Background and aims HTN affects nearly 50% of U.S. adults and is the leading modifiable cardiovascular risk factor. A healthy diet and exercise can improve BP control, but adherence to these interventions is low. We tested whether a multimodal mind–body program, Mindful Awareness Practices (MAP) could improve BP and lifestyle behaviors associated with HTN when compared to a Health Promotion Program (HPP). Methods Adults with BP >120/80 were randomized to MAP or HPP. Outcome measurements of BP, self‐reported diet, and exercise were analyzed with intent‐to‐treat group comparisons using repeated measures linear mixed models. Results There was an MAP–HPP between‐group difference in interactions of time‐by‐systolic BP ( P = 0.005) and time‐by‐diastolic BP ( P = .003). The mean drops in SBP from baseline to week 13 for the MAP group was 19 mm Hg (138 ± 15 mm Hg‐119 ± 6 mm Hg) compared to 7 mm Hg (134 ± 18 mm Hg‐127 ± 22 mm Hg) in the HPP group. Similarly, a greater reduction in DBP was observed in the MAP group compared to the HPP group, 12 mm Hg (89 mm Hg ± 11‐77 ± 7 mm Hg) and 1 mm Hg (81 ± 16 mm Hg‐80 ± 18 mm Hg), respectively. Mediational analysis of the MAP group showed the total effect of mindfulness practice minutes on SBP with indirect effect (ab) of −.057 was significant, resulting in a 40% lower SBP for total effect (c) compared to direct (c′) effect alone. The mediational model suggests MAP has a modest positive influence on participants initiating lifestyle behavior change, which partially explains the greater reduction in BP by the MAP group. Conclusion Our findings suggest a multimodal mind–body program involving mindfulness practice may improve BP control in adults with HTN.

Background: Inspiratory muscle training (IMT) may improve respiratory and cardiovascular functions in obstructive sleep apnea (OSA) and is a potential alternative or adjunct treatment to continuous positive airway pressure (CPAP). IMT protocols were originally designed for athletes, however, we found some OSA patients could not perform the exercise, so we aimed for a more OSA-friendly protocol. Our feasibility criteria included (1) participants successfully managing the technique at home; (2) participants completing daily practice sessions and recording data logs; and (3) capturing performance plateaus to determine an optimal length of the intervention.Methods: Five sedentary OSA patients participated in this feasibility study (three men, mean age = 61.6 years, SD = 10.2). Using a digital POWERbreathe K4 or K5 device, participants performed 30 daily inhalations against a resistance set at a percentage of maximum, recalculated weekly. Participants were willing to perform one but not two daily practice sessions. Intervention parameters from common IMT protocols were adapted according to ability and subjective feedback. Some were unable to perform the typically used 75% of maximum inspiratory resistance so we lowered the target to 65%. The technique required some practice; therefore, we introduced a practice week with a 50% target. After an initial 8 weeks, the intervention was open-ended and training continued until all participants demonstrated at least one plateau of inspiratory strength (2 weeks without strength gain). Weekly email and phone reminders ensured that participants completed all daily sessions and logged data in their online surveys. Weekly measures of inspiratory resistance, strength, volume, and flow were recorded.Results: Participants successfully completed the practice and subsequent 65% IMT resistance targets daily for 13 weeks. Inspiratory strength gains showed plateaus in all subjects by the end of 10 weeks of training, suggesting 12 weeks plus practice would be sufficient to achieve and capture maximum gains. Participants reported no adverse effects.Conclusion: We developed and tested a 13-week IMT protocol in a small group of sedentary, untreated OSA patients. Relative to other IMT protocols, we successfully implemented reduced performance requirements, a practice week, and an extended timeframe. This feasibility study provides the basis for a protocol for clinical trials on IMT in OSA.

ObjectivesObstructive sleep apnoea (OSA) is a risk factor for hypertension (HTN), but the clinical progression of OSA to HTN is unclear. There are also sex differences in prevalence, screening and symptoms of OSA. Our objective was to estimate the time from OSA to HTN diagnoses in females and males.DesignRetrospective analysis of electronic health records (EHR) over 10 years (2006–2015 inclusive).SettingUniversity of California Los Angeles (UCLA) Health System in Los Angeles, California, USA.Participants4848 patients: females n=2086, mean (SD) age=52.8 (13.2) years; males n=2762, age=53.8 (13.5) years. These patients were selected from 1.6 million with diagnoses in the EHR who met these criteria: diagnoses of OSA and HTN; in long-term care defined by ambulatory visits at least 1 year prior and 1 year subsequent to the first OSA diagnosis; no diagnosis of OSA or HTN at intake; and a sleep study performed at UCLA.Primary and secondary outcome measuresThe primary outcome measure in each patient was time from the first diagnosis of OSA to the first diagnosis of HTN (OSA to HTN days). Since HTN and OSA are progressive disorders, a secondary measure was the relationship between OSA to HTN time and age (OSA to HTN=β1×Age+β0).ResultsThe median (lower and upper quartiles) days from OSA to HTN were: all −532 (−1439, –3); females −610 (−1579, –42); and males −451 (−1358, 0). Older age in both sexes was associated with less time to a subsequent HTN diagnosis or more time from a prior HTN diagnosis (β1 days/year: all −16.9, females −18.3, males −15.9).ConclusionsHTN was on average diagnosed years prior to OSA, with a longer separation in females. Our findings are consistent with underscreening of OSA, more so in females than males. Undiagnosed OSA may delay treatment for the sleep disorder and perhaps affect the development and progression of HTN.

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Objectives: Obstructive sleep apnea (OSA) is a risk factor for hypertension (HTN), but the clinical progression of the sleep disorder to the high blood pressure condition is unclear. There are also sex differences in prevalence, screening and symptoms of OSA. The objective was to estimate the time from OSA to HTN diagnoses, with sex-specific quantification. Design: Retrospective analysis of electronic health records (EHR) over a 10-year period (2006 to 2015 inclusive). Setting: UCLA Health System in Los Angeles, California, USA. Participants: 4848 patients: female N=2086, mean [age±std] = 52.8±13.2 years; male N=2762, age=53.8±13.5 years. These patients were selected from 1.6 million patients with diagnoses in the EHR who met the criteria of: diagnoses of OSA and HTN; in long-term care defined by ambulatory visits at least one year prior and one year subsequent to the first OSA diagnosis; no diagnosis of OSA or HTN at intake; and a sleep study performed at UCLA. Primary and secondary outcome measures: The primary outcome measure in each patient was time from the first diagnosis of OSA to the first diagnosis of HTN (in days). Since HTN and OSA are progressive disorders, a secondary measure was relationship between OSA-to-HTN time and age. Results: The mean, std and 95% confidence intervals of the time from OSA to HTN diagnoses were: all -732 ± 1094.9 [-764.6, -701.8] days; female -815.9 ± 1127.3 [-867.3, -764.2] days; and male -668.6 ± 1065.6 [-708.1, -626.8] days. Age was negatively related to time from OSA to HTN diagnosis in both sexes. Conclusions: HTN was on average diagnosed years prior to OSA, with a longer separation in females. Our findings suggest under-screening of OSA, more so in females than males. Undiagnosed OSA may delay treatment for the sleep disorder and perhaps affect the development and progression of HTN.