Additional Non-Pharmacological Intervention for Elderly Patients With Hypertension

To the Editor,

I read with interest the article by Xu and colleagues [1]. The authors evaluated the effectiveness of the knowledge, attitude, practice (KAP) intervention model for elderly patients with hypertension. They compared the change of blood pressure before and after the KAP intervention for a period of 1 year. The blood pressure control rate and the mean values of systolic (SBP) and diastolic blood pressure (DBP) improved significantly, and they concluded that the community physician-led KAP intervention model was effective in the management of hypertension in the elderly. I have some concerns about their study.

Loucks and colleague [2] conducted a 2-year follow-up study to investigate the effect of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on SBP, regardless of whether they were prescribed antihypertensive medications. MB-BP was significantly associated with a reduction in SB. Although KAP and MB-BP are different concepts, a non-pharmacological approach to blood pressure management may contribute to reducing the risk of hypertension. Medical treatment and non-pharmacological approaches such as KAP and MB-BP would integrate the efficacy of reducing blood pressure.

I think that elderly hypertensive patients should pay attention to emotional disorders such as depression. Regarding the effect of mental disorder on hypertension, Jeon and colleagues [3] reported that the adjusted hazard ratios (95% confidence intervals) of moderate and severe depressive symptoms for incident hypertension were 1.12 (1.02–1.24) and 1.29 (1.10–1.50). They also clarified that high blood pressure was associated with a decreased risk of developing depressive symptoms. This means that depressive status would affect subsequent increase in blood pressure, and mental care is important to prevent hypertension.

Finally, Mir and colleagues [4] reviewed the effect of mindfulness-based meditation (MBM) on blood pressure among adults with elevated blood pressure and hypertension. MBM interventions are effective for preventing hypertension and reducing elevated blood pressure. According to a meta-analysis by Chen and colleagues [5], significant reductions in SBP and DBP were observed by MB interventions regardless of gender and baseline blood pressure. I suppose that KAP would become a fundamental basis to improve the efficacy of MB-BP intervention. A randomized control trial with sufficient statistical power and long-term follow-up is needed to understand the combined effect of KAP and MBM intervention on subsequent advantages for controlling hypertension.

The author declares no conflicts of interest.