Mindfulness-based stress reduction for gestational hypertension

By Nancy Gahles

Women are diagnosed with gestational hypertension when they have high blood pressure that develops after 20 weeks of pregnancy. It is uncomplicated hypertension in that there is no excess protein in the urine or other signs of organ damage. Close monitoring is needed as sustained hypertension can lead to complications such as preeclampsia, a condition associated with kidney, liver, blood, brain damage.

According to Mayo Clinic guidelines, after 20 weeks of pregnancy, blood pressure that exceeds 140/90 mm Hg, documented on two or more occasions, at least four hours apart, without any other organ damage, is considered gestational hypertension.

Standardized treatment for hypertension includes angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers,  and renin inhibitors, all of which are generally considered un safe during pregnancy and should be avoided. In one study, anti-hypertensive drugs in pregnancy are indicated when arterial pressure exceeds 140 mm Hg,  equivalent to 180/120, as there is a significant risk of maternal cerebral vascular damage. In this case, the authors of this study advise the effective and safe therapy to be parenteral hydralazine, a vasodilator.

The American Academy of Family Physicians characterize gestational hypertension, noting, “Some women just get high blood pressure near the end of pregnancy. They don’t have any other associated symptoms…this condition doesn’t need any treatment… your blood pressure will go back to normal within a few weeks after you have your baby, but you are more likely to develop chronic high blood pressure later in life.”

For me, as an integrative and holistic practitioner, this caveat does not fall on deaf ears. In fact, it motivates me to ask, why? If this so called benign state of hypertension is induced only during pregnancy, why does it contribute to a chronic condition later in life?

It is now well known in the integrative healthcare community that stress is a causative factor in chronic diseases. In current literature, stress is assumed to be an important factor in the multifactorial pathogenesis of hypertension, as a recent German study documents. Researchers discussed this as far back as 1981. In their review, the concept of stress, its nature, and the participation of the central nervous system are elucidated. This would indicate vagal nerve or parasympathetic dysregulation as a factor.

“The sympathetic nervous system acts as a link between stress and hypertension, especially borderline hypertension”, they said.

Or for our purposes, we can consider gestational hypertension that doesn’t require medical drug treatment. Their hypothesis that stress is a causative factor in the initiation of hypertension is critically discussed, noting that, in patients with a genetic predisposition to hypertension, stress may play an important role in early manifestations of chronic blood pressure elevation.

Genetic predispositions are revealed with a thorough family history but also must elucidate the predisposition of the person presenting as to their stress/worry/fear/rumination history. One might explore history of depression or anxiety as well as trauma. The role of emotions and psychological stress, stated in conclusion, “contributes to temporary or longer lasting increases of blood pressure.”

Integrative interventions for gestational hypertension can be considered valid treatment protocols. In the realm of gestational hypertension and maternal cardiac vagal control, one study addressed both the autonomic nervous system dysregulation and the emotional factors. The findings suggested cardiac vagal control is a possible pathway through which prenatal depressed mood is associated with gestational hypertension.

Maternal stress and the effects of mindfulness meditation on the autonomic nervous system was studied in pregnant Indian women. The authors’ aim was to evaluate the fact that pregnancy complications like hypertension have been strongly correlated with maternal stress. The results showed a significant decrease in perceived stress scores, a significant increase in heart rate variability, a significant decrease of blood pressure indicating that mindfulness meditation is a powerful modulator of the sympathetic nervous system and can thereby reduce the day-to-day perceived stress in pregnant women.

Mindfulness-based stress reduction (MBSR) was also studied as an intervention for people with blood pressure that was higher than desirable but not so high that antihypertensive drugs would be prescribed. The finding is reported in the October issue of Psychosomatic Medicine: Journal of Biobehavioral Medicine.  

It stands to reason then, that if the current standard of care, the safest, for uncomplicated gestational hypertension is hydralazine, a vasodilator, an even safer standard of care can be MBSR.

MBSR was developed by Jon Kabat-Zinn, PhD. In 1979, Kabat-Zinn founded the Stress Reduction Clinic at the University of Massachusetts Medical School in Worchester where he adapted the Buddhist teachings on mindfulness and developed the Stress Reduction and Relaxation Program, known today as MSBR.

Only recently has MBSR gained contemporary recognition. Research has been on the upswing and consequently we are gathering more and more evidence-based data upon which to utilize in our practice, both personally and professionally. I am a Certified Mindfulness Based Stress Reduction (MBSR) practitioner and have found it to be of the utmost value in every case, as a fundamental practice, to change your brain, and your life. The beauty of introducing MBSR to pregnant women is that, once they embody it, they will live it and it will become a lifestyle for their family.

“Mindfulness is the container that holds it all,” said Kabat-Zinn. “Therefore, your commitment to practice is what is important here, and, paradoxically, your willingness to engage in practice for its own sake, to be in touch with life unfolding, however it is in any given moment, yet without being too attached to attaining any outcome. This is at the core of the invitation to enter into this engagement with an open mind and an open heart, without necessarily thinking you know what you will get out of it, and committing yourself anyway, a gesture of faith in yourself and your truest possibilities, which are always unknown. Ultimately, as we shall come to see, life itself is the real teacher, and how we meet it moment by moment the real meditation practice. So, now it is time to roll up our sleeves, and begin.”