Objectives: The primary purpose of this study was to evaluate the effectiveness of guided imagery on maternal blood pressure in relation to quiet rest. Although it is more clinically important to determine whether interventions such as guided imagery can enhance maternal and newborn health outcomes in pregnancies with hypertension, this requires study with a very large sample size. It was important to first ascertain whether guided imagery could improve blood pressure outcomes and be feasible and acceptable to pregnant hypertensive women.

Methods: In this randomized controlled trial, 69 pregnant women with hypertension were randomly allocated to a Guided Imagery (GI) group (n = 34) and a comparison Quiet Rest (QR) group (n = 35). The GI group was asked to use guided imagery relaxation for at least 15 minutes twice per day for the time they were in the study, up to a maximum of four weeks; the QR group was asked to rest quietly with a minimum of external stimuli for the same periods of time. Ambulatory mean arterial blood pressure (MAP) data were collected for daytime hours, one day each week for four weeks, or until delivery, whichever occurred first. Systolic and diastolic BP, anxiety, rest and guided imagery use data were also collected weekly. Both groups also received all routine prenatal care. Statistical analyses were based on intention-to-treat principles.

Results: Sixty women completed at least one week in the study. Although daytime ambulatory mean arterial pressure between baseline and the last week of study participation was not reduced following use of the guided imagery intervention, the mean increase in MAP was 4.35 mmHg less for the guided imagery group than for quiet rest, a statistically significant difference (GI: M = 1.58 mmHg, SD = 7.63; QR: M = 5.93 mmHg, SD = 6.55; t = 2.36, p = .02). However, the effect was not statistically significant when adjusted for baseline MAP and gestation. There was also no evidence of an effect of guided imagery on anxiety. Participant ratings about their satisfaction with their study participation were high.

Conclusions: This study provides the first preliminary evidence that the non-pharmacologic approach of guided imagery may be effective in limiting blood pressure increases in pregnancies complicated by hypertension. Therefore, further rigorous study of guided imagery effects on blood pressure and other health outcomes for pregnant women with hypertension and their infants is warranted.