MBSR on Nocturnal Hypertension

Chinese University of Hong Kong76 enrolled

Overview

Objectives: To examine the feasibility and acceptability of treating nocturnal hypertension by mindfulness-based stress reduction program (MBSR). This will provide data essential for the main trial, which will also examine the definite effectiveness of MBSR to reduce nocturnal blood pressure (BP). Hypothesis to be tested: MBSR and the current trial are acceptable and safe to patients with nocturnal hypertension; and future main trial is feasible in terms of recruitment, dropout rate and adherence to MBSR/BP measurements. Design and subjects: This pilot randomized-controlled trial will recruit 76 patients with nocturnal HT (night-time Systolic BP (SBP) during sleep 120 mmHg) and stage I hypertension (awake SBP = 135-159mmHg), as detected by ambulatory blood pressure monitoring (ABPM). Participants will be allocated in 1:1 ratio by stratified block randomization (by age and presence of mood disorder) to receive MBSR (intervention group) or usual care (control group) respectively. Instruments: ABPM/HBPM/MBSR patients' diary. Interventions: The generic 8-week MBSR will be taught by a certified MBSR teacher. Participants in MBSR arm will be asked to meditate 40 minutes every day during the interventional period. Main outcome measures: rate of recruitment/dropout/adherence to MBSR/BP measurements Data analysis and expected results: The rate of recruitment/dropout/adherence to MBSR/BP measurements will be presented. The acceptability of MBSR and the trial will also be assessed by patients' interviews. A high level of rate of recruitment, adherence to both MBSR and BP measurements and acceptability to MBSR are expected.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Interventions

mindfulness based stress reduction programBEHAVIORAL

Mindfulness training will be delivered through a generic 8-week MBSR. The MBSR will consist of weekly 2-hour classes, in which the techniques to various meditations (e.g., body scan, mindful awareness of breathing, body, sounds, thoughts, emotions, and mindful movements) will be taught and discussed. Participants will be asked to meditate for ≥40 minutes every day during the 8-week program as "homework". Besides cultivating attention control and a non-judgemental stance to experience, psychoeducation about psychological stress and stress response will also be discussed during the MBSR classes. The MBSR teacher will discuss any difficulties encountered during homework meditations in every class to enhance adherence. Each MBSR class can have up to 25 participants. The 8-week program will be taught by a qualified MBSR teacher

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * diagnosed hypertension (HT) from clinical records (with or without anti-hypertensive medications) * nocturnal HT (night-time systolic blood pressure \[SBP\] during sleep ≥120 mmHg) and stage I hypertension (daytime SBP = 135-159 mmHg), as detected by 24-hour ambulatory blood pressure monitoring (ABPM) * no change of dose and type of anti-hypertensive(s) in the prior 2 months Exclusion Criteria: * patients with atrial fibrillation (these patients have greater blood pressure variability) * daytime office systolic blood pressure (BP) ≥180 mmHg or diastolic BP ≥120 mmHg (regardless of nocturnal BP) * patients with known obstructive sleep apnoea * history of dementia or psychotic illnesses * patients with end-stage malignancies * nocturnal worker, because they will have a reverse BP pattern to other participants * patients receiving ≥3 BP medications at maximal tolerated doses * previous participation in structured mindfulness program(s) of ≥8 weeks or regular daily meditation practices * reported sleep time of \<4 hours per day * patients who do not agree to keep the same dose of anti-HT medications during the trial period * patients receiving anti-coagulants

Outcomes

Primary Outcomes

rate of recruitment

number of participants recruited per month during the recruitment period

Time frame: over 1- year

feasibility of repeated ambulatory blood pressure monitoring

the proportion of patients finishing both ambulatory blood pressure monitoring

Time frame: baseline, 8 weeks

Secondary Outcomes

blood pressure as measured by 24-hour ambulatory blood pressure monitoring

daytime, nighttime and overall 24-hour blood pressure