Mindfulness-Based Coaching to Reduce Ambulatory Hypertension in Atrial Fibrillation: A Pilot-Feasibility Randomized Controlled Trial

Background: Hypertension (HTN) is widely implicated in the prevention and management of Atrial Fibrillation (AF), given its centrality in AF pathogenesis and prognosis. As impaired autonomic cardiovascular functioning is the basis of both conditions, strategies that improve autonomic balance can reduce HTN-AF burden.

Methods: The objective of this study was to evaluate the effectiveness of a 16-week mindfulness-based risk reduction (MBRR) coaching program compared to a diet-based risk reduction coaching (DBRR) coaching program based on the Dietary Approaches to Stop Hypertension (DASH) guidelines. The primary outcome was 24-hr ambulatory systolic blood pressure (SBP) during waking and sleeping.

Results: In 30 stable AF patients with elevated waking SBP ( 135mmHg), results for SBP showed statistically significant main effects of time, indicating overall mean reductions in SBP from baseline to 8-weeks (Waking: -6.68, p = 0.002; Sleeping: -5.88, p = 0.006), and from baseline to 16-weeks (Waking: -9.68, p = 0.0001; Sleeping: -6.46, p = 0.009) irrespective of study interventions. Participants in both groups also showed statistically significant improvements from baseline to 8 and 16-weeks in indices of general anxiety, cardiac anxiety, POMS tension, anger, and confusion subscales, along with improvements in mindfulness describing and nonreactivity facets, with no statistically significant between-group differences.

Discussion: Both MBRR and DBRR were effective in lowering SBP during waking and sleeping. Both groups also saw improvements in general and cardiac anxiety, in addition to other mood and mindfulness indices, supporting the use of MBRR and DBRR interventions in AF.