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Patients see lower blood pressures, less stress
What if you could offer your hypertensive patients a treatment strategy that is basically free, has no side effects, doesn’t require a prescription, and has been scientifically proven to lower blood pressure and provide a myriad other health benefits?
Some physicians are doing just that by encouraging patients to practice transcendental meditation (TM), a mental stress reduction technique that produces a state of restful alertness that appears to trigger self-repair mechanisms in the body.
TM has been shown to lower blood pressure (10 to 12 points in systolic blood pressure and six to eight points in diastolic pressure) as effectively as antihypertensive drugs,1 reduce stress2 and myocardial ischemia,3 and lower hospitalization and mortality4 rates from heart disease in more than 500 studies at 210 universities around the world.
A study published in the March issue of Stroke (2000; 31:568-573) showed that stress reduction using TM is associated with a reduction in carotid atherosclerosis. A team of researchers led by Amparo Castillo-Richmond, MD, assistant professor at the Maharishi University of Management (MUM) College of Maharishi Vedic Medicine in Fairfield, IA, studied 138 hypertensive African-American adults who were randomly assigned to a TM program or a cardiovascular education program.
After six to nine months, the mean carotid intima-media thickness declined by 0.098 mm in the TM group — a reduction similar to that found in drug treatment — and increased 0.054 in the education group. The researchers estimate that the decline in the TM group indicates an 11% reduction in the risk of acute myocardial infarction and up to a 15% reduction in the risk of stroke.
"TM doesn’t interfere with pharmacological treatment but improves the results of that treatment, and it improves the quality of life for patients," Castillo-Richmond says. "In the long run, it saves everybody money because there are less complications and less need for medical visits for all diseases, including cardiovascular."
Castillo-Richmond says TM, introduced to the West 40 years ago by Indian spiritual teacher and MUM founder Maharishi Mahesh Yogi and now practiced by 5 million people worldwide, is a settled state in which thought disappears. TM practitioners refer to this as a fourth state of consciousness beyond waking, sleeping, and dreaming. In this absence of thought, the physiology is at its most powerful rest, she says.
TM has been shown to lower the heart rate and decrease oxygen consumption even more than during sleep. The technique produces many signs of deep relaxation. Those signs include reduced muscle and red blood cell metabolism, more stable nervous system functioning, and reduced levels of cortisol (a biochemical marker of stress) and plasma lactate (a chemical marker of metabolic activity), as well as reduced breath rate and increased blood flow to the brain.
David Sands, MD, director of clinical training for the MUM College of Maharishi Vedic Medicine, says one hypertension treatment problem that TM can solve is poor patient compliance with the treatment regimen. "Compliance with medications is low, partly because a lot of these patients have no real symptoms so there’s little motivation," he says.
"Most of the medications produce side effects, also, so the patients see no real benefit. But with TM, they get benefits in every area of their lives. The immediate benefits are so strong that the reinforcement is there. TM causes people to spontaneously act more healthy. They stop smoking and drinking; they eat better; they get more sleep."
Trained TM teachers around the country give individualized instruction to people on how to practice the technique, which is done twice daily for 20 minutes. The technique involves closing the eyes and inaudibly repeating a personalized mantra that brings the thinking process to a settled state. There is no contemplation or concentration as in other types of meditation techniques.
The seven-step course costs $575, but after learning TM, it can be practiced for a lifetime. The one-time fee covers the course as well as a lifetime follow-up program with advanced lectures and personalized review to ensure correct technique.
A few insurers as well as the U.S. Department of Veterans’ Affairs will cover the cost of the course, says Bob Herron, associate professor of health economics and policy at MUM. If they don’t, they should, because of the tremendous potential cost benefits, he adds.
Herron recently published a study that found medical expenses for a group of 1,418 Canadian patients practicing TM dropped by 5% to 13% annually over six years while a comparison group’s payments rose up to 12% annually.5
Herron conducted another study that found TM practitioners had a nearly 60% lower rate of medical expenditures than a control group and a hospitalization rate for cardiovascular disease that was 11.4 times lower.6 TM patients older than 45 had 88% fewer total hospital days than the control group.
Robert Schneider, MD, dean of the MUM College of Maharishi Vedic Medicine, says TM may prevent the need for antihypertensive drugs, avoiding possible adverse side effects as well as high costs. "There are no adverse side effects with TM, but you do get the positive side benefits such as improved psychological health and quality of life."
In September 1999, Schneider, who recently earned the designation of specialist in clinical hypertension from The American Society of Hypertension, received an $8 million grant from the National Institutes of Health to establish the Center for Natural Medicine and Prevention.
The center will study the effectiveness of alternative medical approaches for the treatment and prevention of cardiovascular disease in African-Americans and other high-risk groups. In the last 10 years, Schneider and his national team of collaborators have received more than $10.5 million for research on prevention-oriented natural medicine.
"This federal grant support is based on the recognition of the limitations of modern medicine in preventing heart disease, which despite advances remains the No. 1 cause of death in this country," Schneider says. "The high rates of adverse side effects, skyrocketing costs, and relatively low compliance associated with conventional therapies have led government agencies to support research on promising new approaches."
(For more information on TM, go to: www. mum.edu. For a list of TM class locations, go to: www.tm.org.)
1. Schneider R, et al. A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension 1995; 26:820-827.
2. Alexander C, et al. Trial of stress reduction for hypertension in older African Americans. Hypertension 1996; 28:228-237.
3. Zamarra J, et al. Usefulness of the transcendental meditation program in the treatment of patients with coronary artery disease. Am J Cardiol 1996; 77:867-869.
4. Alexander C, et al. A randomized controlled trial of stress reduction on cardiovascular and all-cause mortality in the elderly: Results of 8 and 15 year follow-ups. Circulation 1996; 93(3):19.
5. Herron R, Hillis S. The impact of the transcendental meditation program on government payments to physicians in Quebec: An update. American Journal of Health Promotion 2000; 14(5). Scheduled to go to press.
6. Orme-Johnson D, Herron R. An innovative approach to reducing medical care utilization and expenditures. American Journal of Managed Care 1997; 3:135-144.