ABSTRACT
Introduction: Chronic stress is associated with incident hypertension and is a promising intervention target for lowering blood pressure (BP), particularly in women. Growing evidence suggests that mindfulness-based interventions can reduce BP and improve psychological outcomes but the in-person format of traditional programs limits access. The goal of this study was to evaluate the feasibility, acceptability and effects of telephone-delivered mindfulness-based cognitive therapy (MBCT-T) in women with prehypertension. Methods: We conducted a pilot RCT in which 37 women meeting JNC 7 criteria for prehypertension (SBP 120-139 mmHg or DBP 80-89 mmHg) and not taking antihypertensive medication were recruited from outpatient clinics or via the EHR. Eligible participants were randomized to usual care or MBCT-T, which involved 8 weekly 1-hour phone sessions delivered to small groups by a trained instructor. Outcomes included feasibility (session completion), acceptability (Client Satisfaction Questionnaire [CSQ]), SBP (mean of 3 clinic BP measurements), perceived stress (PSS-10) and depressive symptoms (PHQ-8). Linear mixed models with a random effect of intervention cohort were performed to compare 3-month changes in outcomes between study arms, adjusting for age and ethnicity. Results: The mean age was 50.7±17.7, 68% of participants were racial/ethnic minorities, and baseline SBP/DBP was 127.8±6.2/77.5±7.2 mmHg. There were no significant differences between study arms in demographics or baseline characteristics. The median number of sessions completed was 6 of 8. Fewer sessions were completed by employed vs. unemployed women (4.5 vs. 7.8,t=3.55, p=.003) and by foreign-born vs. U.S.-born women (2.8 vs. 5.9, t=1.87, p=.08). Overall 3-month retention was 89% but follow-up BP was missing in ∼50% of participants due to COVID-19research restrictions. Three-quarters of MBCT-T participants reported high satisfaction with theintervention (CSQ24). In the subgroup with complete follow-up data, SBP declined in both studyarms but there was no significant between-group difference (p=0.51). Conversely, greater reductionsin perceived stress and depressive symptoms were observed in the MBCT-T arm vs. usual care(between-group differences of 3.63 [PSS-10;p=.163] and 2.90 [PHQ-8;p=.008]). In per-protocolanalyses limited to MBCT-T participants who completed ≥4 sessions, effects were larger forperceived stress and similar for depressive symptoms (between-group differences of 6.17 [PSS-10;p=.012] and 2.77 [PHQ-8;p=.025]). Conclusions: Results support the feasibility and acceptability of telephone-based mindfulnesstraining in diverse women with prehypertension. Promising findings for stress and depressivesymptoms suggest further studies are warranted. Strategies to address barriers to participation, particularly among working women and minorities, are needed.