Mindfulness and forest bath for arterial hypertension in older women: quasi-experimental pilot

Background

Arterial hypertension (AH) is the leading modifiable cardiovascular risk factor, yet pharmacotherapy adherence remains suboptimal. ESH guidelines recommend adjunctive lifestyle interventions including stress reduction, but evidence for mindfulness- and nature-based approaches in older hypertensive populations is limited. Within the University of Rijeka project No. uniri-iskusni-biomed-23-181, we evaluated a mindfulness-based living course (MBLC) and guided forest bath (Shinrin-yoku, SY) among older women with treated AH in Rijeka, Croatia.

Methods

A quasi-experimental pre-post study enrolled 63 women aged ≥60 with diagnosed AH: MBLC (n = 21, 8 weekly workshops), SY (n = 20, 3 guided forest sessions) and a comparison group (n = 22, usual care). Outcomes at baseline (T0) and post-intervention (T1) included perceived stress (PSS-10), chronic disease self-efficacy (SEMCD-6), HRQoL (EQ-5D-5L, EQ-VAS), blood pressure, and serum cortisol. Two-way repeated-measures ANOVA with LSD correction was used; groups were balanced at baseline.

Results

Mean age was 73.3 years. A significant time×group interaction emerged for perceived stress (p = 0.002, η²=0.185): SY reduced PSS-10 (16.4→13.9, p = 0.002) while comparison did not. Both interventions improved self-assessed health (EQ-VAS: MBLC p = 0.022; SY p = 0.005; interaction p = 0.006, η²=0.157) and reduced cortisol (MBLC p = 0.016; SY p = 0.006; time effect p = 0.002, η²=0.158), with no change in the comparison group. SY also improved self-efficacy (p = 0.008) and diastolic BP (p = 0.019). No significant effects were found for systolic BP or heart rate.

Conclusions

Forest bath showed the most consistent short-term improvements across psychological, subjective health, and physiological outcomes. Both interventions reduced cortisol and improved self-assessed health, supporting non-pharmacological, person-centred approaches in AH management for older women. Larger randomised trials with longer follow-up are needed.

Key messages

• Forest bathing reduced stress, self-efficacy, and diastolic BP in older hypertensive women.

• Mind-body interventions complement pharmacotherapy and suit community-based hypertension care.