Can mindfulness and meditation strategies be a useful alternative to popping pills to lower blood pressure? While conventional wisdom suggests a simple and evident link, the clinical application of mindfulness and meditation to treat hypertension is more complicated than it first appears. As such, we approach the role of meditation in blood pressure management by asking more detailed questions. Can meditation help reduce blood pressure in those that already require antihypertensive drugs? Could meditation enhance the effects of medication therapy, yielding a greater reduction in blood pressure than either would produce on its own?
Let’s dig deeper into this attitude of mind, and the possible effects it can have on cardiovascular health.
Reducing SBP by just 3 mm Hg in the general population has the potential to reduce stroke mortality by 8% and coronary artery disease mortality by 5%.10, 11 The published findings of the InterStroke Study, one of the largest studies of its type in the world, concluded definitively that uncontrolled HTN is the single most influential risk factor for stroke. 12
Transcendental meditation and mindfulness involve entering into a state of concentration, contemplation, and reflection. It has been practiced in various forms for thousands of years, with the goal of improving “well-being.”
What does that mean? The practice promotes inner calmness, physical relaxation, and reduced anxiety and depression. It involves progressive muscle relaxation that can lead to the reduction of blood pressure as well as heart rate variability. Other benefits include improved insulin sensitivity, lipid profiles, and hormone levels that affect heart health. It stands to reason that these effects could have a real impact on heart disease—caused in part by high blood pressure—which is the leading cause of death worldwide.
How does it work? Recent discoveries in neuroscience indicate that the thoughts and emotions we hang on to—our mental baggage if you will—can cause significant changes in our neural wiring. Since meditative practices often involve practicing “letting go” of troublesome thinking, the links between meditation, mindfulness, and clinical outcomes would seem to be self-evident.
Designing a study that elucidates these links and describes their actual effects can be quite challenging and costly. Further, the difficulty substantially increases when we attempt to determine whether the results we see are actually due to meditation and mindfulness, or whether something else is doing some of the heavy liftings. For example, the placebo effect can account for as much as 30% of the effects seen in any treatment. Some studies support meditation to reduce blood pressure, while other studies contradict those findings. After reviewing the available research, we’ve found a few things that allow us to recommend meditation only as an adjunct to care provided by a medical doctor for the treatment and management of hypertension:
1. There are no extensive peer-reviewed studies available.
The majority of available studies show there can be significant benefits to lowering blood pressure using various mindful breathing exercise though their remains a few studies that contradict their findings.
The strongest studies are in peer-reviewed journals and are usually conducted over several months or even years. Good research design includes having a large number of study participants—at least 100 people, and ideally a lot more—as this helps to show the results are real and not just a one-time fluke. Further, a study should not be funded by an organization that can profit from the results, as that can introduce bias to the study findings.
Finally, while good research can provide revolutionary results, it’s wise to adhere to the old maxim: “if it sounds too good to be true, it usually is.” While a lack of peer-reviewed science doesn’t mean that meditation and mindfulness aren’t useful in the fight against blood pressure, it does mean that it’s a little early to swap in all your medications for meditation and that you might at the very least be able to reduce the quantity and dosage of your medications.
2. Blood pressure is influenced by genetic, ethnic, and biological factors that cannot be easily influenced by meditation.
The risk of developing a chronic disease involves a complex mix of genetic, behavioral and environmental factors. If there are many paths to a chronic disease, managing that disease will necessarily require different approaches and strategies as well. In other words, no one activity will be the be-all, end-all of cardiovascular disease; there are simply too many contributory factors to be taken down with one silver bullet. If such a silver bullet existed, the world would hear about it, and a massive study (or some large studies) would back it up.
3. In all likelihood, a combination of mindfulness, meditation, medication, and lifestyle management is the key to lowering blood pressure, but that story is not new.
Good health comes from a combination of a healthy diet, exercise, and stress management. Anyone can learn these things, though some have an easier time than others. There’s no magic in this story. Just the mere notion that with the addition of mindfulness, meditation and proper adherence to blood pressure medication, your blood pressure may improve to the point that your doctor can lower the dose of your medications. It’s not a miracle, and it certainly isn’t an instant cure; however, mindfulness and meditation do show real benefits in many areas of life, especially if practiced regularly over time. Even a few minutes a day can be helpful.
What can you do?
Practice mindful and meditative methods to help you manage your blood pressure. As your ability to control your mind increases, mental well-being is improved, which can lower blood pressure over time. For more information on blood pressure monitoring and education, get to know Cardiowell.
Practicing self-selected relaxation techniques can have an immediate impact on your mind and perception of stress. Being conscientious of the signs of stress will help your health, as this awareness will help you determine when you need to apply these relaxation techniques. Understanding the different types of triggers for your anxiety and stress—and their associated side -effect high blood pressure—can help you re-map your brain to be more stress-resistant. Resilience against the damage of in-the-moment stress through continual self-assessment and a focused approach can reduce anxiety and chronic stress; in turn, can be helpful in preventing the onset of chronic diseases related to high blood pressure.
Are you ready to increase your ability to cope with life’s challenges? Here are nine surefire ways to manage stress and help you manage your blood pressure:
1. Take charge of your schedule.
Include time in your schedule to take care of yourself. Use a calendar to map out your activities, events, and time for self-care. Plan ahead and walk through your schedule mentally. If your calendar is too full and you feel anxious about following through on all of your tasks, it’s time to approach them one-by-one, identify them, and break them down. Your heart will thank you.
2. Organize yourself.
Spend time each day getting ready for the next day. Organize your task list into “must do,” “should do,” and “could do” sections. Push as much as you can to the “should do” and “could do” items, so that your full focus is on as few “must do” items as possible. Then, start with the most important “must do” items, and approach the other sections as time and energy permit.
3. Don’t be afraid to say “no.”
If your plate is full, say “no” to requests for your time and energy. If “no” doesn’t work in a particular situation, find a compromise by letting people know what’s on your plate and when you could reasonably expect to meet or have something done, his can be a powerful tool in reducing your overall stress and anxiety.
4. Express your feelings.
Feeling overwhelmed? Talk about it! Let a trusted friend or loved one be there for you; that’s what they’re there for! People with hypertension are known to bottle up their emotions. As you practice expressing yourself, you’ll increase your ability to find and express the emotions you’re feeling and reflect on them. Annoyance and frustration, for example, are forms of anger. When you notice you’re feeling these emotions, ask yourself what is causing them and whether those things warrant the negative energy. Then, decide what you can do about it! Adjusting your expectations and your response to the expectations placed upon you can do wonders for your stress level.
5. Evaluate your stressors.
Have a heart-to-heart with stress, and what you can do about it step-by-step. Make a list of your stressors and create your plan to either cope with them or remove them. Go one by one. Determine what you can’t change, avoid, or eliminate; then get creative about handling them! If traffic causes you stress, leave an hour early and finish your last hour of work at home. If you have a family member that creates stress for you, respectfully decline frequent social situations that include them. Taking a moment to look at your stressors and what you can do about them can yield positive results, and you’ll get better at it each time you practice.
6. Eat Healthy
Focusing on healthier snacking and eating has been shown to reduce blood pressure and improve cardiovascular health. Stress wears down your ability to make healthy choices. Irrational decisions stem from being tired. Your resistance to sugar-filled foods and crunchy salty chips is worn down by exhaustion, studies say. Getting an energy fix from healthy choices such as honey-crisp apples, crunchy nuts, carrots, celery, dehydrated fruit, or popcorn can steer you away from further emotional distress. Avoid all sugary drinks, especially those with artificial sweeteners. A recent study published in Stroke, by the American Heart Association Journal showed that artificially sweetened drinks could increase your risk of stroke by up to three times.
7. Take care of you first.
Eat three healthy meals a day and prepare for them before you do anything else for anyone else. Get 8 hours of sleep nightly, exercise for at least 30 minutes every day, and take the time to reflect on your feelings before prioritizing anything else in your life. Taking care of yourself makes you stronger, which will put you in a better position to help others!
8. Manage technology.
Gain control over your cell phones, computers, and iPads. The distractions of online interactions like social media and emails can rob you of valuable minutes throughout the day, making you less productive and more stressed-out about your “must do” list. Setting boundaries can help! Practice “unplugging” from your electronic devices at the end of the day, or at least putting them in a “time-out” for a while. Do your life a favor: don’t let devices run it.
9. Avoid competitive thinking.
Do you create our stress? Envy and jealousy can build up stress and resentment, neither of which is beneficial to your health. Adjust your expectations. Focus on humility and gratitude for the little accomplishments and joys in your life. Positive thinking perpetuates itself when practiced in a mindful fashion.
De-Stress with Relaxation Techniques
Practicing the strategies listed above will help you to get a handle on your stress level. For additional stress-busting techniques, there are many things you can do to promote relaxation and good health. Combining stress management and relaxation techniques is a powerful way to reduce the impact that stress and anxiety can have on your physical and emotional well-being. If you set aside 10 – 20 minutes daily for relaxation techniques, you can reduce your risk for many stress-related conditions, including insomnia, cardiovascular disease, accidents, and even cancer.
It can be difficult, especially in the beginning, so don’t get discouraged! Relaxation doesn’t always come easy, but with practice and some experimentation, you can find methods that work for you. Remember: there isn’t a right or wrong way to relax! Rather, relaxation involves finding and practicing activities that are enjoyable or complimentary to your daily life.
Here are a few activities that can help you relax, reduce stress and lower blood pressure:
Exercise improves mental and physical health, releases built-up stress in the body, and increases circulation by getting your blood pumping. Aerobic and group exercises–such as kayaking, rowing, walking, cycling, skating, and swimming–can be a way to keep things interesting and challenging for those who tend to get bored. Exercise also promotes good sleep which is essential for the heart.
Meditation involves your mind and your body and includes focused breathing with thoughtful relaxation techniques that can improve tranquility and reduce stress. Find a comfortable, quiet place and sit in a comfortable position. Then, close your eyes, relax your body, and focus your concentration on relaxing from your head slowly down to your neck, and then down through every muscle until you reach your toes. Meditating, and putting the body in a restful “pause,” can block out a significant amount of negativity, and lead to you feeling more relaxed and capable of handling the stresses of the day. There are many apps available to help you master meditative methods. Try one today!
Visualization, or guided imagery, is a variation of traditional meditation that requires you to employ not only your visual sense, but your senses of taste, touch, smell, and sound as well. Engaging all the senses doesn’t happen by accident. It takes time and focused energy to submit to your senses completely.
Find a quiet place. Close your eyes. Imagine that you are in a peaceful place. Try to imagine all the details – what do you see, smell, hear, feel? The more information you visualize, the better this works. You can choose whatever imagery you want. For instance, if you imagine you are walking through the park you would:
· Hear the birds chirping
· See the birds flying from tree to tree
· Hear children playing
· Feel the sun on your face
· Notice the shadows on the ground
· Smell the foods cooking on the grill
How visualization works:
As you imagine being somewhere else, your mind is focused on the details of the imagination and not on the stress or anxiety that you were feeling. You may lose track of where you are in your peaceful place – that is normal. The idea is to let your mind go somewhere tranquil and focus on relaxation for a while. There are many other techniques you can use to help you manage your stress – the important thing is to practice some form of relaxation.
4. Deep breathing
Breathing mindfully at six breaths per minute has been shown to reduce blood pressure. Breathing at six breaths per minute helps to synchronize the heart and lungs and send extra oxygen through your body that helps promote relaxation and reduce stress. Focus on full, deep, cleansing breaths, a simple and powerful technique which is the cornerstone of many other relaxation and meditation practices. Combine with scented candles, aromatherapy, music, massage, or a warm bath for more great results!
Deep breathing from the abdomen allows you to get as much fresh air as possible in your lungs. When you take deep breaths from the abdomen, rather than shallow breaths from your upper chest, you inhale more oxygen. The more oxygen you get, the less tense, short of breath and anxious you feel. Here’s how to deep breathe:
• Sit comfortably with your back straight. Put one hand on your chest and the other on your stomach.
• Breathe in through your nose for FOUR counts. The hand on your stomach should rise. The hand on your chest should move little by little. Hold that breath for SIX counts.
• Exhale through your mouth for NINE counts, pushing out as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you exhale, but your other hand should move slightly. Practice 4-6-9 breathing for three cycles.
• Continue to breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count in a deliberate manner as you exhale.
Learn how the Cardiowell App can help improve your breathing.
5. Positive thinking
Self-talk that increases stress needs to stop! Negative thoughts eat up good energy that can be spent getting more done and helping others. Typically, positive thinking leads to the positive energy that can be contagious to those around you. Positive-thinking exercises like positive self-talk suppress the release of cortisol from the adrenal glands and can help you feel calm and peaceful.
6. Deep muscle stretches
Stretch your muscles out, or get a massage or both. Doesn’t fit your schedule? Here’s how to do it now, right at your desk! Tense all your muscles for 10 seconds and then let go. You can also purchase a foam roller to do “self-myofascial release,” which is just a fancy term for self-massage.
Break the cycle of stress and high blood pressure by trying yoga! By combining breathing, meditation, and physical poses--also called postures--yoga can increase strength and flexibility while promoting mindfulness and relaxation. Yoga poses vary in intensity: some require nothing more than your attention and a mat to lie on, while others will stretch your physical limits. A practical yoga session involves a number of different postures, conducted in a sequence designed to provide a workout that involves your whole body and focuses your mind.
While there are many books, videos, and internet resources devoted to this practice, beginners will find yoga more safe and approachable if they find a trained instructor to guide them. A good instructor will encourage you to explore your physical limits without exceeding them, maximizing the effect of yoga while keeping it safe for you. Research your local providers to determine which yoga teachers have experience with your health conditions and concerns; then, find a class that fits your schedule and go for it! Individual classes may help you progress more quickly and refine your technique; however, many beginners locate the camaraderie and support offered by group classes increase both their enjoyment of yoga and their motivation to continue doing it. Yoga can be strenuous, so it's wise to check with your health care provider before starting the practice, but almost anyone can practice--and benefit from--some form of yoga.
A recent article published at the 68th Annual Conference of the Cardiological Society of India in 2016 showed hatha yoga could decrease blood pressure by as much as 4.9mmHg. According to the author Dr. Angrish “Although the reduction in blood pressure was modest, it could be clinically very meaningful because even a 2 mmHg decrease in diastolic BP has the potential to lower the risk of coronary heart disease by 6% and the risk of stroke and transient ischemic attack by 15%”8
8. Tai Chi, Qigong
A Chinese martial art that uses slow movements, tai chi is sometimes described as “meditation in motion” because it promotes serenity through gentle movements—connecting the mind and body. Originally developed in ancient China for self-defense, tai chi evolved into a graceful form of exercise that’s now used for stress reduction. It aids in a variety of other health conditions. Qigong is related to tai chi, and also involves meditative activities that combine mind, body, and breathe control.
Small needles are placed at specific acupuncture points around the body with the goal of improving health and wellness. During a typical acupuncture treatment, the needles are left in for about 20-30 minutes. During this time the body temperature may lower; organ systems, heartbeat, and respiration may slow down; and muscle tension dissipates. In most cases, the patient will sink into a very relaxed state.
Research shows that acupuncture causes the body to release neurotransmitters such as endorphins and serotonin. Endorphins are the body’s natural opiates, which relieve pain and increase the patient’s relaxation response.
Endorphins and serotonin also stimulate the adrenal gland, which secretes cortisol. Cortisol is the body’s stress-fighting and anti-inflammatory hormone. It helps regulate immune functions, blood pressure, and glucose metabolism. Over the course of treatments, patients experience a heightened sense physical, emotional and mental well-being.
10. Take a time-out
Remove yourself from a stressful situation for a few minutes to get your thoughts, emotions, and perspective together. Taking a few moments to de-escalate the stress and improve your ability to focus and think creatively will help you navigate stressful events more effectively.
Listening to music has a calming effect. Try putting together a selection of music that you find calming and play it during stressful times of the day, such as during a daily commute. Music can also help you make your mind before stressful events.
Hobbies can be relaxing, but it’s important to ask yourself if you honestly feel relaxed or if your hobby sometimes becomes stressful for you. Avoid leisure activities that are competitive, involve a lot of running around, or that can become frustrating. For relaxation, focus on non-competitive hobbies, such as painting, photography, gardening, bird watching, reading, cooking, dancing, model building, car restoration, creative writing, scrapbooking, woodworking, fishing, knitting, jewelry making, collecting, billiards, and astronomy.
Choose games that allow you to relax and enjoy yourself. If the games you enjoy are frustrating or competitive, you may want to choose a different relaxation tool. Examples of games include cards, bridge, chess, darts, mahjong, Scrabble, bocce, croquet, board games (such as Monopoly), dominoes, and craps.
Taking a long, hot bath can be relaxing. Consider adding Epsom bath salts for added relaxation. The magnesium found in the salts can improve the relaxation of blood vessels, which may lower blood pressure.
Pets can lower stress levels and relax you. Before deciding to get a pet, consider the type of pet you would enjoy and whether or not getting a pet is right for you.
Walking can be a great way to shed stress, and it’s good for your physical health too! Consider different routes such as walks in the city or countryside, by the water, with a beautiful view, or at sunrise or sunset, to add to the relaxing effects.
If you are stressed, you may need extra rest. Consider heading to bed a little earlier if you feel particularly stressed or, if you can find time during your day, try to fit in a quick power nap. Chilled cucumbers placed over your eyes can add to the relaxation effect.
If you follow professional sports, consider going to a few games versus watching them on TV.
They say laughter is the best medicine, and there’s an abundance of research that supports the health benefits of laughing. Tune into a comedy channel on TV or radio, or check out a local live comedy show.
The type of relaxation method is not important; rather, it’s taking time to relax and unwind that produces the benefits. Relaxation takes practice. If you can master the art of mindful relaxation, you’ll reap both physical and mental benefits, leaving you better equipped to handle life’s stressors without spiking your stress level and blood pressure!
1. Bai, Z., et al. "Investigating the effect of transcendental meditation on blood pressure: a systematic review and meta-analysis." Journal of human hypertension 29.11 (2015): 653-662. View Article.
2. Blom, Kimberly, et al. "Hypertension analysis of stress reduction using mindfulness meditation and yoga: results from the harmony randomized controlled trial." American journal of hypertension 27.1 (2014): 122-129. View Article
3. Zawadzki, Matthew J., et al. "Absorption in self-selected activities is associated with lower ambulatory blood pressure but not for high trait ruminators." American journal of hypertension (2013): hpt118. View Article.
4. A Barnes, Vernon, and David W Orme-Johnson. "Prevention and treatment of cardiovascular disease in adolescents and adults through the Transcendental Meditation® program: a research review update." Current hypertension reviews 8.3 (2012): 227-242. View Article.
5. Meditation alone doesn’t lower blood pressure: study. Reuters. Health News. Oct 4, 2013.View Article.
6. Schneider, Robert H., et al. "Long-term effects of stress reduction on mortality in persons≥ 55 years of age with systemic hypertension." The American journal of cardiology 95.9 (2005): 1060-1064. View Article.
7. Labarthe, Darwin, and Carma Ayala. "Nondrug interventions in hypertension prevention and control." Cardiology clinics 20.2 (2002): 249-263. View Article.
8. Angrish, Ashutosh. Yoga reduces blood pressure in patients with hypertension. presented at the 68th Annual Conference of the Cardiological Society of India (CSI). (2016). View Article.
9. Matthew P. Pase, et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia. A Prospective Cohort Study. American Heart Association Journal. (2017). View Article.
10. StamlerJ, RoseG, StamlerR, et al. INTERSALT study findings. Public health and medical care implications. Hypertension 1989; 14:570–7. View Article.
11. AppelLJ. Lifestyle modification as a means to prevent and treat high blood pressure. J Am Soc Nephrol 2003;14:S99–102. View Article
12. O'DonnellMJ, XavierD, LiuL, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112–23. View Article.