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C HAPTER 41 / Complementary and Alternative Approaches in Cardiovascular Disease 911
Treatments are designed to amplify the natural tendency of the variables, such as blood pressure, heart rate, and peripheral vascu-
body to heal and eliminate toxins from the body. lar resistance, often linked with cardiovascular problems. Medita-
Naturopathic remedies include diet and clinical nutrition tive techniques have been recommended to reduce heart rate,
counsel, particularly, use of naturally processed foods and herbs. lower blood pressure, reduce body weight, or improve the lipid
Other therapies involve application of heat, water, air, or electric- profile. However, it is not clear whether meditation has long-term
ity; physiotherapy, acupuncture, or manipulations; homeopathy; effects on cardiovascular health. The Agency for Health Care Re-
and psychotherapy and counseling. search and Quality (AHRQ) published a comprehensive review of
Naturopathic physicians normally provide primary care and 817 studies of health applications of meditation published be-
do not perform major surgery, dispense pharmaceutical prescrip- tween 1956 and 2005. 23
tions (other than botanicals or body-based substances), or use ra- Evidence reviewed in the AHRQ summary suggests that med-
dioactive substances for diagnosis or treatment. itation can evoke acute lowering of blood pressure in both healthy
adults and in those with hypertension. Zen Buddhist meditation
Osteopathic Medicine (compared with a blood pressure monitoring group) was associ-
ated with lowering diastolic blood pressure by approximately
Osteopathy was developed by Andrew Taylor Still, a physician who 6 mm Hg. Similarly, Transcendental Meditation was associated
became disillusioned with allopathic medicine after three of his with small decreases in systolic (weighted mean difference 4.3 mm
children died in the meningitis epidemic of 1864. His goal was to Hg) and diastolic (weighted mean difference 3.1 mm Hg) blood
establish practices to treat disease and promote health, rather than pressure when compared to progressive muscle relaxation. Some
treat symptoms. He developed osteopathic manipulative treat- mind-body interventions also involve energy medicine. Qi gong
ment and established his own medical schools. There are currently involves breathing and movements which focus the mind and
about 20 schools of osteopathic medicine in the United States to- move qi through channels or meridians in the body. In two trials,
day; their graduates become fully licensed physicians, Doctors of hypertensive patients taught qi gong were compared with subjects
Osteopathy. Three principles guide osteopathy, as follows: (1) the on a waiting list. The qi gong groups displayed a substantial re-
body is a unit designed to move, (2) structure and function are re- duction in blood pressure (average systolic drop 17.8 mm Hg; di-
ciprocally interrelated by motion, and (3) the body possesses self- astolic 12 mm Hg) compared to those waitlisted. Tai chi is an-
regulatory and self-healing mechanisms which are enhanced by other form of focusing the mind and completing structured
the unrestricted motion of blood and body chemicals. 21 movements. Tai chi, yoga plus biofeedback, and yoga alone were
each superior to no treatment or health education in decreasing
systolic blood pressure; yoga alone and yoga plus biofeedback re-
MIND–BODY INTERVENTIONS duced diastolic blood pressure when compared with groups re-
FOR CARDIOVASCULAR HEALTH ceiving no treatment. 23
Two trials reviewed in the AHRQ analysis (total of 99 partici-
There are several types of mind–body interventions used to im- pants) demonstrated that tai chi was more effective than another
prove health. Some mind–body interventions are based on a be- exercise in reducing resting heart rate. In two other studies, yoga
lief that the content of thoughts, beliefs, and emotions affects was compared with lipid-lowering medications in reducing choles-
physical functioning; therapies are thought to improve health by terol. One study followed patients for 4 months; the drugs were
evoking a more positive attitude. Other mind–body approaches more effective than yoga in reducing total and low-density lipopro-
promote health by freeing the mind of troubling thoughts or by tein (LDL) cholesterol. Another study followed patients for a year;
focusing thought so as to exclude usual mental patterns (e.g., the yoga and drug groups had similar reductions in cholesterol. 23
meditation or yoga; prayer, music, dance, or art therapy). Some Meditation studies are difficult to compare. Studies vary in
mind–body therapies involve teaching the patient to control and type and duration. Often the descriptions of the physical as-
regulate physical functioning and reduce stress responses (e.g., pects of the meditation techniques or training paradigms are
biofeedback). incomplete, making it difficult to judge the integrity of the in-
terventions. Another concern is the lack of standards of
Meditation dosage, including frequency or number of sessions to achieve
desired results. It is difficult to judge if the intervention (med-
Meditation involves mental discipline, replacing typical thought itation) is delivered as designed since it is an internal process.
patterns with a deeper state of relaxation or awareness. It has been However, there are no documented adverse effects for medita-
a healing and/or spiritual practice in many cultures and religions tion, thus the possibility of positive outcomes outweigh the
for more than 5,000 years. 22 Meditation goals sometimes include risk of harm.
improved self-awareness, higher levels of consciousness, strength-
ened mental focus, or more relaxed frame of mind. 23 It often in- Biofeedback
volves focusing, centering, and relaxing the mind and body by us-
ing techniques such as listening to the breath, repeating a phrase Biofeedback methods are effective in acutely altering physiological
(called a mantra), avoiding thought, or focusing thought. Medita-a parameters such as heart rate, blood pressure, body temperature,
tion usually involves focusing on the breath or using a specific and heart rate variability (a measure of the variation in the beat to
breathing pattern. Generally, meditation practices require training beat interval). Long-term effects are less well established. In one
to tame, quiet, or focus the mind and achieve a state of detached randomized study of 38 hypertensive subjects, heart rate variability-
awareness. 23 based biofeedback in combination with emotional-response re-
Meditation has been employed in cardiovascular disease as training to manage the stress response was associated with reduced
a method of regulating the stress response and physiological blood pressure 3 months following training. 24