Application Of Mindfulness-Based Stress Reduction Therapy In Middle-Aged And Elderly Women With Hypertension

Background:Hypertension is a global cardiovascular and cerebrovascular disease.There is a large number of patients with hypertension in China,especially in middle-aged and elderly people.Middle-aged and elderly female patients with hypertension are more likely to have psychological problems such as mood fluctuations and sleep disorders,which lead to high blood pressure and poor efficacy of antihypertensive drugs.Therefore,emotional management of middle-aged and elderly female patients with hypertension is very important.Mindfulness-based stress reduction is one of the common techniques of psychological and behavioral therapy,and its safety and effectiveness have been confirmed.The 2020 International hypertension practice guideline proposed that mindfulness therapy can assist in lowering blood pressure by improving mood.There are related studies on the role of mindfulness therapy in the treatment of hypertension at home and abroad,but only a small number of small sample studies on the effect of mindfulness therapy on ambulatory blood pressure,and there is no study on its effect on vascular function and cardiac function.Objective:1.To explore the moderation of mindfulness on anxiety and somatization symptoms in middle-aged and elderly female patients with hypertension.2.To study the effects of mindfulness-based stress reduction(MBSR)and health education on office and ambulatory blood pressure,mood,sleep,cardiac function,and vascular function in middle-aged and elderly female patients with hypertension.Methods:1.In the cross-sectional study,a total of 109 middle-aged and elderly female patients with hypertension were participated from April to July 2022,who were valid responses to the Five Facet Mindfulness Questionnaire(FFMQ),the General Hospital Anxiety and Depression Scale(GHAD),and the Somatization symptom self-rating scale(SSS).The moderating effect of mindfulness was determined using multidistance linear regression.2.This was a single-center exploratory study,33 middle-aged and elderly female patients with hypertension were divided into the mindfulness group(n=20)and the health education group(n=13).The mindfulness group received professional mindfulness-based stress reduction training,while the control group received health education related to hypertension for 3 months.The general information,psychological scale,blood routine,biochemical test data,office blood pressure,ambulatory blood pressure,vascular function,cardiac function and other data were collected at baseline and 3 months after treatment.Results:1.The average quantification of all participants:mindfulness was 123.86±10.49,anxiety was 7.41±3.62,and somatization symptoms was 41.2±9.44.High mindfulness participants anxiety(P=0.000)and somatization symptoms(P=0.001)were significantly reduced.Anxiety was positively correlated with somatization symptoms(r=0.606,P=0.000),while mindfulness level was negatively correlated with both anxiety(r=-0.468,P=0.000)and somatization symptoms(r=-0.439,P=0.000).Moreover,mindfulness had a significant moderating effect on the relationship between anxiety and somatization symptoms(n=109)(B=-0.166,t=2.125,P=0.036).The regulation of mindfulness on anxiety and somatic symptoms was more significant in participants with low mindfulness levels(n=56)(B=0.144,t=2.805,P=0.008),but not in participants with high mindfulness levels(n=53)(B=0.037,t=-0.864,P=0.393).2.At the next visit after 3 months of treatment,2 participants in the control group were lost to follow-up.There were no significant differences in baseline blood pressure,psychological-related scale scores,vascular function,and cardiac function between the two groups.After three months of training,In the experimental group,ambulatory blood pressure was significantly decreased(P=0.003),the level of mindfulness was significantly improved(P=0.022),self-efficacy was significantly improved(P=0.036),anxiety was significantly decreased(P=0.048),somatization symptoms were significantly reduced(P=0.029),sleep quality was significantly improved(P=0.020),vascular endothelial function was significantly improved(P=0.022)left atrial systolic strain(LAS-A)was significantly increased(P=0.038),and left ventricular diastolic function(E/e’)significantly improve(P=0.040).Conclusions:1.The moderating effect analysis based on regression analysis showed that mindfulness level had a significant moderating effect on anxiety and somatization symptoms,especially in low mindfulness level.2.Mindfulness-based stress reduction can improve the level of mindfulness and selfefficacy of patients,reduce anxiety and somatization symptoms,improve sleep quality,reduce diastolic blood pressure at night,improve vascular endothelial function,left atrial contraction,reserve function and left ventricular diastolic function.