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Hindawi Publishing CorporationInternational Journal of HypertensionVolume 2012, Article ID 578397, 11 pagesdoi:10.1155/2012/578397

Review Article

Current Perspectives on the Use of Meditation toReduce Blood Pressure

Carly M. Goldstein,1, 2 Richard Josephson,1, 2, 3 Susan Xie,4 and Joel W. Hughes1, 2, 3

1 Kent State University, Kent, OH 44242, USA2 Summa Health System, Akron, OH 44309, USA3 Harrington Heart & Vascular Institute, University Hospitals Case Medical Center andDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA

4 Rice University, Houston, TX 77005, USA

Correspondence should be addressed to Joel W. Hughes, [email protected]

Received 9 August 2011; Revised 17 October 2011; Accepted 24 October 2011

Academic Editor: Tavis S. Campbell

Copyright © 2012 Carly M. Goldstein et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Meditation techniques are increasingly popular practices that may be useful in preventing or reducing elevated blood pressure. Wereviewed landmark studies and recent literature concerning the use of meditation for reducing blood pressure in pre-hypertensiveand hypertensive individuals. We sought to highlight underlying assumptions, identify strengths and weaknesses of the research,and suggest avenues for further research, reporting of results, and dissemination of findings. Meditation techniques appear toproduce small yet meaningful reductions in blood pressure either as monotherapy or in conjunction with traditional pharma-cotherapy. Transcendental meditation and mindfulness-based stress reduction may produce clinically significant reductions insystolic and diastolic blood pressure. More randomized clinical trials are necessary before strong recommendations regarding theuse of meditation for high BP can be made.

1. Introduction: Meditation Techniques asTreatments for Elevated Blood Pressure

According to worldwide estimates, hypertension affects ap-proximately 1 billion people, resulting in 7.1 million attrib-uted deaths per year [1]. In the United States, nearly halfof all adults have blood pressure (BP), expressed in termsof systolic (SBP) over diastolic blood pressure (DBP), in theprehypertensive (SBP of 120–139 or DBP of 80–89) or hyper-tensive (SBP > 140 or DBP > 90) range [2, 3]. As one ofthe most widespread, least controlled diseases around theworld, hypertension poses a threat to adults from all culturesand lifestyles. Factors such as improved treatment, phar-macologic interventions, preventative measures, and lifestylechanges have contributed to a 60% decrease in age-adjusteddeath rates from stroke and a 50% decrease in age-adjusteddeath rates from coronary heart disease in the United Statessince 1972. However, despite these improvements, BP con-trol among American adults still remains suboptimal. For

example, two-thirds of hypertensive individuals are not beingcontrolled to recommended BP levels. Furthermore, approx-imately 30% of American adults are unaware of their hyper-tension, and over 40% of those with hypertension are notreceiving treatment [3].

Current treatment guidelines for hypertension includeantihypertensive medications and health-promoting lifestylemodifications such as weight reduction, the DASH eatingplan (increased fruits and vegetables, and low fat dairy prod-ucts with reduced saturated and total fat), reduced dietarysodium, increased physical activity, and moderation ofalcohol consumption. Ideally, antihypertensive medicationsand lifestyle modifications successfully reduce BP to optimallevels. However, despite the effectiveness of antihypertensivemedication [4], adherence to medication regimens is oftenpoor and interferes with the goal of reducing BP [5, 6]. Inaddition, hypertensive medications can produce trouble-some side effects such as insomnia, sedation, dry mouth,drowsiness, impotence, and headaches [4]. Due to difficulty

2 International Journal of Hypertension

adhering, side effects, and prescription drug costs, hyperten-sive individuals may desire a nonpharmacologic interventionto avoid or complement their antihypertensive medicationregimen. Therefore, whereas continued improvement inpharmacologic treatments is necessary, these advancementsmust be complemented by nonpharmacological approachesto BP control. Toward that end, mind-body interventionssuch as relaxation, stress management, and meditation—whether used alone or in combination with lifestyle mod-ifications—have been evaluated as potential treatments forhigh BP (refer to Table 1 for an overview of the major typesof mind-body interventions). Ample evidence exists re-garding the effects of relaxation and stress management onBP to draw some conclusions, which are discussed below.However, less is known regarding the potential of meditationas an intervention for hypertension. The purpose of thisfocused paper is to evaluate the evidence that meditation isan effective intervention for lowering elevated BP (refer toTable 2 for a summary of studies in the literature search).

2. Mind-Body Interventions

Relaxation therapies for hypertension have been evaluatedfor over 30 years with disappointing results. For example,the Hypertension Intervention Pooling Project found notreatment effect for SBP and a small effect for DBP [22]. Ina study by Irvine and Logan, relaxation therapy producedeffects equal to a group that received support therapy, andthe relaxation group did not produce a larger decrease in BP[23]. Positive results sometimes observed for relaxation canoften be explained by methodology [24]; that is, individualswith higher baseline BPs tend to benefit more than individ-uals with lower baseline BPs, and repeated monitoring ofBP appears sufficient to reduce BP levels [24, 25]. Overall,relaxation techniques, the most common being progressivemuscle relaxation (PMR), are not considered effective meth-ods for treating hypertension [26]. Consequently, PMR caneven be used as a control group for randomized controlledtrials of other mind-body interventions.

In contrast, stress-management therapies have had somesuccess reducing BP [27–30]. In a meta-analysis, multicom-ponent stress management treatments were more effective inreducing BP (13.5 mm Hg SBP and 3.4 mm Hg DBP) thansham treatments, whereas single-component therapies (e.g.,relaxation alone) did not produce significant results [31].Another meta-analysis reported that multicomponent stress-management therapies were more effective in reducing BPthan single-component relaxation-based therapies [32]. TheCanadian Coalition for High Blood Pressure Prevention andControl has recommended multicomponent stress manage-ment be considered for hypertensive individuals whose stressappears to contribute to their hypertension [30].

Despite the promise of multicomponent stress-manage-ment interventions, implementation has not been wide-spread. Historically, the field of behavioral medicine hastaken a keen interest in the contribution of stress to eleva-tions in BP. Naturally, evidence that stress contributes to ele-vated BP and hypertension was followed by attempts to treatstress in order to reduce BP. However, stress-management

interventions for high BP are neither widely available norcommonly practiced. Although we cannot be certain, wespeculate the association of stress management programswith mental health treatment may introduce stigma andreduce patient acceptance of stress-management approaches.The expense of treatment programs and relative scarcity ofhealthcare professionals qualified to provide stress manage-ment to patients with high BP may also contribute to thelimited implementation of multicomponent stress manage-ment programs as a uniquely behavioral medicine solutionto hypertension.

Another mind-body intervention for high BP is medita-tion. It appears to be a promising option, as meditation isportable and can be practiced independently of structuredtreatment programs, although evaluation in clinical trialsobviously requires a clear treatment protocol. Meditation hasless association with mental health stigma and may be a moreacceptable intervention than stress-management treatmentsin many cultures.

The most widespread types of meditation interventionscan be roughly grouped into mantra meditation, such astranscendental meditation (TM) and mindfulness medita-tion. Mindfulness meditation involves an attitude of open-ness, acceptance, and reflection rather than impulse andjudgment toward the practitioner’s current experiences, aswell as the observation of thoughts, feelings, and the externalworld alike through calm, detached sensory awareness [33].Mantra meditations focus on a word, phrase, or concept.The mantras often have soft sounds, like “Om,” and thesewords are thought to produce different vibrations in differentpeople, producing various effects on the individual [34]. Inthe TM technique, the mantras, which are used for soundvalue rather than meaning, become increasingly secondaryin experience and eventually disappear, while self-awarenessbecomes primary in experience as the practitioner tran-scends to a state of pure consciousness [35].

Mindfulness—described as a calm awareness of one’sbody, mind, and environment that embodies an interactionbetween nonjudgmental acceptance and focuses on the pre-sent moment—has existed for over 2,500 years and canbe found in numerous religions, cultures, meditation tech-niques, and psychotherapies [36]. Although it is the 7th stepof the Noble Eightfold Path in Buddhism, there is noth-ing inherently religious about mindfulness as it is mostlytaught completely independent from any religious doctrine.Mindfulness meditation research became formalized in 1979when Dr. Jon Kabat-Zinn founded the MBSR program atUniversity of Massachusetts-Amherst to treat the chronicallyill [37]. Other practices and interventions that utilize theconcept of mindfulness include yoga [38], acceptance andcommitment therapy [39], dialectical behavior therapy [40],Tai Chi [41], and Qigong [42].

2.1. Transcendental Meditation. TM has been extensivelystudied as a meditation therapy for high BP. In one study,the feasibility and efficacy of TM and progressive musclerelaxation (PMR) were tested via a subgroup analysis by sexand level of hypertension risk in older African Americans[17]. Compared to control subjects who underwent lifestyle

International Journal of Hypertension 3

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over

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0]

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dult

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yrs.

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mm

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SBP,

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nm

edic

ated

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r8

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ctiv

e(P

MR

trai

nin

g)

3re

adin

gsta

ken

at5-

min

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terv

als,

follo

wed

by2

addi

tion

alm

easu

rem

ents

wit

hin

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ks.

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dom

ized

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ther

apis

ts

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ced

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ifica

nt

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sin

clin

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P(b

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9m

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g)an

dD

BP

(by

1.9

mm

Hg)

Non

e


Ta

ble

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onti

nu

ed.

Med

itat

ion

stu

dyov

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ose

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trol

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gth

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ings

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dom

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TM

[11]

35(a

dole

scen

tsw

ith

hig

hn

orm

alB

Pag

ed15

–18

yrs.

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ican

Am

.,1

Cau

casi

anA

m.,

rest

ing

SBP

≥85t

han

d≤9

5th

perc

enti

le)

TM

,wit

h15

min

med

itat

ion

sess

ion

stw

ice/

day

for

2m

os.

Act

ive

(hea

lth

edu

cati

on)

3co

nse

cuti

veoc

casi

ons,

len

gth

ofba

selin

eN

R

Ran

dom

ized

,NR

ifbl

inde

dN

RT

Mgr

oup

show

edgr

eate

rde

crea

ses

inre

stin

gSB

Pan

din

SBP

duri

ng

acu

test

ress

orN

one

TM

[12]

60(A

fric

anA

mer

ican

adu

lts,

aged

>20

year

s;w

ith

hig

hn

orm

alB

Pof

130–

139/

80-8

5,st

age

1hy

pert

ensi

onB

Pof

140–

159/

90–9

9,or

stag

eII

hype

rten

sion

BP

of16

0–17

9/10

0–10

9)

TM

for

6–9

mos

.(a

vera

gein

terv

enti

onpe

riod

of6.

8±

1.3

mos

.)

Act

ive

(CV

Dri

skfa

ctor

prev

enti

oned

uca

tion

prog

ram

)

3re

adin

gsta

ken

atea

chof

3co

nse

cuti

vevi

sits

(las

t2vi

sits

wer

eav

erag

ed)

Ran

dom

ized

,si

ngl

e-bl

ind

Cer

tifi

edin

stru

ctor

sfr

omth

eA

fric

anA

mer

ican

com

mu

nit

y

Bot

hgr

oups

had

sign

ifica

nt

decr

ease

sin

BP

(TM

grou

pby

7.77±

10.3

4m

mH

gSB

Pan

d3.

5±

7.6

mm

Hg

DB

P,co

ntr

olgr

oup

by6.

74±

12.8

SBP

and

5.9±

8.6

DB

P),

but

only

the

BP

decr

ease

inT

Mgr

oup

was

asso

ciat

edw

ith

corr

espo

ndi

ng

decr

ease

inca

roti

din

tim

a-m

edia

thic

knes

s)

Non

e

TM

[13]

39(n

orm

oten

sive

Cau

casi

anA

m.m

ale

adu

lts,

mea

nag

eof

24.6

yrs.

)

TM

for

4m

os.

Act

ive

(cog

nit

ive-

base

dst

ress

edu

cati

on)

BP

mea

sure

dev

ery

4m

in.f

or20

min

.R

ando

miz

ed,

sin

gle-

blin

dQ

ual

ified

TM

inst

ruct

or

TM

decr

ease

dam

bula

tory

DB

Pby

4.8±

2.4

mm

Hg

(8.8±

3.0

mm

Hg

inh

igh

-com

plia

nce

subg

rou

p)

Non

e

TM

[14]

298

(un

iver

sity

stu

den

ts,B

P<

140/

90an

d>

90/6

0m

mH

g,w

ith

159

ina

hype

rten

sion

risk

subg

rou

pfo

rh

avin

gSB

P>

130

mm

Hg,

DB

P>

85m

mH

g,or

oth

erri

skfa

ctor

s)

TM

for

3m

os.

Pass

ive

3re

adin

gsta

ken

at1-

min

.in

terv

als

(las

t2re

adin

gsw

ere

aver

aged

)

Ran

dom

ized

,si

ngl

e-bl

ind

Res

earc

hst

affan

dT

Min

stru

ctio

nal

staff

Inth

ehy

pert

ensi

onri

sksu

bgro

up,

TM

sign

ifica

ntl

yre

duce

dSB

Pby

5.0

mm

Hg

and

DB

Pby

2.8

mm

Hg;

redu

ctio

ns

inov

eral

lsam

ple

wer

en

otsi

gnifi

can

t.T

Mpr

odu

ced

sign

ifica

nti

mpr

ovem

ents

into

talp

sych

olog

ical

dist

ress

,an

xiet

y,de

pres

sion

,an

ger/

hos

tilit

y,an

dco

pin

g.

Non

e

TM

[15]

100

(Afr

ican

Am

eric

anad

oles

cen

tsag

ed16.2±

1.3

yrs.

,w

ith

hig

hn

orm

alSB

P)

TM

for

4m

os.

Act

ive

(hea

lth

edu

cati

onco

ntr

olw

ith

lifes

tyle

edu

cati

onse

ssio

ns)

Rea

din

gsta

ken

from

6AM

–11P

Mev

ery

20m

in.

(day

tim

e)an

d11

PM

-6A

Mev

ery

30m

in.

(nig

htt

ime)

over

24h

rs.

Ran

dom

ized

,NR

ifbl

inde

dN

R

TM

grou

psh

owed

grea

ter

decl

ines

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modification education only, TM produced significant de-clines in BP after 3 months for both men (by 12.7 mm HgSBP and 8.1 mm Hg DBP) and women (by 10.4 mm Hg SBPand 5.9 mm Hg DBP). In contrast, women practicing PMRfailed to show significant declines, while men practicingPMR experienced significant declines solely in DBP (by6.2 mm Hg) [17]. An earlier randomized controlled trial ofTM by the same authors reported that 20 elderly patientswho were treated with TM exhibited a 12.4 mm Hg drop inSBP, compared to a 2.4 mm Hg reduction for patients in thecontrol group [21].

The short-term efficacy of TM and PMR in treating mildhypertension was also evaluated in 127 African Americanmen and women aged 55 to 85 years, compared with a life-style modification education control program [18]. TM re-duced SBP (10.7 mm Hg) and DBP (4.7 mm Hg), whichwas significantly greater than those observed for relaxation(4.7 mm Hg SBP and 3.3 mm Hg DBP). Between the twostress-reducing approaches, TM was about twice as effectiveas PMR. Later, Schneider and colleagues [19] conductedanother study following African American hypertensive indi-viduals over one year while they underwent TM, PMR, orconventional health education classes as a control. The TMgroup experienced greater decreases in SBP and DBP thanthe PMR or control groups, as well as reduced use of anti-hypertensive medication, relative to increases for PMR andthe control group. Consequently, the TM program may beparticularly useful in the long-term treatment of hyperten-sion in African Americans, for whom many of these effectshave been demonstrated. Schneider and colleagues also con-ducted a recent meta-analysis, which revealed that, comparedwith combined controls, the TM group showed substantialdecreases in all-cause mortality, cardiovascular mortality,and cancer-related mortality [20].

In another study [16], unmedicated patients with hyper-tension underwent TM-based training (treatment group),TM-based training without a mantra (placebo controlgroup), or no training (no-treatment control group). Com-pared with the no-treatment controls, modest BP declineswere observed in both the treatment and placebo controlgroups, with DBP percentage showing a significant decrease[16]. The similarity in effectiveness of TM training and TMtraining without a mantra could be attributed to the fact thatboth were in effect “meditation” groups or that changes inBP were due to another factor. A meta-analysis that onlyincluded high-quality assessments—as determined by 11factors, which included participant selection, randomization,blinding, full description of the therapeutic intervention, andappropriate measurements of BP—found TM, compared tocontrols, associated with clinically meaningful reductions of4.7 and 3.2 mm Hg in SBP and DBP, respectively [43]. TMhas also appeared to reduce carotid arteriosclerosis in AfricanAmericans [12] and a 4.8 mm Hg drop in ambulatory DBPamong white males treated with TM [13].

A study assessing the effects of TM on BP, psychologicaldistress, and coping among university students was alsothe first randomized clinical trial to demonstrate that TMsignificantly increased coping and reduced BP in associationwith lessened psychological distress in a hypertension risk

subgroup. The TM program may decrease the risk for devel-oping hypertension in young adults [14]. TM also reducedresting BP among adolescent African Americans with highnormal BP (with a resting SBP ≥85th and ≤95th percentile)over two months, with larger declines than those in a healtheducation control group, demonstrated during both at restand during acute laboratory stressors [11]. In another studyon African American adolescents with high normal systolicBP, the 4-month TM group showed greater declines indaytime SBP (P < 0.04) and DBP (P < 0.06) comparedto the health education control group, further exhibiting abeneficial impact of TM in youth at risk for hypertension.This study is of particular interest due to its utilization ofambulatory 24-hour BP monitoring, which not only tendsto be relatively free of placebo effects and to be highlyreproducible but also records BP regularly over a prolongedtime period in the participants’ natural environments, thusincreasing sensitivity to changes in average BP and providinga more reliable measure of overall BP [15]. Ambulatorystudies like the one produced here by Barnes and colleaguesare valuable because they generate the potential to measuretreatment effects out of the laboratory and in day-to-day life,which may allow generalization of treatment effects.

2.2. MBSR. Mindfulness-based stress reduction (MBSR), asubset of mindfulness meditation that has been standardizedand manualized, is said to treat depression and anxiety, lowerstress, and treat health conditions like hypertension. MBSRis a program that utilizes meditation and stress managementtechniques. Originally founded by Dr. Jon Kabat-Zinn, TheCenter for Mindfulness in Medicine, Health Care, and Socie-ty at the University of Massachusetts Medical School (http://www.umassmed.edu/cfm/) has treated over 19,000 patientswith MBSR.

MBSR was originally developed and used in a behavioralmedicine setting for individuals with chronic pain [44] andtypically consists of eight 2.5-hour weekly group sessions.These sessions contain instruction and practice in mindful-ness meditation, as well as conversations of stress, coping,and homework assignments. Students learn a range ofmindfulness skills including body scan exercises, sitting med-itation, and yoga exercises. Homework consists of practicingthese skills for at least 45 minutes per day, 6 days per week,in addition to practicing mindfulness skills during groupmeetings. The program concludes with an 8-hour intensivemindfulness retreat with a therapist. During and after theprogram, students are encouraged to pay mindful, non-judgmental attention to daily activities like walking, eating,and talking. One goal is for participants to see that mostsensations, emotions, and thoughts are short-lived and donot require immediate suppression.

Recent studies have evaluated the effectiveness of MBSRfor reducing BP, as well as breathing awareness meditation(BAM), a primary exercise in MBSR, in producing declinesin BP among differing populations. In one study, 121 AfricanAmerican ninth graders (with a resting SBP >50th percentileand


in 24-hour SBP. Another study also conducted among 166African American ninth graders at increased risk for essentialhypertension compared the treatment effects of BAM, theBotvin LifeSkills Training, or a health education control [9].Significant group differences emerged, with the BAM groupexhibiting the greatest decreases in SBP, DBP, and heart rate.

MBSR has also shown some potential for lowering BPin individuals with elevated BP. A recent study comparingthe effects of MBSR versus PMR on prehypertensive adultsfound that MBSR produced significant reductions in SBPand DBP. A 4.9 mm Hg reduction in clinic SBP was observedin the MBSR group compared to 0.7 mm Hg in the PMRgroup, and MBSR produced a 1.9 mm Hg reduction in DBPcompared to a 1.2 mm Hg increase for PMR [10]. Theresults were qualitatively similar to reductions in BP reportedin a meta-analysis of TM [45], as well as the reductionobserved in the PREMIER trial of comprehensive lifestylemodification for high BP [46]. In another study, adult femaleposttreatment cancer patients who underwent MBSR didnot experience significant differences in BP compared tothe waitlist control group [7]. However, when patients wereanalyzed by “higher BP” and “lower BP” groups through amedian split based on BP readings during the first week oftreatment, “higher BP” MBSR participants had lower SBPcompared to controls at the end of the MBSR program.Given the normotensive sample and preliminary results dueto methodological limitations of the study (e.g., results mayhave been an effect of regression to the mean), more well-designed trials are needed to evaluate the utility of MBSR inreducing clinically elevated BP [7].

3. Methodological Considerations

A report on meditation techniques conducted by the UnitedStates Agency for Healthcare Research and Quality (AHRQ)evaluated the methodological quality of 286 randomizedcontrolled trials employing meditation practices in a varietyof populations [33]. Studies were evaluated using the Jadadscores, as the Jadad scale is the most commonly used assess-ment scale of methodological quality of randomized con-trolled trials in health care research [47]. Scores (on a scaleof 1–5, from lowest to highest methodological quality)are based on reported method of randomization, double-blinding, and description of withdrawals and dropouts, withlow scores indicating a higher risk of bias [48]. The quality ofmeditation trials was evaluated to be poor overall, with only14% being rated high quality (i.e., Jadad scores ≥3 points);the studies reviewed were found to have too many qualitativeor observational reports, limited descriptions of participantcharacteristics (including if the inclusion criteria required anofficial diagnosis of prehypertension or hypertension), smallsample sizes, inadequately described blinding proceduresand randomization, lack of control groups, insufficient fol-lowup periods, limited reporting of intention-to-treat statis-tical analyses, and inadequately described losses to followup[33]. Furthermore, much of the research published on spe-cific forms of meditation has been conducted by the orga-nizations that create or disseminate those specific forms of

meditation. Although the methodological quality of this re-search is improving, meditation techniques should be testedby independent research teams who have no association withorganizations promoting a particular approach to medita-tion. Recent additions to the literature have increasinglyadhered to the CONSORT recommendations (ConsolidatedStandards of Reporting Trials; 49). There are many method-ological improvements that can be made. For example,conflict of interest and researcher bias can be minimized bycollaborative efforts with outside institutions having inde-pendent oversight of data collection and analysis, indepen-dent replication, rigorous blinding, allocation concealment,randomization, and selection of a suitable control condition.

4. Future Directions and Studies

Future research targeting meditation interventions must be-gin by adequately defining the role of mindfulness or otherconcepts and components in meditation and delineatingintentions for applications to the study population. Med-itation treatments should be standardized and manualizedas much as possible to ensure maximal external validity.Additionally, similarities and differences between kinds ofmeditation interventions should be highlighted within pub-lications. The role of mindfulness and meditation in a givenintervention should be explained. Furthermore, assessmentsthat target measurements of the construct, mindfulness, andthe process through which mindfulness is achieved, medi-tation, should be refined and psychometrically validated inmedical populations and healthy controls.

Future studies should clearly outline their inclusion andexclusion criteria, with efforts to extend meditation interven-tions to hypertensive individuals who otherwise belong tounderstudied populations. Including a variety of populationsmakes the examination of potential moderators such asethnicity possible. Aims should include using larger samplesizes and continuing with the disease-specific approach tointerventions, implying the use of strict inclusion criteriarequiring participants must be diagnosed with either prehy-pertension or hypertension to participate. There may needto be a better selection of control protocols, with preferencegiven to similar interventions that have been validated tonot produce the results experimenters expect to find (ornot) in the experimental condition. In addition, studiesdefining dose response would be substantially beneficial inhelping not only to confirm the correlation-effect link, butalso to determine how much of an intervention producesboth statistically and clinically significant effects. This wouldfacilitate wider dissemination and scalability.

Procedural and statistical methodology must be explicitlyoutlined so the studies can be critiqued and replicated andso articles published from the studies can be included inreviews and meta-analyses. With improved adoption of theCONSORT guidelines [49], better systematic comparisons ofeffects of different mindfulness interventions can be estab-lished. Hopefully, as the methodology and reporting of thesestudies is strengthened and clarified, scientists will be able toadopt more experimental designs, ultimately optimizing theability to make causal inferences.


Meditation is an intervention for hypertension and pre-hypertension that is perhaps best characterized as being inits adolescence. There is clearly considerable promise, with avariety of studies demonstrating efficacy in the short-termreduction of BP similar to that achieved with single-agentdrug therapy. On the other hand, many of these studiesare potentially biased due to lack of blinding, inadequatebaseline measurements of BP, and limited followup. All med-itation techniques are not created equal, and few studies havedirectly compared one technique to another. More impor-tantly, there has been essentially no evaluation to determinewhat may be the essential components of a putatively suc-cessful methodology or if an entire “standard” approach isrequired. This has major implications for scalability, partic-ularly in resource-limited settings where both clinical stafftime and patient meditation environment and time maybe constrained. Hypothesis-driven mechanistic studies arerare and, if well conceived and executed, could dramat-ically advance the field. Potential mechanisms of actioninclude alterations in the autonomic nervous system, withchanges in the sympathovagal balance favoring the latter.Perhaps meditation affects mood in hypertensives; in othersettings depression has been associated with physical inac-tivity and altered eating patterns, both of which may affectBP.

Hypertension is paradigmatic of a chronic disease, withclinical sequelae typically developing after years of elevatedBP. Long-term followup, after the acute intervention is com-plete but, while the patient is still employing meditative tech-niques, is essential. Perhaps “booster doses” of instructionwill be required. While prima facie meditation would appearto be free of side effects, few studies have systematicallyevaluated their presence and consequences. It is possible thatthe most significant side effect may be procedural, wheremeditation is simplistically viewed only as an alternative orsubstitute for antihypertensive drugs. Pharmacotherapy ofhypertension frequently involves multiple drugs, particularlyin those with substantially elevated baseline pressure. It isunlikely that meditation will be effective as monotherapy inall (and perhaps most of) patients with established hyper-tension. A therapeutic approach of multimodality treatment,wherein meditation is truly viewed as complementary todrug treatment, is an important underexplored area, withthe potential to expand the number of individuals whocould both benefit from meditative techniques and achieveimproved BP control.

Perhaps the greatest potential benefits of meditationtechniques in the treatment of individuals with hypertensionare in developing countries. Many of these countries areexperiencing large population growth and with the increas-ing penetration of a Western lifestyle come both increasedcaloric and sodium intake and decreased physical activity.In these circumstances, cardiovascular diseases, particularlyhypertension, are assuming increased prevalence. Meditationtechniques, if they can be delivered efficiently and effectively,may prove to be valuable tools to treat the growing epidemicof hypertension, particularly if they eliminate the inconve-niences of laboratory monitoring or prescription refills andindeed have few and rare side effects.

It is our hope that this overview of meditation techniqueshas highlighted prior successes, outlined the limitations exis-tent in the field today and provided inspiration and guidanceto move the field forward with mechanistic, specificallydetailed, and long-term studies in the future.

Considering the current healthcare system in the UnitedStates, it is possible for mindfulness interventions to beimplemented as both prevention and treatment programs(pending confirmation of their effectiveness). Most mindful-ness interventions can be taught in a group format, whichreduces the cost on participants and the burden on clinicians.As more treatments are standardized and their efficacy canbe demonstrated in clinical trials, insurance companies maybe more inclined to fund mindfulness training. Longitudinalstudies must also be executed to determine if mindfulnesscan act as a protective factor against an array of psychosocialand medical ailments. Positive results may indicate thatmindfulness interventions could produce a clinically signifi-cant resiliency or protection against problems requiring carefrom mental health and medical professionals. As a promis-ing construct in complementary and alternative medicines,there is a strong possibility that mindfulness could becomea component of effective interventions designed to preventhypertension and lower suboptimal BP.

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