Skip to main content
NCBI home page
Cureus logoLink to Cureus
. 2024 Apr 17;16(4):e58434. doi: 10.7759/cureus.58434

Effect of Meditation, Mindfulness-Based Stress Reduction, and Relaxation Techniques as Mind-Body Medicine Practices to Reduce Blood Pressure in Cardiac Patients: A Systematic Review and Meta-Analysis

Dapkupar Wankhar 1, Archana Prabu Kumar 2, Venugopal Vijayakumar 3, Velan A 4, Arthi Balakrishnan 5, Poornima Ravi 3, Bhandari Rudra 6, Maheshkumar K 7,✉
Editors: Alexander Muacevic, John R Adler
PMCID: PMC11099499  PMID: 38765359

Abstract

Elevated blood pressure is one of the major risk factors for cardiovascular diseases. Available evidence on mind-body medicine (MBM) techniques on blood pressure is inconclusive and provides conflicting results. The objective of the current systematic review and meta-analysis is to evaluate the effect of MBM techniques on blood pressure in patients with cardiovascular disease. Randomized control trials (RCTs) done between the years 2000 and 2020 on cardiovascular disease, using MBM techniques such as meditation, mindfulness-based stress reduction and relaxation techniques were searched through electronic databases such as PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), EMBASE and Cochrane Library. Three authors independently performed article selection, data extraction and validation. Meta-analysis was performed using a random effect model and standardized mean difference (SMD) with 95% confidence interval (CI) estimated for the effect size. Fifteen RCTs with 927 patients were included in the meta-analysis. Heterogeneity among the studies was very high for all analyses (I2>94%). For studies comparing systolic blood pressure, MBM interventions show a significant (p=0.01) effect when compared to conventional treatment, an overall estimated effect size of SMD - 0.78 (95% CI: -1.36, -0.20). For studies comparing the diastolic blood pressure, MBM intervention did not show any significant effect when compared to the conventional treatment, an overall effect size of SMD -0.26 (95% CI: -0.91, 0.39). The findings of the meta-analysis suggest that MBM interventions may improve systolic blood pressure alone in patients with cardiac diseases. With high heterogeneity and low quality of the included studies, more robust evidence is required before suggesting MBM as an effective treatment modality for reducing blood pressure in cardiovascular diseases.

Keywords: pranayama, systematic review and meta analysis, cardio vascular disease, integrative approach, cam therapy, hypertension, blood pressure, relaxation, yoga, mind body medicine

Introduction and background

Cardiovascular disease (CVD) is the world's leading cause of morbidity and mortality. It refers to a wide range of illnesses that affect the heart and blood vessels [1]. Elevated blood pressure is the major risk factor that leads to cardiovascular disease onset and its consequences [2]. All cardiovascular diseases, particularly stroke, heart attack, heart failure and myocardial infarction are linked with elevated blood pressure. Hypertension (HTN) can lead to end organ failure which is clinically represented as transient ischemic attack, cerebral infarction, intracerebral or subarachnoid bleed, acute coronary syndrome, acute kidney injury and haemorrhage [3]. Anxiety, stress, depression and anger influence onset and severity of hypertension and cardiovascular disorder [4]. People with stress, anxiety, and depression are more prone to develop HTN. Psychological stressors affect autonomic and neuroendocrine functions, altering levels of serum cortisol and cytokines, and producing chronic inflammation in blood vessels [5]. Evidence correlating mental stress to endothelial dysfunction shows increased peripheral microvascular tone and vasoconstriction of the coronary artery [6]. Many challenges are faced by healthcare practitioners in attaining blood pressure control, including patient difficulty in consuming various drugs to meet blood pressure standards [7]. Mind-body medicine (MBM) therapies involve interaction between brain, mind and body. Meditation and other mind-body practices such as mindfulness and yoga are gaining increasing significance, with over 14% of the adults in U.S. having undergone one of these interventions [8]. MBM is documented to be beneficial in the management of blood pressure and cardiovascular diseases [9,10]. MBM practices produce a cascade of physiological responses like reduced oxygen consumption and lowered blood pressure and heart rate [11]. Previous studies with MBM interventions showed beneficial effects in migraine, psychological disorders, chronic pain management and neurological disorders, but there is a lack of evidence to show the efficacy of MBM on patients with cardiovascular diseases [11-13]. Therefore, the objective of this meta-analysis is to investigate the effects of MBM interventions on patients with cardiovascular diseases like coronary artery disease, stable angina, acute myocardial infarction, arterial hypertension and chronic heart failure for blood pressure control. To validate the recent updates we restricted the search between the years 2000 and 2020.

Review

Methodology

Search Strategy

This systematic review and meta-analysis was designed, performed and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [14]. A comprehensive literature search was done using electronic databases such as PubMed, Scopus, Cochrane Library, Prospero, and Embase. The randomized control trials focusing on MBM interventions that were published between the years 2000 and 2020 were included. We used a combination of search terms like “Mind-Body Medicine”, OR “Meditation”, OR “Mindfulness based stress reduction”, OR “Relaxation Techniques”, OR “Breathing technique”, AND “Hypertension”, OR “Blood Pressure”, OR “Coronary Artery Disease” OR “Cardiovascular diseases” and Medical Subject Headings MesH term ("Mind-Body Therapies"[Mesh]) AND "Cardiovascular Diseases"[Mesh]. Three authors (AV, PR and AB) independently evaluated title and abstract to discover papers that met the inclusion and exclusion criteria and then access the full text of the articles that matches the requirements. Any disagreements about study selection or possible rearrangements were resolved by discussion between three reviewers, including the corresponding author (MK), in order to avoid inaccuracies, if any.

Selection of Studies

Inclusion criteria: All the studies which had met the following PICO criteria were included: (I) Participants (P): Patients diagnosed with one of the cardiovascular diseases such as hypertension, heart failure, myocardial infarction, and other coronary artery diseases. (II) Intervention (I): Mindfulness techniques, relaxation techniques, meditation techniques, and mindfulness-based stress reduction. (III) Comparator group (C): Health education, social programs, a waiting list, and routine care with or without drugs are provided to the control group. (IV) Outcomes (O): Systolic blood pressure and diastolic blood pressure were measured using the standard method.

Exclusion criteria: Patients who did not have cardiovascular disease were not included in the study. Additionally, studies with non-randomized designs, articles in languages other than English, and studies published before 2000 were excluded. Furthermore, studies that employed interventions or therapies other than MBM were not considered for inclusion.

Data Extraction and Reliability

Two authors independently extracted data from studies and assessed them using Excel (Microsoft, Redmond, WA, USA). The extracted data included information such as author, year, country, age, sample size, study design, details of interventions for the experimental group, details of interventions for the control group, and outcome parameters. Only studies comparing mind-body practices with a control group containing more than one practice or control arm were included in the analysis.

Assessment of Risk of Bias

Three investigators (AV, PR, and AB) evaluated the methodological quality of the included studies following the guidelines outlined in the Cochrane Handbook for assessing the risk of bias in randomized trials. Key domains assessed included random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, presence of other sources of bias, completeness of outcome data, and selective outcome reporting. These domains were evaluated across all included studies to ensure a comprehensive assessment of methodological quality [15].

Statistical Analysis

The mean differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between experimental and control groups were computed. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to determine the effect size. Heterogeneity was assessed using the I2 statistics and Cochran Q test, and a random-effect model was employed to improve result accuracy. Egger tests were conducted to identify potential publication bias among the included studies, with a significance level set at 0.05. Additionally, potential publication bias was assessed using a funnel plot, where an asymmetric inverted funnel-shaped scatter plot of treatment effects against study size could indicate publication bias or systematic heterogeneity. The analysis was conducted using the metafor package in R statistical software version 4.2.1 (R Foundation for Statistical Computing, Vienna, Austria) [16].

Results

Literature Selection

A total of 1736 articles were initially identified through the literature search. Following the screening of titles and abstracts by three independent authors, 1606 articles were excluded. Subsequently, the full text of 130 potential articles was carefully reviewed, resulting in the inclusion of 15 articles that met the predefined inclusion criteria for the meta-analysis (Figure 1).

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram illustrating the search strategy for the review.

Figure 1

Open in a new tab

Literature Characteristics

Table 1 shows the literature characteristics of the included studies. Fifteen studies are included for 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]. The age of the participants ranges from 30 to 80 years. All the studies included both male and female participants except one study which included only male participants [27]. The minimum sample size in both the study and control group was 15 each, while the maximum sample size in the study group was 99 and the control group was 102. A total of seven studies recruited hypertensive patients [17-20,22,28,29], five studies included patients with coronary artery diseases [21,26,27], two studies were done on patients with heart failure [23,29] and one study included both patients with coronary artery disease and heart failure [31]. Around seven studies had meditation as their intervention [17,19,21,24,26,28,31], five studies gave mindfulness-based stress reduction (MBSR) [18,22,24,25,31], and two studies gave breathing technique [17,29] as an intervention. Control group was given usual care, health education, rehabilitation therapy and psychological therapy. Minimum duration of intervention was four weeks and maximum duration was 16 weeks. Most commonly used parameters for assessment in all the studies were systolic and diastolic blood pressure.

Table 1. Characteristics of the studies included in the meta-analysis .

RCT- Randomized controlled study; CHF- Chronic heart failure; HTN- Hypertension; CAD- Coronary artery disease; MI- Myocardial infarction; CHD- Congestive heart disease

Author Country Age Sex Sample Size Study Design Intervention for experimental group Intervention for control group Intervention details Condition
Anderson DE et al., 2010 [17] USA 53.4 (2.8 ) Both E-20,  C-20 RCT Device guided breathing Natural breathing 15 minutes /day/ 4 weeks HTN
Palta P et al., 2012 [18] USA 72.3 (4.4 ) Both E-12, C-8 RCT Mindfulness based stress reduction Social support 90  minutes /week/ 8 weeks HTN
Duraimani S et al., 2015 [19] USA 60.4 ( 11.9  ) Both  E-24, C-24 RCT Transcendental meditation Health education 20 minutes / 16 weeks HTN
Schneider RH et al., 2019 [20] USA 53.3 (9.4 ) Both sex E-41, C-44 RCT Transcental meditation Health education 20 minutes twice a day/3 months HTN
Delui MH et al., 2013 [21] Iran 40 -65 Both E-15, C-15 RCT Mindfulness Meditation Usual care 20- 25 minutes/ 10 sessions CAD
Momeni J et al., 2016 [22] Iran 47 ( 7 ) Both E-30, C-30 RCT Mindfulness based stress reduction Psychological therapy 2.5 hour/week/8 weeks HTN
Curiati JA et al., 2005 [23] Brazil 74.8 (6.7) Both E-8, C-7 RCT Meditation techniques Weekly meeting 30 minutes/ 12 weeks CHF
Maura Paul-Labrador M et al., 2006 [24] Los Angeles 67.7 (9.0) Both E-52, C-51 RCT Transcendental Meditation Health education 1.5hours /16 weeks CHD
Neves A et al., 2009 [25] Portugal 59.5. ( 10.8 ) Both  E-40, C-41 RCT Relaxation & imaginary relaxation techniques Cardiac rehabilitation 1 hour / 12 weeks  MI
Schneider RH et al., 2012 [26] Iowa 59.9 (10.7  ) Both E-99,  C-102 RCT Transcendental meditation Health education 20 minutes /3 months CAD
Marquez PH et al., 2019 [28] Spain 56.5( 7.7 ) Both sex E-24, C-18 RCT Mindfulness Meditation Health education 2 hours /week/8 weeks HTN
Drozdz T et al., 2015 [29] Italy 65.5  ( 11.6  ) Both  E-20, C-20 RCT Slow breathing training Usual care 15 minutes /session/ 12 weeks CHF
Blom K et al., 2014 [30] Canada 57 ( 12 ) Both E-46,  C-41 RCT Mindfulness based stress reduction & Yoga Waiting list 45 minutes /day/ 12 weeks HTN
Nijjar PS et al., 2019 [31] USA 58.6 (10.8 ) Both sex E-30,  C-15 RCT Mindfulness based stress reduction Usual care 2.5 hours/week/8 weeks CAD CHF
Parswani MJ et al., 2013 [32] India 30-65 Male E-15, C-15 RCT Mindfulness based stress reduction Health education 1-1.5 hour/ 8 weeks CAD
Open in a new tab

Risk of Bias Assessment

Table 2 presents an overview of the methodological quality assessment conducted for the included studies. With respect to random sequencing, all of them were rated low risk and 10 studies were rated low risk in general allocation concealment while in the rest (five studies) it’s unclear [19,21,23,25,28]. With regards to blinding of participants and personnel reporting, 12 studies rated low risk and one study had high risk [28]. Twelve studies were rated low risk in blinding of outcome assessment, while the rest (three studies) had high risk [23,28,29]. Other sources of bias, data-selective outcomes and incomplete outcomes are unreported.

Table 2. Risk of Bias assessment of included studies .

AUTHOR Random Sequence Generation Allocation concealment Blinding of participants and personnel reporting Other sources of bias Blinding of outcome assessment Incomplete outcome Data Selective outcome
Anderson DE et al., 2010 [17] Low Risk Low Risk unclear Low Risk unclear unclear unclear
Palta P et al., 2012 [18] Low Risk Low Risk Low Risk Not clear Low Risk unclear unclear
Duraimani S et al., 2015 [19] Low Risk Not clear Low Risk Not clear Low Risk unclear unclear
Schneider RH et al., 2019 [20] Low Risk Low Risk Low Risk Low Risk Low Risk unclear unclear
Delui MH et al., 2013 [21] Low Risk Not clear Low Risk Not clear Low Risk unclear unclear
Momeni J et al., 2016 [22] Low Risk Low Risk Low Risk unclear Low Risk unclear unclear
Curiati JA et al., 2005 [23] Low Risk Low Risk Low Risk High Risk High Risk unclear High Risk
Maura Paul-Labrador M et al., 2006 [24] Low Risk Low Risk Low Risk Low Risk Low Risk unclear Low Risk
Neves A et al., 2009 [25] Low Risk unclear Low Risk unclear Low Risk Low Risk unclear
Schneider RH et al., 2012 [26] Low Risk Low Risk Low Risk Not clear Low Risk unclear unclear
Marquez PH et al., 2019 [28] Low Risk Not clear High Risk unclear High Risk unclear unclear
Drozdz T et al., 2015 [29] Low Risk Low Risk Low Risk High Risk High Risk Low Risk High Risk
Blom K et al., 2014 [30] Low Risk Low Risk Low Risk High Risk Low Risk unclear unclear
Nijjar PS et al., 2019 [31] Low Risk Low Risk Low Risk unclear unclear unclear Unclear
Parswani MJ et al., 2013 [32] Low Risk Low Risk unclear Not clear Low Risk Low Risk unclear
Open in a new tab

Meta-Analysis

Among the included studies, the combined results (Figure 2) revealed a significant effect on SBP (SMD: -0.78, 95% CI: -1.36, -0.20), with notable heterogeneity observed among the studies (I2 94%, p < 0.001). Conversely, changes in DBP did not favor MBM intervention (Figure 3) (SMD: -0.26, 95% CI: -0.91, 0.39), and significant heterogeneity between studies was observed (I2 95%, p < 0.001).

Figure 2. Forest plot for SBP within cardiovascular patients with MBM intervention.

Figure 2

Open in a new tab

SMD- standardized mean difference, SBP- systolic blood pressure, MBM- mind-body medicine

Figure 3. Forest plot for DBP in cardiovascular patients with MBM intervention.

Figure 3

Open in a new tab

SMD- standardized mean difference, DBP- diastolic blood pressure, MBM- mind-body medicine

Subgroup Analysis

Subgroup analyses performed to examine the effect of MBM intervention on blood pressure changes showed systolic blood pressure to decrease effectively with frequency of less than eight weeks (SMD: -0.62, 95%CI=- -1.20, 0.05), with meditation (SMD: -1.76, 95%CI: -2.49, -1.04) and breathing technique (SMD: -0.78, 95CI: -1.36, -0.20) and compared with passive control group (SMD: -1.25, 95% CI: -2.28, -0.23). No such effects were noted for the MBM intervention on diastolic blood pressure changes (Table 3).

Table 3. Subgroup analysis by duration and frequency of mind-body medicine interventions.

CI- confidence interval, SBP- systolic blood pressure, DBP- diastolic blood pressure, I2- heterogenicity; P< 0.0.5 set as significant

Subgroups   SBP Mean difference in mmHg (95% CI) P I2 DBP Mean difference in mmHg (95% CI) P I2
Duration >30 min -0.56 (-1.02; -0.10) 0.03 72% --0.26 (-0.90; 0.37) 0.71 82%
<30 min -1.09 (--2.66; 0.49) 0.42 97% -0.27 (-2.00; 1.47) 0.52 98%
Frequency > 8 weeks -0.96 (-2.23; 0.32) 0.56 97% 0.05 (-0.96; 1.07) 0.23 96%
< 8 weeks -0.62 (-1.20, -0.05) 0.01 74% -0.54 (-1.59; 0.51) 0.41 93%
Type of Intervention Meditation -1.76 (-2.49; -1.04) 0.02 96% -0.59 (-2.08; 0.90) 0.65 98%
Relaxation -0.47 (-1.00; 0.05) 0.56 65% -0.26 (-0.61; 0.09) 0.82 27%
Breathing Techniques -0.78 (-1.36; -0.20) 0.03 94% -0.26 (-0.91; 0.39) 0.19 95%
Comparison Group Passive control -1.25 (-2.28; -0.23) 0.002 96% -0.51 (-1.79; 0.76) 0.52 97%
Active control -0.55 (-1.68; 0.59) 0.81 60% 0.02 (-2.50; 2.53) 0.70 90%
Usual care -0.03 (-3.01; 1.45) 0.52 94% 0.01 (-0.20; 0.22) 0.35 0%
Open in a new tab

Publication Bias and Sensitivity Analysis

Findings of the Egger (P Egger=0.17, p=0.87) and a symmetry of the funnel plot (Figures 4, 5), suggest that there was no significant publication bias among studies. Sensitivity analysis results suggested that there was no essential change in the combined results or estimated heterogeneity after the exclusion of studies one by one.

Figure 4. Funnel plot for SBP in cardiovascular patients with MBM intervention.

Figure 4

Open in a new tab

SBP- systolic blood pressure, MBM- mind-body medicine

Figure 5. Funnel plot for DBP in cardiovascular patients with MBM intervention.

Figure 5

Open in a new tab

DBP- diastolic blood pressure, MBM- mind-body medicine

Discussion

To the best of our knowledge, this is the first-ever meta-analysis on the effect of MBM intervention for blood pressure reduction in patients with cardiovascular diseases. Results of the present meta-analysis suggested reduction in systolic blood pressure with MBM interventions, such as meditation, mindfulness-based stress reduction and relaxation techniques among patients with cardiovascular disease, and a statistically insignificant difference for diastolic blood pressure. Subgroup analysis with the duration and frequency of MBM intervention also revealed the same for systolic blood pressure. The duration of the MBM interventions varied across the studies ranging from four weeks to 16 weeks. The majority of the included studies (n=7) used meditation as a MBM intervention followed by MBSR and breathing techniques.

Previous review done on MBM interventions on reduction in incidence of secondary cardiac events in patients with coronary heart disease concluded that MBM intervention can reduce the incidence of cardiac events (OR=0.33) and systolic blood pressure (Mean difference=-3.33 mmHg). However, the study stated that it does not reduce mortality (OR=0.8) and diastolic blood pressure (Mean difference= -1.30 mmHg) [9]. Findings from another meta-analysis also showed that MBM interventions were effective to combat stress, depression and blood pressure among patients with cardiac diseases [10]. They found moderate to low effects for the systolic (effect size: 0.48) and diastolic blood pressure reductions (effect size: 0.36) with MBM intervention. These findings were consistent with our current findings for systolic blood pressure and contradictory for diastolic blood pressure [10]. SBP increases the risk of secondary cardiac events and is also a predictor of cardiovascular illness. MBM can be an effective intervention to prevent secondary cardiac events, our meta-analysis is in line with previous studies.

To validate recent updates in the MBM research, we have included the studies published in the recent years, between 2000 and 2020 which might possibly be a limitation of the study as well. Another possible limitation is restricting to MBM interventions of meditation, mindfulness-based stress reduction and relaxation techniques, as few literature suggests other interventions such as taichi, qiqong and hypnotism as MBM interventions, which is beyond the scope of this review and are not included in this systematic review and meta-analysis. MBM technique is a lifestyle-based intervention and an emerging discipline, widely used in recent times [32]. However, the available scientific evidence on the beneficial effects of MBM is inconclusive. The current meta-analysis suggests MBM to patients with cardiovascular diseases, due to the clinically significant improvement in SBP.

Future implication or recommendation

Future studies on MBM and cardiovascular diseases should address specific research questions and future claims on the beneficial effects should be scientifically validated before accepting the same.

Conclusions

The findings of the present meta-analysis do not provide substantial evidence to support the use of MBM in patients with cardiovascular diseases. While there was a clinically significant improvement observed in systolic blood pressure, the reduction in diastolic blood pressure was not statistically significant across the various MBM techniques. Due to the heterogeneous component of the intervention, more rigorous clinical trials have to be carried out in the future.

Acknowledgments

V. Venugopal and Dapkupar Wankhar contributed equally to the work and should be considered co-first authors.

The authors have declared that no competing interests exist.

Author Contributions

Concept and design:  Maheshkumar K, Venugopal Vijayakumar, Archana Prabu Kumar, Bhandari Rudra, Velan A, Arthi Balakrishnan, Poornima Ravi

Drafting of the manuscript:  Maheshkumar K, Venugopal Vijayakumar, Archana Prabu Kumar, Bhandari Rudra, Velan A, Arthi Balakrishnan, Poornima Ravi, Dapkupar Wankhar

Critical review of the manuscript for important intellectual content:  Maheshkumar K, Venugopal Vijayakumar, Archana Prabu Kumar, Bhandari Rudra, Velan A, Arthi Balakrishnan, Poornima Ravi, Dapkupar Wankhar

Supervision:  Maheshkumar K, Venugopal Vijayakumar, Archana Prabu Kumar, Dapkupar Wankhar

Acquisition, analysis, or interpretation of data:  Venugopal Vijayakumar, Bhandari Rudra, Velan A, Arthi Balakrishnan, Poornima Ravi, Dapkupar Wankhar

References

  • 1.On validation of cardiovascular risk scores. Woodward M. BMJ. 2016;354:0. doi: 10.1136/bmj.i4483. [DOI] [PubMed] [Google Scholar]
  • 2.Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Ettehad D, Emdin CA, Kiran A, et al. Lancet. 2016;387:957–967. doi: 10.1016/S0140-6736(15)01225-8. [DOI] [PubMed] [Google Scholar]
  • 3.Early onset hypertension is associated with hypertensive end-organ damage already by midlife. Suvila K, McCabe EL, Lehtonen A, Ebinger JE, Lima JA, Cheng S, Niiranen TJ. Hypertension. 2019;74:305–312. doi: 10.1161/HYPERTENSIONAHA.119.13069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Mental stress as a causal factor in the development of hypertension and cardiovascular disease. Pickering TG. Curr Hypertens Rep. 2001;3:249–254. doi: 10.1007/s11906-001-0047-1. [DOI] [PubMed] [Google Scholar]
  • 5.The effects of acute psychological stress on circulating inflammatory factors in humans: a review and meta-analysis. Steptoe A, Hamer M, Chida Y. Brain Behav Immun. 2007;21:901–912. doi: 10.1016/j.bbi.2007.03.011. [DOI] [PubMed] [Google Scholar]
  • 6.Endothelial dysfunction: clinical implications. Drexler H. Prog Cardiovasc Dis. 1997;39:287–324. doi: 10.1016/s0033-0620(97)80030-8. [DOI] [PubMed] [Google Scholar]
  • 7.Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Chobanian AV, Bakris GL, Black HR, et al. Hypertension. 2003;42:1206–1252. doi: 10.1161/01.HYP.0000107251.49515.c2. [DOI] [PubMed] [Google Scholar]
  • 8.A new era for mind-body medicine. Dossett ML, Fricchione GL, Benson H. N Engl J Med. 2020;382:1390–1391. doi: 10.1056/NEJMp1917461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Mind-body medicine in the secondary prevention of coronary heart disease: a systematic review and meta-analysis. Cramer H, Lauche R, Paul A, et al. Dtsch Arztebl Int. 2015;112:759. doi: 10.3238/arztebl.2015.0759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Mind-body practices for patients with cardiac disease: a systematic review and meta-analysis. Younge JO, Gotink RA, Baena CP, Roos-Hesselink JW, Hunink MG. Eur J Prev Cardiol. 2015;22:1385–1398. doi: 10.1177/2047487314549927. [DOI] [PubMed] [Google Scholar]
  • 11.Mind-body therapies for headache. Sierpina V, Astin J, Giordano J. Am Fam Physician. 2007;76:1518–1522. [PubMed] [Google Scholar]
  • 12.The science of mind body medicine and the public health challenges of today. Fricchione GL. S Afr J Psychol. 2014;44:404–415. [Google Scholar]
  • 13.The use of mind-body medicine in chronic pain management: differential trends and session-by-session changes in anxiety. Cosio D, Swaroop S. J Pain Manag Med. 2016;2 [PMC free article] [PubMed] [Google Scholar]
  • 14.PRISMA statement. Takkouche B, Norman G. Epidemiology. 2011;22:128. [Google Scholar]
  • 15.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Higgins JP, Altman DG, Gøtzsche PC, et al. BMJ. 2011;343:0. doi: 10.1136/bmj.d5928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Conducting meta-analyses in R with the metafor package. Viechtbauer W. J Stat Softw. 2010;36:1–48. [Google Scholar]
  • 17.Regular slow-breathing exercise effects on blood pressure and breathing patterns at rest. Anderson DE, McNeely JD, Windham BG. J Hum Hypertens. 2010;24:807–813. doi: 10.1038/jhh.2010.18. [DOI] [PubMed] [Google Scholar]
  • 18.Evaluation of a mindfulness-based intervention program to decrease blood pressure in low-income African-American older adults. Palta P, Page G, Piferi RL, Gill JM, Hayat MJ, Connolly AB, Szanton SL. J Urban Health. 2012;89:308–316. doi: 10.1007/s11524-011-9654-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Effects of lifestyle modification on telomerase gene expression in hypertensive patients: a pilot trial of stress reduction and health education programs in African Americans. Duraimani S, Schneider RH, Randall OS, et al. PLoS One. 2015;10:0. doi: 10.1371/journal.pone.0142689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Stress reduction in the prevention of left ventricular hypertrophy: a randomized controlled trial of transcendental meditation and health education in hypertensive African Americans. Schneider RH, Myers HF, Marwaha K, et al. Ethn Dis. 2019;29:577–586. doi: 10.18865/ed.29.4.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Comparison of cardiac rehabilitation programs combined with relaxation and meditation techniques on reduction of depression and anxiety of cardiovascular patients. Delui MH, Yari M, Khouyinezhad G, Amini M, Bayazi MH. Open Cardiovasc Med J. 2013;7:99–103. doi: 10.2174/1874192401307010099. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.The effects of mindfulness-based stress reduction on cardiac patients' blood pressure, perceived stress, and anger: a single-blind randomized controlled trial. Momeni J, Omidi A, Raygan F, Akbari H. J Am Soc Hypertens. 2016;10:763–771. doi: 10.1016/j.jash.2016.07.007. [DOI] [PubMed] [Google Scholar]
  • 23.Meditation reduces sympathetic activation and improves the quality of life in elderly patients with optimally treated heart failure: a prospective randomized study. Curiati JA, Bocchi E, Freire JO, et al. J Altern Complement Med. 2005;11:465–472. doi: 10.1089/acm.2005.11.465. [DOI] [PubMed] [Google Scholar]
  • 24.Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Paul-Labrador M, Polk D, Dwyer JH, et al. Arch Intern Med. 2006;166:1218–1224. doi: 10.1001/archinte.166.11.1218. [DOI] [PubMed] [Google Scholar]
  • 25.The effect of cardiac rehabilitation with relaxation therapy on psychological, hemodynamic, and hospital admission outcome variables. Neves A, Alves AJ, Ribeiro F, Gomes JL, Oliveira J. J Cardiopulm Rehabil Prev. 2009;29:304–309. doi: 10.1097/HCR.0b013e3181b4ca27. [DOI] [PubMed] [Google Scholar]
  • 26.Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Schneider RH, Grim CE, Rainforth MV, et al. Circ Cardiovasc Qual Outcomes. 2012;5:750–758. doi: 10.1161/CIRCOUTCOMES.112.967406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Mindfulness-based stress reduction program in coronary heart disease: a randomized control trial. Parswani MJ, Sharma MP, Iyengar S. Int J Yoga. 2013;6:111–117. doi: 10.4103/0973-6131.113405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, et al. J Hum Hypertens. 2019;33:237–247. doi: 10.1038/s41371-018-0130-6. [DOI] [PubMed] [Google Scholar]
  • 29.Blood pressure changes in patients with chronic heart failure undergoing slow breathing training. Drozdz T, Bilo G, Debicka-Dabrowska D, et al. Blood Press. 2016;25:4–10. doi: 10.3109/08037051.2016.1099800. [DOI] [PubMed] [Google Scholar]
  • 30.Hypertension analysis of stress reduction using mindfulness meditation and yoga: results from the HARMONY randomized controlled trial. Blom K, Baker B, How M, et al. Am J Hypertens. 2014;27:122–129. doi: 10.1093/ajh/hpt134. [DOI] [PubMed] [Google Scholar]
  • 31.Randomized trial of mindfulness-based stress reduction in cardiac patients eligible for cardiac rehabilitation. Nijjar PS, Connett JE, Lindquist R, et al. Sci Rep. 2019;9:18415. doi: 10.1038/s41598-019-54932-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Hassed C, de Lisle S, Sullivan G, Pier C. Adv Health Sci Educ Theory Pract. 2009;14:387–398. doi: 10.1007/s10459-008-9125-3. [DOI] [PubMed] [Google Scholar]

Articles from Cureus are provided here courtesy of Cureus Inc.

RESOURCES