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To Lower Blood Pressure, Open Up And Say 'Om'

In his 20 years as director of the hypertension program at Massachusetts General Hospital, Dr. Randy Zusman has maintained a rather traditional approach.

He writes plenty of prescriptions for standard medications to treat high blood pressure. But in recent years, Zusman has gotten more assertive with patients about lifestyle choices.

"You're going to have to change your diet, you're going to have to lose weight, exercise, stop smoking," Zusman tells patients. "If it's not an important priority, keep doing what you're doing, I'll give you the pills. But if you really want to be there, you're going to have to change."

The Relaxation Response

 

The "relaxtion response" technique was first described 30 years ago by cardiologist Herbert Benson.

 

At its core, the technique involves sitting quietly with eyes closed for 10 to 20 minutes and repeating silently a word or phrase as you breathe slowly and naturally.

 

Read more about how to meditate using the relaxation response at the Benson-Henry Institute for Mind Body Medicine.

A Prescription For Meditation

Lately, Zusman has added a new recommendation: meditation. It's based on what he learned from a recent, three-month study he helped direct in conjunction with Boston's Benson-Henry Institute for Mind Body Medicine.

Patients who took part in the research were being treated for high blood pressure using standard medications and had agreed to try training in what's known as the relaxation response, a technique first described by cardiologist Herbert Benson 30 years ago.

"I'd been using medications in these patients, they were hopefully following my recommendations," Zusman explains. But "we still couldn't get their blood pressure under control. And I was somewhat skeptical that meditation could be the key to blood pressure control."

One patient in the institute study was a man named Jerome Smith. At 67, Smith is retired from his job as a corporate executive at DuPont, but he still works as a consultant part time. He says he's always had a type-A personality.

So, sitting alone in a quiet room was certainly not an easy technique.

"It was a foreign concept in terms of my normal practices," Smith says.

But he got lots of help, and with weekly one-one-one training sessions he learned how to meditate. "You're just letting all your tension go," he says.

Sometimes, realizing that you're not in control can make you more effective in matters where you do have control.

Relaxing Results

At the end of the study, Smith got some good news. His blood pressure was down, so he was able reduce the dosage of one of his medications.

Zusman says that about 40 of the 60 patients trained in the relaxation response had similar results.

"Their blood pressure dropped, and they dropped some of their medication. It was striking. It was statistically significant, but more important it was clinically significant to these people," he says.

What helps to explain these results, Zusman says, is the relatively new understanding of how the relaxation response assists the body.

It helps increase the formation of a compound called nitric oxide, which causes blood vessels to open up. This, in turn, lowers blood pressure.

"It's basically a plumbing problem. You're pushing the same amount of blood through a bigger pipe," Zusman says. "And that's what nitric oxide — which all of us make in our body — does in response to relaxation response."

Commitment Required

Here's the rub: The relaxation response is not a gift. A daily meditation practice requires discipline and allocating time each day.

Smith, the study participant, says this is the hard part. A year after the study, he says his daily practice has begun to fall off because life's just gotten too busy

Although Zusman says this can happen, he's learned that the relaxation response is yet one more tool to control blood pressure.

Whether it's temporary or more long term depends on how well people can stick with it.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne. Good morning.

STEVE INSKEEP, host:

Good morning. I'm Steve Inskeep. A cardiologist found a new way to treat high blood pressure, and he did it by gaining a new understanding of the connection between your body and your mind. What he learned is the subject of Your Health on this Thursday morning. NPR's Allison Aubrey met Dr. Randy Zusman at a Boston grocery store to find out about his epiphany.

ALLISON AUBREY: Dr. Randy Zusman has been director of the hypertension program at Massachusetts General for over 20 years. And in all that time he's maintained a rather traditional approach. Treating high blood pressure with standard medications is effective, so he writes plenty of prescriptions. But in recent years, he's gotten more assertive with his lifestyle spiel.

Dr. RANDY ZUSMAN (Massachusetts General Hospital): I tell the patient, do you want to see your grandchild married? Do you want to see your granddaughter grow up?

AUBREY: And when they say yes, of course they'd like to see that, he tells them that in order to cut their risk of a debilitating stroke or heart attack they need to take action.

Dr. ZUSMAN: You're going to have to change your diet, you're going to have to lose weight, you're going to have to exercise, stop smoking. If it's not an important priority, keep doing what you're doing, I'll keep giving you the pills. But if you really want to be there, you're going to have to change.

AUBREY: Knowing the right thing to do is a lot easier than actually doing it, and this is not lost on Zusman. So he counsels people on how to make lots of small changes. Standing in the cereal aisle, he gives some of his usual tips on reading sodium labels. Turns out even a bowl of Cheerios have about a tenth of your daily salt allotment.

Dr. ZUSMAN: So this would be a lot of salt to get in the course of your breakfast.

AUBREY: And lately he's started to add a word about meditation. It's based on what he learned from a recent study he helped direct in conjunction with the Mind Body Institute at his hospital. Patients who were being treated for high blood pressure using standard medications agreed to try training in what's known as the relaxation response, a technique first described by cardiologist Herbert Benson 30 years ago.

Dr. ZUSMAN: I'd been using medications in these patients. They were hopefully following my recommendations. We still couldn't get their blood pressure controlled. And I was somewhat skeptical that meditation would actually be the key to blood pressure control.

AUBREY: One of the patients in the Mind Body Institute study was a man named Jerome Smith. At 67, he's retired from his job as a corporate executive at DuPont, but he still works as a consultant part time. When I talked to Smith by telephone he told me that he's always had a type-A personality. So sitting in a quiet room by himself doing nothing certainly was not a technique he arrived at intuitively.

Mr. JEROME SMITH (Patient): It was a foreign concept as far as my normal practices.

AUBREY: So he got lots of help. During weekly one-one-one training sessions, Smith learned how to meditate. And to reinforce the techniques he used this instructional CD.

(Soundbite of CD)

Unidentified Woman: Imagine that the sound of the in-breath is hum, and the sound of the out-breath is suh.

AUBREY: Now imagine sitting at a red light breathing this way. For Smith this replaced his habit of trying to figure out how to get a jump start on the traffic around him.

Mr. SMITH: You're just letting all your tension go, instead of looking at your watch and saying I should be there by now and I'm not.

AUBREY: Sometimes realizing that you're not in control can make you more effective in matters where you do have control.

At the end of the three-month study, Jerome Smith got some good news. His blood pressure was down, so he was able reduce the dosage of one of his medications. Cardiologist Randy Zusman says about 40 of the 60 patients trained in the relaxation response got similar results.

Dr. ZUSMAN: So their blood pressure dropped, and they dropped some of their medication. It was striking. It was statistically significant, but more importantly it was very clinically significant to these people.

AUBREY: Zusman says what helps to explain these results is the relatively new understanding of how the relaxation response works. It helps to increase the formation of a compound called nitric oxide, which causes the blood vessels to dilate or open up. And this in turn lowers blood pressure.

Dr. ZUSMAN: So it's basically a plumbing problem. You're pushing the same amount of blood through a bigger pipe at a lower pressure. And that's what this substance, nitric oxide - which all of us make in our body - does in response to the relaxation response.

AUBREY: So here's the rub. The relaxation response is not a gift. A daily meditation practice requires discipline, allocating time each day. Patient Jerome Smith says this is the hard part. A year after the study, he says his daily practice has begun to fall off because life's just gotten too busy. And Zusman says this can happen.

Dr. ZUSMAN: There are certainly some people who can't do it. There are some people who do it quite easily.

AUBREY: Dr. Randy Zusman says what he's learned is that the relaxation response is yet one more tool to control blood pressure. Whether it's temporary or more long term depends on how well people can stick with it.

Allison Aubrey, NPR News.

(Soundbite of exhale)

INSKEEP: You can find more about the relaxation response form of mediation at npr.org in the Your Health section. Transcript provided by NPR, Copyright NPR.

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