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In this episode, we delved into the fascinating world of cardiovascular health, specifically focusing on hypertension, with the esteemed cardiologist Dr. Maria Emilia Figueiredo Teixeira from Brazil. Dr. Maria Emilia shared insights from her groundbreaking research on the influence of gratitude, forgiveness, and spirituality on hypertension control.
- 00:00:00 Hypertension has become more of a concern these days. It’s actually one of the most prevalent cardiovascular diseases. And most people who have it don’t even know they have it. And those who do
- 00:00:10 have really inadequate, often really inadequate control over it. Today, we are so pleased to host Dr. Maria Amelia, a cardiologist from
- 00:00:21 Brazil, who has done some interesting research on gratitude, forgiveness, spirituality, and its effect on hypertension. I’m
- 00:00:31 Andrea Spyros. I’m a behaviour design consultant and a professional speaker, and I work with organizations to harness the power of high-performance habits, increasing engagement, resilience, and overall well-being.
- 00:00:45 I am Dr. Shabnam Das Kar, a functional medicine doctor and Tiny Habits certified coach. I teach people how to improve their focus, get rid of brain fog, and reduce their risk of dementia down the line.
- 00:00:59 And today, welcome, Dr. Amelia, Maria Amelia. We’re so pleased to have you today. Please share with us, there’s a lot we want to unpack about your research. Please share with us what got you interested in doing this type of research.
- 00:01:19 Hi, Andrea. Hi, Dr. Shabnam. It’s my privilege to be here. Thank you for the opportunity to bring the results of our latest research, the results from the field trial that we presented recently at the late-breaking clinical trials of the ACC24. So we started to research this theme in
- 00:01:29 2020. As a cardiologist, I’m very intrigued by the situation of hypertension in Brazil and the whole world. As you said, it’s prevalent
- 00:01:53 disease with inadequate control, bringing lots of death worldwide. And we know there is a gap. We
- 00:02:05 know how to treat it with lifestyle habits, medications, but still it’s not adequately treated. And why
- 00:02:15 isn’t it treated? And what else is influencing those blood pressure controls that we’re not looking at and
- 00:02:27 is avoiding us from having good control. I know that we’re not taking, we, I say as a population, but hypertensive patients are
- 00:02:37 not treating themselves well, are not looking at themselves, are not measuring their blood pressures, and are not taking their pills adequately,
- 00:02:48 are not having good lifestyle habits, and what about their behaviors, their feelings? I think they’re not working on that either. So I started to look at
- 00:03:07 the influence of those feelings, and we got good results on this research that I call the field trial.
- 00:03:17 Thank you, Dr. Maria. So the trial that Dr. Maria is talking about, and she had presented at the American College of Cardiology very recently, I think it was just last
- 00:03:28 week. And the name of the trial, so Andrea, this is for people who want to know what it is that the trial is. The name of the trial is a clinical trial to
- 00:03:39 evaluate the influence of a spirituality intervention on blood pressure control, central hemodynamics, and endothelial function. And
- 00:03:49 it has a very interesting acronym, FIELD, F-W-L, FIELD trial. So, Dr. Maria, interesting thing is, I know your specialty is
- 00:03:57 you’re a cardiologist, and which is this place in Brazil that you work at, your institution?
- 00:04:08 I work and research at the hypertension unit of the Federal University of Goiás. Goiás is a state in the center of Brazil, very close to
- 00:04:18 Brasilia, our capital. And this work, as you said, the acronym FIL, is the work I did for my PhD. It’s my PhD thesis, recently
- 00:04:31 ended.
- 00:04:39 Oh, wow. So in the subject title, there are two terms, I think, Dr. Maria, I’d like you to explain it for our audience. One
- 00:04:49 is central hemodynamics and the other one is endothelial function. So what is central hemodynamics?
- 00:05:00 the aorta. We have a device that measures it, not invasively, but we can estimate the blood pressure on the aorta.
- 00:05:13 And this is an important information because we may measure blood pressure in our arms, I mean, peripheral, but we
- 00:05:25 we must know how this blood pressure is on the central vessels. So first of all, this is what we research. The second term, endothelial function, refers
- 00:05:35 to the function of the inner layer of the arteries. That’s called endothelium. This inner layer, the endothelium, is responsible for many
- 00:05:46 things, but specifically here for the field trial, we studied its capacity of dilating the vessels, the arteries, if necessary. Why
- 00:05:57 do we study that? Because when the arteries get sick, they get rigid, they get stiff, and they do not dilate. So
- 00:06:07 we in this endothelium is responsible for when it knows that the endothelium, the organism,
- 00:06:18 I’m sorry, the organism is in ischemia, I mean, there’s not enough blood to bring oxygen and nutrients. This endothelium is
- 00:06:28 responsible for liberating nitric oxide into the circulation, and this substance will make
- 00:06:39 the vessels dilate to bring more blood. So when the vessel is sick, is rigid, is stiff, it does not dilate, even
- 00:06:49 though there is this liberation of nitric oxide. And we can study this function with this technique called flow-mediated dilation
- 00:07:01 that evaluates the diameter of the artery. And then after five minutes of ischemia, we can measure again this vessel.
- 00:07:11 If its diameter is at least 10% more than the beginning before the ischemia, we have a normal If
- 00:07:21 it dilates less than that, it’s a stiff vessel, so a sick vessel. That’s what we studied together with blood pressure measurement.
- 00:07:32 So just a little clarification. So what Dr. Maria is talking about, the blood pressure in the aortas, the aorta is the big blood vessel that goes from the heart
- 00:07:42 and supplies blood to all the different organs in the body. And this aortic blood pressure is not routinely measured. So Dr. Maria,
- 00:07:53 is that mostly a research tool? Because if I go to the doctor, my family doctor, he or she is not going to measure my aortic blood pressure. And
- 00:08:03 endothelial function that you mentioned is basically one of the earliest problems that happens in someone who is at risk for heart disease and stroke. And
- 00:08:14 it’s also, interestingly, the problem in a lot of men with erectile dysfunction, but we are not going into all that today. But basically, what I want to highlight is In
- 00:08:24 your study, you looked at things way more than only blood pressure. And the blood pressure was, was it like a 24-hour ambulatory or was it home blood
- 00:08:40 pressure or was it in-office blood pressure measurement?
- 00:08:51 standard for that. The importance of this parameter is that it is considered the best parameter to evaluate non-pharmacological and short-term interventions like the one we use
here. - 00:09:13 Oh, wow, that is awesome. So next, I think Andrea and I are very interested in your paper on your research work
- 00:09:24 is on spirituality. So I know your Brazilian Cardiology Society has a definition of what is spirituality because we like to differentiate between spirituality and
- 00:09:35 religiosity. So Andrea, what would you like to say and then we’ll ask Dr. Maria to define. It was a very good and interesting definition of
spirituality. - 00:09:46 Yeah, I think it’s important that our listeners to understand the actual principles that Dr. Maria Amelia has looked at on
- 00:09:57 here. In many parts of the world, spirituality is undefined and often conflated with being religious. And
- 00:10:07 So, for the purposes of Dr. Maria Amelia’s study, we know that wasn’t necessarily the case. So if you’re listening here, we’re gonna have you, Dr. Maria Amelia, define this
- 00:10:18 for them so that you can understand exactly what she was researching so you can understand more fully the impact of the results and some things that you can do
yourself. So please share the definition, Dr. Maria Amelia. - 00:10:24 OK, so spirituality we defined as a set of moral, mental, and emotional values that guide thoughts, behaviours, and attitudes in
- 00:10:35 the life circumstances of intra and interpersonal relationships suitable to scientific evaluation. And that’s what we’re talking about. Now, we’re
- 00:10:45 not talking about, but let’s define religion as an organized system of beliefs, practices, and symbols designed to facilitate closeness
- 00:11:08 with the transcendent or the divine and foster understanding of one’s relationship and responsibilities with others living in the community. And religiosity can
- 00:11:19 be defined as how much an individual believes, follows, and practices a religion. It can be organizational, like going to church, temples, or religious services, or non-organizational,
- 00:11:30 such as praying, reading books, or attending religious programs. I bring those definitions from the latest Brazilian guidelines of
- 00:11:41 cardiovascular prevention. And there’s a whole chapter on spirituality and cardiovascular medicine. on
- 00:11:52 that guideline, because the Brazilian Society of Cardiology has a formal scientific department of spirituality and cardiovascular medicine, where we
study this theme and we give lectures and conferences. We try to bring this knowledge to the medical education. - 00:12:12 Wow. Is that the only cardiology department in the world with a spirituality specialty?
- 00:12:23 Well, I don’t know if it’s the only one, because medical schools in the United States have a formation on spirituality and
- 00:12:35 medicine, but maybe from scientific society, if it’s not the only, it’s one of the only ones in the world. The guideline is the first one to
have this theme on it. And we also have from the same Brazilian Society of Cardiology positioning on hypertension and spirituality, a formal document from the society. - 00:12:48 Oh, wow. I have to read that.
- 00:12:58 So share with us what exactly you practiced in the study or you did in this study to get the effects that you did.
- 00:13:17 It’s a very simple intervention. We formulated a 12-week intervention containing either one of those four contents, a
- 00:13:27 video or a quote for self-reflection, or a small task related to the content of the last video, or a day off. And
- 00:13:39 all those contents worked on basically four feelings. Forgiveness, gratitude, optimism, and life purpose. So first
- 00:13:50 we brought definitions from the dictionary. Then we brought information that those feelings can be beneficial for our health. And then
- 00:14:00 we proposed some work on those feelings. Like, for example, asking the participant to write a message for someone he or she must forgive,
- 00:14:12 but don’t send it. And then ask a message for someone to be forgiven, and to forgive him. And later to write a message for
- 00:14:22 someone you’re grateful for, or write some proposals of life for the next days or for the next years. We tried
- 00:14:32 to stimulate that, to engage the patient on participating by writing the messages. And then later we asked them to send the messages and if they could not
tell us why. - 00:14:37 That’s so interesting. So, Dr. Maria, the participants in the study, these were people with hypertension, I think you said stage 1 and stage 2. So
- 00:14:48 the definition of hypertension in Brazil, is it the same as we use in the American Heart Association definitions or is it different? it’s
- 00:15:09 the same it’s basically the same so basically stage one is 130 to 139 for systolic that’s the upper number and the diastolic is 80 to
- 00:15:20 89 and for the stage two it is 140 millimeters of mercury or higher and diastolic is 90 or higher so these were people who were
diagnosed with hypertension and they were already on medication right - 00:15:27 Yes, most of them were already on medication. And that’s important to say, no changes in the medications were made during the follow-up period,
- 00:15:38 during those 12 weeks period. I have just a comment on the blood pressure levels. We start on 140 and 90 for stage
one hypertension and 160 and 100 for stage 2 hypertension. - 00:15:58 Okay, so these patients were actually at a higher blood pressure level than the definitions that we use in North America. So that is just important to
- 00:16:09 remember, because a lot of the research is like people don’t understand because they don’t define correctly. So what you are, you actually, in a way, we’re looking at people who
- 00:16:19 are at much higher blood pressure levels than the same stage in North America, we would say, because in medicine. So, Andrea, we like to get into the weeds because what
- 00:16:30 is the definition of hypertension for you versus me? But then it’s important to remember that. And the other thing is, Dr. Maria, was this like, did
you use an app or was it WhatsApp messages is what I understand. - 00:16:45 Okay, so our definition of hypertension is stage one starting in 140 systolic and 90 diastolic. And
- 00:16:55 stage two starts at 160 systolic and 100 diastolic. We did not include patients that were in
- 00:17:06 stage three, that’s starting on 180 systolic and 110 diastolic, obviously because those patients had to have a change
- 00:17:16 in their medications. So definition is that for Brazilian society of cardiology. We used messages sent
- 00:17:27 through WhatsApp. Because it was simple, just send a message. It’s a widely used app. Everyone, almost
- 00:17:48 everyone, or at least all the participants had it already installed in their cell phones, knew how to use it. So we used something that was already known by everyone.
- 00:18:00 And we sent those messages daily. Every morning, there was a researcher responsible for sending the messages. and getting confirmation that they received that message,
- 00:18:11 and for the tasks, getting the answer back. We did not evaluate the content of the answers, and we told the participants we would not evaluate that because we did not want to
inhibit them. We wanted them to be free to say whatever they wanted, to really engage in that proposal. - 00:18:33 Yeah. So, and the other thing is these messages, like what I’m trying to figure out is because what you found was really amazing because,
- 00:18:54 and I’m going to ask you about the results that you found, 7.6 millimeters of systolic blood pressure lowering without using a prescription medication. That
- 00:19:05 is like really fantastic. But what I’m trying to understand Dr. Maria is, so these patients, when you ask them to let us say, write a letter of gratitude. You
were not really tracking whether they actually did that, right? - 00:19:14 We tracked if they did, but we did not track the content.
- 00:19:25 okay yeah that that would be private i am so did you find any difference between like messages of forgiveness or optimism or gratitude
- 00:19:36 or uh you know meaning versus like was there any difference between the different types of messages or whether it was a video or whether it was a text message
or all of them seem to have the same kind of effect - 00:19:47 We did not evaluate that separately. We evaluated just the whole intervention.
- 00:19:58 Wow, that is like, so, you know, what I’m trying to, the impact of this is sending a, you know, a broadcast on WhatsApp is sort of,
- 00:20:08 Andrea, what we would call a one-time action. So Andrea will explain what is a one-time action and how
easy it is to do it. And if you automate it, it’s even easier. - 00:20:13 Well, I think the bigger implications of this are, just to pull back a little bit, is that these WhatsApp messages were going to
- 00:20:23 individuals, and the individuals who were participating were answering them. So they answered, they wrote a gratitude statement, but they maybe didn’t send it. They wrote a forgiveness statement,
- 00:20:34 but maybe didn’t send it. They were asked to do a task and did the task. other tasks around, maybe they watched a video on optimism or other aspects of
- 00:20:44 this. So the study focused on optimism, gratitude, forgiveness. And then they had a significant reduction, 7.6, significant
- 00:20:58 reduction in their systolic blood pressure. This is without changes in medication. And so, The impact of this is them is
- 00:21:09 very interesting world with the, you know, bigger implications for this highly undiagnosed and poorly treated blood pressure that
- 00:21:21 people may have. The one time actions are really just they’re prompted by the WhatsApp messaging.
Our podcast guest:
Dr. Maria Emilia Figueiredo Teixeira MD, PhD, FESC
Cardiologist and Researcher at the Hypertension Unit of the Federal University of Goiás, Brazil.
Dr. Maria Emilia on Instagram
Watch the audio-only version on YouTube
Reference
FEEL Study: Focus on Spirituality, Gratitude Can Lead to Decrease in BP, Increase in FMD
