Key Points:
- HTN is a leading cause of cardiovascular (CV) morbidity and mortality worldwide, but blood pressures remain uncontrolled worldwide.
- Spirituality, a comprehensive concept encompassing both personal and interpersonal factors, has been previously studied as a protective factor against CV disease.
- The authors conducted a randomized non-inferiority trial comparing intervention with a daily WhatsApp message, encouraging forgiveness, gratitude, optimism or life purpose, versus usual care for 12 weeks on peripheral and central BP.
- The intervention group demonstrated a significant improvement in both peripheral (7.6 mmHg; p<0.001) and central BP compared to the control group, suggesting evidence of BP improvement with a spirituality intervention on par with many anti-hypertensive medications.
HTN is a top cause of CV morbidity and mortality worldwide, though it remains underdiagnosed, undertreated, and under-controlled. Previous observational studies have suggested a protective role of spirituality against increased BP and CVD. As such, spirituality may represent a novel modifiable risk factor and determinant of CV health, useful for both clinical practice and research. The author’s note a previous definition of spirituality as “a set of moral, mental and emotional values that guide thoughts, behaviors and attitudes in the life’s circumstances of intra- and interpersonal relationship, suitable to scientific evaluation,” as distinct from religion, previously defined by a source from the authors as “an organized system of beliefs, practices and symbols designed to facilitate closeness with the transcendent or the Divine and foster understanding of one’s relationship and responsibilities with others living in the Community.” The investigators sought to determine, as a primary outcome, whether a spirituality-based intervention compared with usual care reduces BP after 12 weeks in patients with mild or moderate HTN.
In the study, 100 patients with stage 1 or 2 HTN were randomized to either usual care or a spirituality-based intervention (SBI) arm promoting four edifying feelings: forgiveness, gratitude, optimism, and life purpose. The intervention arm accomplished this using a daily WhatsApp message sent with either a video, quote for self-reflection, short task, or a day-off message. Engagement was tracked through “read receipts” on WhatsApp and responses for task-based messages. Medications and lifestyle changes were otherwise unchanged. Peripheral BP was monitored with both office and home BP monitoring, and central BP was determined through flow mediated dilation (FMD).
Baseline characteristics were balanced among prevalence of diabetes, physical activity, smoking, and alcohol intake; however, there was a substantially lower population of males in the intervention group than the control group (9/51 vs 20/49, respectively; p = 0.011). Ultimately, the intervention arm demonstrated more substantial reduction from baseline to study conclusion in office-based SBP than the control arm (–7.6 vs –0.55; p=0.047) as well as higher FMD change (4.12 vs –3.34; p<0.001). The study did not show significant differences in home BP between groups.
The authors conclude that this SBI promoting forgiveness, gratitude, optimism, and life purpose may demonstrate decreased stress, deactivating sympathetic nervous system, decreasing BP, and thereby increasing CV health. They do note that the study was limited by 25% non-adherence and a small sample size. However, given the improvement in office SBP on par with some anti-hypertensive medications, further trials are needed for investigation, possibly incorporating a larger sample size, other edifying-feelings to be promoted in an SBI, and evaluation of major cardiovascular outcomes.