Commentary : Journal of Cardiovascular Nursing

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Letter to the Editor

Commentary

Schneider, Robert H. MD, FACC; Salerno, John W. PhD

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The Journal of Cardiovascular Nursing ():10.1097/JCN.0000000000000969, January 16, 2023. | DOI: 10.1097/JCN.0000000000000969
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We appreciate the efforts of the recent meta-analysis of the effects of the Transcendental Meditation (TM) technique on blood pressure (BP).1 In certain ways, it is more comprehensive than previous systematic reviews and meta-analyses on the topic. The authors are correct in that published randomized controlled trials (RCTs) show that the TM technique significantly reduces high BP. However, several RCTs contradict the authors' comment in their conclusion that the BP effect wanes after 3 months.

Evidence

The first RCT published in 2005 allocated subjects with hypertension to a TM group or an education control group and followed them up for 1 year.2 The results showed changes in systolic/diastolic BP of −3.1/−5.7 mm Hg compared with −0.5/−2.9 mm Hg for controls over the 12-month follow-up period. In addition, the TM group showed reduced use of antihypertensive medication over 12 months.

The second RCT published in 2012 allocated 201 patients with coronary heart disease to a TM group or an education control group and followed them for up to 9 years.3 The results showed an average BP difference of −4.8 mm Hg systolic over 5.5 years for TM versus education control. In terms of clinical event outcomes, there was a significant 48% reduction on the composite of total mortality, nonfatal myocardial infarction, and nonfatal stroke.

The third RCT published in 2021 allocated 304 participants with high normal or normal BP to a TM or control group and followed them for up to 36 months.4 The results showed a significant −3.3-mm reduction in systolic BP in the high-normal TM versus controls after an average of 20 months of follow-up. In addition, there was a signal for 48% relative risk reduction of hypertensive events in the TM group.

Fourth, a pooled analysis of 2 RCTs that allocated 202 subjects with high BP to TM or control conditions who were followed for an average of 7.6 years found a 30% risk reduction in cardiovascular mortality and a 20% risk reduction in total mortality.5

These RCTs demonstrate long-term effects of TM practice on BP in adult patients with high BP and, most importantly, on the clinical consequences of high BP—death, myocardial infarction, and stroke. After all, this is the purpose of lowering high BP.

REFERENCES

1. Schneider JK, Reangsing C, Willis DG. Effects of transcendental meditation on blood pressure: a meta-analysis. J Cardiovasc Nurs. 2022;37(3):E11–E21. doi:10.1097/JCN.0000000000000849.
2. Schneider RH, Alexander CN, Staggers F, et al. A randomized controlled trial of stress reduction in African Americans treated for hypertension for over one year. Am J Hypertens. 2005;18(1):88–98.
3. Schneider RH, Grim CE, Rainforth MV, et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in blacks. Circ Cardiovasc Qual Outcomes. 2012;5:750–758.
4. Schneider RH, Grim C, Kotchen T, et al. Randomized controlled trial of stress reduction with meditation and health education in black men and women with high normal and normal blood pressure. Am J Prev Cardiol. 2021;8:100279. doi:10.1016/j.ajpc.2021.100279.
5. Schneider RH, Alexander CN, Staggers F, et al. Long-term effects of stress reduction on mortality in persons >55 years of age with systemic hypertension. Am J Cardiol. 2005;95(9):1060–1064.
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