A Brief Mindfulness Intervention to Lower Repeat BP in Primary Care

Context: Mindfulness-based interventions (MBI) are being studied for their potential role in syndromes of overactive sympathetic tone. Longer-duration interventions have demonstrated reduction of physiological parameters such as systolic blood pressure (Carlton 2007; Loucks 2019; Lee 2020). However, MBI brief enough for the primary care setting have received little attention. Blood pressure control is a major quality KPI impacting reimbursement from insurers for primary care practices. While it is not uncommon for a repeat blood pressure to be lower than the initial reading, it is unknown if this effect could be potentiated by listening to a short mindful breathing exercise while waiting.

Study Design: Pilot randomized controlled trial.

Population: Adult patients 18-85 presenting for ambulatory care with initial BP □ 140/90.

Intervention: Randomization by a computer-based survey on an iPad to receive a 5-minute mindful breathing exercise (intervention) or a 5-minute timer (control).

Primary Outcome: Percentage of patients in each group whose repeat blood pressure is below 140/90 (at goal).

Secondary Outcomes: 1) Mean absolute change in systolic and diastolic blood pressure readings in each group. 2) Prior experience with and interest in learning mindfulness meditation.

Results: Out of 39 patients approached for enrollment, 33 completed the study and 31 had complete data for analysis (15 intervention, 16 control). After intervention or timer, 40% of the intervention group vs 25% of the control group were at goal (NS). Mean BP reduction was 6.5/3.4 in the intervention group and 2.9/0.8 in the control group (p values for SBP and DBP were 0.22 and 0.18, respectively). More than half of participants reported prior experience with mindfulness exercises, 23% regularly and 26% a small amount. 52% were interested in learning more about mindfulness meditation.

Conclusions: Although this pilot study was underpowered to find a significant difference between groups on repeat blood pressure readings, the trend toward higher likelihood of repeat blood pressure reaching goal by 15% could be important for reaching system performance goals and warrants further study. Data interpretation was affected by a small number of significant outliers. The population’s prior exposure to mindfulness meditation was an unexpected finding.