with Hypertension? A Systematic Review and Meta-Analysis of 30 Years of Evidence

Ciro Conversano, Graziella Orrù, Andrea Pozza, Mario Miccoli, Rebecca Ciacchini, Laura Marchi, Angelo Gemignani, Ciro Conversano, Graziella Orrù, Andrea Pozza, Mario Miccoli, Rebecca Ciacchini, Laura Marchi, Angelo Gemignani

Abstract

Background: Hypertension is among the most important risk factors for cardiovascular diseases, which are considered high mortality risk medical conditions. To date, several studies have reported positive effects of mindfulness-based stress reduction (MBSR) interventions on physical and psychological well-being in other medical conditions, but no meta-analysis on MBSR programs for hypertension has been conducted. Objectives: The objective of this study was to determine the effectiveness of MBSR programs for hypertension. Methods: A systematic review and meta-analysis of randomized controlled trials examining the effects of MBSR on systolic and diastolic blood pressure (BP), anxiety, depression, and perceived stress in people with hypertension or pre-hypertension was conducted. The PubMed/MEDLINE and PsycINFO databases were searched in November 2020 to identify relevant studies. Results: Six studies were included. The comparison of MBSR versus control conditions on diastolic BP was associated with a statistically significant mean effect size favoring MBSR over control conditions (MD = -2.029; 95% confidence interval (CI): -3.676 to -0.383, p = 0.016, k = 6; 22 effect sizes overall), without evidence of heterogeneity (I2 = 0.000%). The comparison of MBSR versus control conditions on systolic BP was associated with a mean effect size which was statistically significant only at a marginal level (MD = -3.894; 95% CI: -7.736-0.053, p = 0.047, k = 6; 22 effect sizes overall), without evidence of high heterogeneity (I2 = 20.772%). The higher the proportion of participants on antihypertensive medications was, the larger the effects of MBSR were on systolic BP (B = -0.750, z = -2.73, p = 0.003). Conclusions: MBSR seems to be a promising intervention, particularly effective on the reduction of diastolic BP. More well-conducted trials are required.

Keywords: blood pressure; hypertension; meditation; mindfulness; mind–body therapies.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flowchart of the study selection process. Abbreviations: MBSR = mindfulness-based stress reduction, RCT = randomized controlled trial.
Figure 2
Figure 2
Forest plot of the effect sizes of MBSR versus control conditions on diastolic BP. Abbreviations. BP = blood pressure, MBSR = mindfulness-based stress reduction.
Figure 3
Figure 3
Funnel plot of the effect sizes of MBSR versus control conditions on diastolic BP.
Figure 4
Figure 4
Forest plot of the effect sizes of MBSR versus control conditions on systolic BP.
Figure 5
Figure 5
Funnel plot of the effect sizes of MBSR versus control conditions on systolic BP.

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