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BACKGROUND The HARMONY study was a randomized, controlled trial examining the efficacy of an 8-week mindfulness-based stress reduction (MBSR) program for blood pressure (BP) lowering among unmedicated stage 1 hypertensive participants. METHODS Participants diagnosed with stage 1 hypertension based on ambulatory BP were randomized to either immediate treatment of MBSR for 8 weeks or wait-list control. Primary outcome analysis evaluated whether change in awake and 24-hour ambulatory BP from baseline to week 12 was significantly different between the 2 groups. A within-group before and after MBSR analysis was also performed. RESULTS The study enrolled 101 adults (38% male) with baseline average 24-hour ambulatory BP of 135±7.9/82±5.8mm Hg and daytime ambulatory BP of 140±7.7/87±6.3 mmHg. At week 12, the change from baseline in 24-hour ambulatory BP was 0.4±6.7/0.0±4.9mm Hg for the immediate intervention and 0.4±7.8/−0.4±4.6mm Hg for the wait-list control. There were no significant differences between intervention and wait-list control for all ambulatory BP parameters. The secondary within-group analysis found a small reduction in BP after MBSR compared with baseline, a finding limited to female subjects in a sex analysis. CONCLUSIONS MBSR did not lower ambulatory BP by a statistically or clinically significant amount in untreated, stage 1 hypertensive patients when compared with a wait-list control group. It leaves untested whether MBSR might be useful for lowering BP by improving adherence in treated hypertensive participants. CLINICAL TRIALS REGISTRATION NCT00825526. [ABSTRACT FROM AUTHOR]

Background: Psychosocial and lifestyle stressors, such as job strain and marital factors, have previously been associated with a sustained increase in blood pressure (BP). Methods: In a 1-year longitudinal study, we evaluated whether job strain and marital cohesion continued to be associated with ambulatory blood pressure (ABP). The final study cohort included 229 male and female volunteers who were still employed and living with a significant other as at baseline and could complete all aspects of the follow-up testing. Results: The interaction between job strain and marital cohesion was significantly associated with a change in ABP during 1 year for 24-h systolic BP but not diastolic BP (P = .018 and .13, respectively). This association also occurred for job strain (P = .011). Subjects with high job strain and a low cohesive marriage had an increase in systolic BP by 3 mm Hg during 1 year, and those with job strain who also had a highly cohesive marriage had a reduction of systolic BP by 3 mm Hg during 1 year. An exploratory analysis for gender effects found that the interaction between job strain and marital cohesion was found only in women (P = .025). Conclusions: Marital cohesion consistently interacted with the sustained elevation of BP associated with job strain over time in men and women. Low marital cohesion exacerbated the effect of job strain to elevate BP and high marital cohesion ameliorated it. This interaction may be gender specific in that it was demonstrated separately in women but not in men. [Copyright &y& Elsevier]

Background: Research has demonstrated that psychosocial and lifestyle factors are associated with sustained increases in blood pressure (BP). Methods: Using post-hoc analyses from the Baseline Double Exposure cohort study, alcohol consumption and gender were examined as to their association with ambulatory BP (ABP) in participants with normal or elevated and untreated BP. Results: The current study included 248 subjects, 135 (54.4%) of whom were women, with a mean age (± SD) of 50.8 ± 6.6 years. The main effects model, which included BMI, multiple regression analysis with 24 h systolic BP as the dependent variable found that alcohol consumption (P = .033), male gender (P = .004), and age (P = .039) were significant variables associated with higher systolic BP, whereas exercise (P = .037) was associated with lower systolic BP. From the regression analysis, the independent effect of alcohol consumption (≥10 drinks per week) on systolic BP was 4.4 mm Hg for all subjects during 24 h and 7.1 mm Hg during spousal contact, whereas in women with this degree of alcohol consumption the effect on systolic BP was 8.4 mm Hg during 24 h and 11.4 mm Hg during spousal contact. When the interaction term of gender by drinking status was added to the same regression model, the term was not significant for systolic BP during 24 h, but was significant during spousal contact time (P = .047). Conclusions: The current study demonstrates an association between alcohol with higher systolic BP, more pronounced in women than men, particularly during spousal contact time. This is the first time that the interaction of alcohol and gender with ABP has been demonstrated. [Copyright &y& Elsevier]

Most national and international guidelines for diagnosing hypertension include 24-h ambulatory blood pressure monitoring (ABPM) and self (home) BP monitoring (SBPM) as optional methods for identifying hypertensive patients. However, none of the current guidelines have yet included ABPM or SBPM as fundamental tools for diagnosing hypertension, preferring instead to rely on conventional office readings recorded by mercury sphygmomanometry. During the past 10 years, clinical outcome studies have consistently reported 24-h ABPM and SBPM to be significantly better predictors of cardiovascular events compared with the office BP, even when recorded under “research conditions.” Based on the available evidence, the Canadian Hypertension Education Program has now developed an algorithm for diagnosing hypertension that offers three options: 1) conventional office BP, 2) SBPM, or 3) 24-h ABPM. Out-of-office BP measurements are recommended, whenever feasible, to minimize both measurement error associated with mercury sphygmomanometry and the white coat effect experienced by some patients. [Copyright &y& Elsevier]

Background: Psychosocial stressors such as job strain and marital stress have been associated with a sustained increase in blood pressure (BP). Methods: We evaluated whether job strain and marital cohesion were associated with ambulatory BP in workers with normal or untreated elevated BP using baseline data from the Double Exposure study. The study population included 248 male and female volunteers who were nonmedicated, employed, and living with a significant other, all for a minimum of 6 months. Blood pressure was measured with an ambulatory BP monitor and participants completed a diary that recorded time during work, spousal contact, and sleep. Job strain and marital cohesion were calculated from the Job Content Questionnaire and the Dyadic Adjustment Scale, respectively. Results: Of the subjects, 54.4% were female with a mean age of 50.8 years (6.6, SD). In all, 21.3% reported job strain. Significant assocations were found between 24-h systolic BP (SBP) and alcohol consumption (P = .033), job strain (P = .007), male gender (P = .004), and age (P = .039) and was inversely associated with exercise (P = .037). An interaction between 24-h SBP, job strain, and marital cohesion was found such that greater marital cohesion was associated with lower SBP in subjects with job strain. Conclusions: Psychosocial factors may influence the development of early hypertension. This should be clarified by the cohort phase of the Double Exposure study. [Copyright &y& Elsevier]