This is a randomized non-inferiority trial; data collection will be carried out in the University of Goias Hypertension League ( Liga de Hipertensão Arterial da Universidade Federal de Goiás ) and in the Rio de Janeiro State University ( Universidade do Estado do Rio de Janeiro ). The protocol will be registered on the Brazilian Registry of Clinical Trials (ReCEB, Registro Brasileiro de Ensaios Clínicos ).

The study population will be composed of hypertensive adults (stage 1 or 2) at low or moderate cardiovascular risk, under stable treatment with antihypertensive medications for more than 30 days, which was evaluated by BP measures taken during the last visit.

Sample calculation was performed using the OpenEpi calculator. A systolic blood pressure (SBP) of 130.9 ± 9.2 and 135.81 ± 9.3 mmHg²⁰ was considered in the IG and the CG, respectively, with a 95% confidence interval and an 80% power of test, with 54 participants in each group.

Stage 3 hypertensive patients (SBP ≥ 180 mmHg and/or diastolic blood pressure [DBP] ≥ 110mmHg) will be excluded.

After patient enrollment, patients who decline to participate in any procedure, and/or show a rise in BP during the follow-up, preventing their participation in the study without changing the drug regimen will be excluded.

The staffs involved in the study will meet for the presentation and discussion about the project, and training of the members for the correct execution of the protocol and uniformization of patient approach, for the sake of methodological rigor.

Patients will be selected based on the last BP recorded in the medical record, and on the classification of AH stage and cardiovascular risk, and will be invited to participate in the study by telephone. Those who accept to participate will be invited for the first visit.

Randomization of participants into one of the two groups will be performed by using www. randomizer.org.

All patients will receive information about healthy life habits. Then, the medical history will be taken, and clinical examination and interview will be performed for completion of four questionnaires – Durel,^{21 , 22} willingness to forgive,²³ the gratitude questionnaire,²⁴ and the spiritual well-being questionnaire.²⁵ All procedures will be performed by trained investigators, following the same script, to standardize the visits and instructions.

In addition, casual BP will be measured by oscillometry using a Dyna-MAPA AOP device (Cardios, Brazil), that provides measurements of peripheral BP, central BP (cBP), pulse wave velocity (PWV) (using an algorithm and ARC SOLVER equation and expressed as meter/second), and the augmentation index adjusted to 75% of the heart rate (AIx).^{26 , 27} Peripheral BP measurements will be obtained according to the latest Brazilian guidelines on hypertension.⁸

Ambulatory blood pressure monitoring (ABPM) will be performed using a Dyna-MAPA AOP device (Cardios, Brazil), following the latest Brazilian guidelines on ABPM.²⁸

Flow-mediated dilation (FMD) will be determined by a high-resolution ultrasound scanner and a robotic arm to obtain a precise positioning and measurement of the brachial artery (UNEX EF 38G), according to the technique proposed by Celermajer et al.²⁹ and recommendations of the International Brachial Artery Reactivity Task Force.^{30 , 31} FMD is the current gold standard method to evaluate endothelial function; a FMD > 10% indicates a healthy endothelium, and values below that are predictive of increased cardiovascular risk.³²

An intermediate visit will be held six weeks after V0, by telephone call, to verify patient well-being and encourage adherence to the intervention (IG), highlighting the importance of performing the daily activities proposed and clarifying possible doubts. In-person visits will be scheduled with patients with BP levels above 180/110mmHg and patients with symptoms such as precordial pain or severe headache.

The final visit will be held for both IG and CG after the program proposed, with an acceptable time window of ± three days. All patients will undergo the same procedures of V0.

The intervention will begin in the morning after the V0 and have a duration of 12 weeks. This follow-up period was used in previous non-pharmacological intervention studies with hypertensive patients and shown to be sufficient to detect changes in BP.^{33 , 34}

The intervention will consist of a series of previously recorded videos, messages, short tasks related to the subject of the video and days off ( Table 1 ). Themes related to spirituality, forgiveness, gratitude, optimism, life purpose, and spiritual well-being will be addressed. The content will be available through a smartphone app, which will register the activities performed by each participant daily.

Table 1

Day	Task	Day	Task	Day	Task	Day	Task
1	V 1	22	AT 6	43	R	64	TM 22
2	TM 1	23	TM 8	44	V 9	65	AT 21
3	AT 1	24	R	45	TM 15	66	R
4	R	25	V 6	46	AT 14	67	V 12
5	V 2	26	TM 9	47	TM 16	68	TM 23
6	TM 2	27	AT 7	48	AT 15	69	AT 22
7	AT 2	28	TM 10	49	TM 17	70	TM 24
8	R	29	AT 8	50	AT 16	71	AT 23
9	V 3	30	R	51	R	72	R
10	TM 3	31	V 7	52	V 10	73	V 13
11	AT 3	32	TM 11	53	TM 18	74	TM 25
12	R	33	AT 9	54	AT 17	75	AT 24
13	V 4	34	AT 10	55	TM 19	76	TM 26
14	TM 4	35	TM 12	56	R	77	R
15	AT 4	36	AT 11	57	V 11	78	V 14
16	TM 5	37	AT 12	58	TM 20	79	TM 27
17	R	38	R	59	AT 18	80	TM 28
18	V 5	39	V 8	60	TM 21	81	R
19	TM 6	40	TM 13	61	AT 19	82	V 15
20	AT 5	41	AT 13	62	R	83	TM 29
21	TM 7	42	TM 14	63	AT 20	84	AT 25

V: video; TM: thinking message; AT: activity; R: respite

The adherence to the intervention will be considered satisfactory when 75% or more of the proposed tasks are completed.

The CG will be monitored at the same frequency as the IG. If the results in the IG are significantly better than in the CG, the latter will receive the same treatment at the end of the study period.

Data will be analyzed using the Software Stata 14.0. Qualitative variables will be expressed as mean and standard deviation, and quantitative variables as mean and standard deviation or median and interquartile range.

Normality of data distribution will be tested by the Kolmogorov-Smirnov test. Statistical tests will be applied according to normality of the data for between-group (IG and CG) and within-group comparisons (before and after). If this is the case, the intention-to-treat analysis will be performed, and only with patients who complete the study protocol.

The primary outcome will be peripheral systolic blood pressure and the secondary outcomes will be: cSBP, PWV, mean SBP and FMD.

The project was submitted and approved by the Ethics Committee of the UFG General Hospital.