Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
review and meta-analysis of randomised controlled trials. J Psychosom Res 2014; 76:341–351.
Journal of Hypertension 2020, 38:2335–2341
aCollege of Integrative Medicine, Maharishi International University,bInstitute for
Prevention Research, Fairfield, Iowa andcDepartment of Internal Medicine, Division of
Cardiology, University of Michigan Medical School, Ann Arbor, Michigan, USA Correspondence to Robert H. Schneider, MD, Institute for Prevention Research, Fairfield, IA 52556, USA. Tel: +1 641 472 4600 x 275; e-mail: rschneider@preven-tion-research.org
J Hypertens 38:2335–2341 Copyright ß 2020 Wolters Kluwer Health, Inc. All rights reserved.
DOI:10.1097/HJH.0000000000002625
Reply
Aletta E. Schuttea,b, Fadi Charcharc,d,
Dorairaj Prabhakarane,f,g, on behalf of the 2020 ISH Global Hypertension Practice Guidelines Committee
T
he 2020 ISH Global Hypertension PracticeGuide-lines [1] include a detailed list of lifestyle modifi-cations with varying levels of evidence for the reduction of blood pressure and cardiovascular risk. We listed some novel and inexpensive approaches, such as Transcendental Meditation, to purposefully broaden inter-ventions that could be employed in low and high resource settings. We thank Drs Schneider, Salerno and Brook for their noteworthy correspondence emphasizing the import-ance of this inclusion as a useful intervention to lower cardiovascular risk [2]. The authors correctly highlight that we only cited one systematic review to support this inter-vention, and that there is a broader range of evidence that require citation. We not only appreciate this notion but also wish to reiterate our statement in the guidelines that the Guidelines Committee did not perform a detailed system-atic literature review for the purpose of writing the guide-lines, but mostly extracted evidence from recently published guidelines. This was done with the purpose to produce short and practical guidelines.
As for Transcendental Meditation, it was also high-lighted in an accompanying Editorial to the guidelines by Mancia and Dominiczak [3] that traditionally guidelines would not focus on stress-reducing measures such as
meditation because of challenges to be studied by a con-trolled experimental design. Indeed, in a recent systematic review and Scientific Statement by the American Heart Association, it was concluded that studies of meditation suggest a possible benefit on cardiovascular risk, but the overall quality and quantity of study data are modest [4,5]. Nevertheless, due to the low cost and low risk of meditation and potential benefit to reduce blood pressure and related aspects such as endothelial function, insulin resistance and myocardial ischemia, it remains an intervention with potential benefit and we encourage studies to provide robust evidence supporting improved cardiovascular outcomes.
Original correspondence supplementary: http://links. lww.com/HJH/B441
ACKNOWLEDGEMENTS
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens 2020; 38:982–1004.
2. Schneider RH, Salerno J, Brook RD. 2020 International Society of Hypertension global hypertension practice guidelines – lifestyle modi-fication. J Hypertens 2020; 38:2340–2341.
3. Mancia G, Dominiczak A. The new International Society of Hyperten-sion guidelines on hypertenHyperten-sion. J Hypertens 2020; 38:981.
4. Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, et al. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. J Am Heart Assoc 2017; 6:e002218.
5. Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, Gaylord-King C, et al. Stress reduction in the secondary prevention of cardio-vascular disease: randomized, controlled trial of transcendental medi-tation and health education in Blacks. Circ Cardiovasc Qual Outcomes 2012; 5:750–758.
Journal of Hypertension 2020, 38:2335–2341
aFaculty of Medicine, University of New South Wales, The George Institute for Global
Health, Sydney, Australia,bHypertension in Africa Research Team, South African MRC
Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefst-room, South Africa, cFederation University Australia, School of Health and Life
Sciences, Ballarat,dUniversity of Melbourne, Department of Physiology, Melbourne,
Victoria Australia,ePublic Health Foundation of India,fCentre for Chronic Disease
Control, New Delhi, New Delhi, India andgLondon School of Hygiene and Tropical
Medicine, London, UK
Correspondence to Aletta E. Schutte, PhD, University of New South Wales, Sydney, 2053, NSW, Australia. Tel: +61450315918; e-mail: a.schutte@unsw.edu.au J Hypertens 38:2335–2341 Copyright ß 2020 Wolters Kluwer Health, Inc. All rights reserved.
DOI:10.1097/HJH.0000000000002626
Correspondence
