Feasibility and preliminary effectiveness of mindfulness-based stress reduction program on patients with nocturnal hypertension: a pilot randomized controlled trial

Background: Nocturnal blood pressure (BP) during sleep is a stronger predictor of cardiovascular events than daytime BP.This pilot randomized controlled trial (RCT) aimed to assess feasibility and preliminary effectiveness of mindfulness-based stress reduction (MBSR) in managing nocturnal hypertension.Methods: Eligible patients were randomized to either a generic MBSR program or usual care (1:1).Primary outcomes included recruitment rate, dropout rate, adherence to ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), and MBSR participation.Secondary outcomes encompassed BP measurements from ABPM, mood symptoms, sleep quality, mindfulness levels, and safety at 8 weeks, with acceptability evaluated through interviews.Results: All eligible patients were recruited (76/113), with 13 participants recruited monthly and a retention rate of 100%.The 83.3% of MBSR participants attended at least six classes, and they engaged in home practices on 77% of days during the 8-week program.All participants completed ABPM at baseline and 8 weeks; however, only 55.3% reported adequate nocturnal HBPM readings.While MBSR significantly reduced nocturnal systolic BP (121.9 vs. 128.6mmHg, P < 0.001), no significant differences were observed on other outcomes and no adverse events were detected.Patients noted benefits from the MBSR course, although HBPM and ABPM disrupted sleep for a minority.Conclusion: This is the first RCT to investigate the effect of mindfulness on nocturnal BP in a Chinese population.We confirm the feasibility of a definitive RCT regarding patient recruitment and retention, acceptability of the intervention (i.e., MBSR), and data collection (e.g., repeated ABPM).Although MBSR may reduce nocturnal systolic BP by 7 mmHg, this needs to be confirmed in a definitive RCT.