Meditation reduces sympathetic activation and improves the quality of life in elderly patients with optimally treated heart failure: a prospective randomized study.
OBJECTIVE
We tested whether meditation can reduce sympathetic activation, evaluated by norepinephrine blood levels (NE), and improve quality of life in elderly persons with congestive heart failure (CHF).


METHODS
This was a prospective, randomized study conducted from April 2000 to October 2001 in an ambulatory care teaching hospital in São Paulo, Brazil.


METHODS
We studied 19 patients with CHF, 74.8 +/- 6.7 years old, receiving diuretics, optimal doses of an angiotensin-converting enzyme inhibitor or angiotensin II inhibitor, maximum tolerated carvedilol dose (23.1 +/- 13.6 mg) and spironolactone 25 mg (10 patients).


METHODS
After 2 months of optimal treatment with carvedilol, patients were randomized into two groups. The meditation group (M) was provided an audiotape, 30 minutes long, to listen to at home, twice a day, for 12 weeks, plus a weekly meeting. The control group (C) just had weekly meetings.


METHODS
We determined before and after 14 +/- k1 weeks, NE (in pg/mL); quality of life with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ); VO2 and VE/VCO2 slope by cardiopulmonary exercise testing; left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume index (LVDDi) measured by echocardiography.


RESULTS
Meditation reduced NE (mean +/- SEM) from 677.7 +/- 96.6 to 387.1 +/- 39.1 pg/mL (p = 0.008) in M versus 491.4 +/- 35.9 to 470.6 +/- 31.2 (p = 0.34) in C; improved MLWHFQ total score (mean +/- SEM) from 33.2 +/- 6.6 to 21.6 +/- 6.8 points (p = 0.02) in M versus 18.4 +/- 8.0 to 25.1 +/- 8.9 (p = 0.41) in C; and reduced the VE/VCO2 slope (mean +/- SEM) from 31.2 +/- 3.0 to 28.2 +/- 2.6 (p = 0.04) in M versus 28.4 +/- 2.7 to 28.8 +/- 2.6 (p = 0.24) in C. No changes occurred in LVEF, LVDDi, and VO(2).


CONCLUSIONS
In elderly patients with optimally treated CHF, meditation reduced NE, improved quality of life, and reduced the VE/VCO(2) slope. Our results support the possible role of meditation as a new hope in the treatment of CHF.
Geriatrics Service, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil. jaec@terra.com.br
José Antonio
JA
Curiati
Edimar
E
Bocchi
José Octávio
JO
Freire
Ana Claudia
AC
Arantes
Márcia
M
Braga
Yolanda
Y
Garcia
Guilherme
G
Guimarães
Wilson Jacob
WJ
Fo
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001938:Brazil; D002227:Carbazoles / Q000008:administration & dosage; D004562:Electrocardiography; D005260:Female; D006266:Health Education / Q000379:methods; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D019122:Meditation / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D013564:Sympathetic Nervous System; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
D000806:Angiotensin-Converting Enzyme Inhibitors; D002227:Carbazoles; C041514:carbazole