Mindfulness for blood pressure reduction?

This umbrella review summarized the effectiveness of mindfulness-based interventions (MBIs) for lowering blood pressure (BP) and evaluated the methodological quality and certainty of existing meta-analyses using AMSTAR 2 and GRADE. Meta-analyses of randomised clinical trials (RCTs) involving adults with or without hypertension were identified through comprehensive searches conducted from database inception. Two reviewers independently performed study selection, data extraction, and quality assessment.

From 1324 records, 11 systematic reviews and meta-analyses met the inclusion criteria. These included 2–16 primary RCTs with sample sizes ranging from 101–767 and examined heterogeneous populations, including individuals with elevated BP, established hypertension, or broader cardiometabolic risks.

Most reviews reported systolic and diastolic BP reductions following MBIs, although pooled effects showed substantial heterogeneity and wide confidence intervals. Reporting of adverse events was limited, and only two reviews noted the lack of long-term follow-up evidence.

The methodological quality was rated low or critically low in all reviews, except the Cochrane review which was high-quality and reported systolic BP reductions of −6.08 mmHg (95% CI: −12.79–0.63) and diastolic reductions of −5.18 mmHg (95% CI: −10.65–0.29) compared with active controls. Against inactive controls, systolic BP decreased by −6.62 mmHg (95% CI: −13.15–−0.10) and diastolic by −3.35 mmHg (95% CI: −5.86–−0.8).

The authors concluded that the current evidence suggests MBIs may modestly reduce BP, potentially within clinically meaningful ranges. High-quality, adequately powered RCTs are needed to determine whether MBIs should be recommended as routine treatments for hypertension.

I am, of course, delighted to hear that our review was of good quality. I am less pleased that it was the only one of decent rigor. This, I feaar, highlights a problem that we have often mentioned: in the realm of so-called alternative medicine (SCAM) the methodological quality of research is often inacceptably low. Systematic reviews are supposed to overcome this problem by rigorously weighing the evidence according to its quality and weeding out the unreliable from the reliabale. It is therefore particularly depressing to realise that even systematic reviews are frequently of poor quality that misleads us all.

And what about the clinical value of MBIs for treating hypertension? As the authors of the above paper point out, the effects are modest. What they don’t say is that they might be of little clinical relevance. This is particularly true, in my view, because we have a whole range of measures that lower BP more reliably, dramatically, and practically, i.e. without the investment of the time required for MBIs. Therefore, I do not think that MBIs are suitable for a first line anti-hypertensive therapy. By all means, patients who are into this sort of thing should try it. But even for them, I would only recommend it as an adjunct to other measures.