Cardiovascular disease (CVD) mortality and morbidity rates are significantly higher in African Americans than in whites. Greater rates of hypertension in blacks are a major contributor to this differential. Numerous studies implicate chronic psychosocial stress in the etiology of hypertension and CVD in African Americans. The investigators have shown in both a short-term trial and in a longer-term randomized clinical trial, that mild hypertension and psychosocial stress can be significantly reduced in inner-city African Americans through stress reduction with the Transcendental Meditation (TM) program compared to physical relaxation or education controls. Meta-analyses have associated similar BP reductions with 20 to 40 percent less CVD events over several years. Preliminary data from the investigators' trial of stress reduction with hypertensive urban African Americans indicated that after a five-year follow-up, the TM group had a 64 percent reduction in CVD mortality and morbidity risk compared to controls (by intent-to-treat analysis). All cause mortality decrease similarly. Another preliminary trial indicated a similar decreased in all-cause and CVD mortality over 15 years of follow-up in elderly Caucasian subjects practicing this stress reduction approach. The current proposal will extend this research by investigating the effectiveness of stress reduction (TM program) in preventing CVD morbidity and mortality in high risk African Americans. This will be a five-year, randomized, single-blind, controlled, community-based trial of 374 African Americans with mild hypertension, LVH, and CHD. The combination of these clinical factors has been shown in recent epidemiological studies to triple the risk for CVD mortality in African Americans. Male and female subjects will be recruited at the Medical College of Wisconsin Hospitals in Milwaukee from the country s largest registry of African Americans with CHD. After baseline, subjects will be randomized to either TM or a health education control while continuing their usual medical care. The primary outcomes to be evaluated by survival analysis will be combined in CVD mortality and morbidity events (including myocardial infarction, stroke, coronary revascularization and CVD hospitalization ). CVD risk factors-including BP, lipids, smoking, exercise, psychosocial stress, quality of life, and compliance-will be evaluated semi-annually along with the primary clinical outcomes over an average four-year follow-up. A program evaluation will also be conducted to evaluate cost effectiveness and treatment delivery and clinical training factors. If successful, this study will demonstrate the efficacy and feasibility of a behavioral stress reduction method in preventing CVD morbidity and mortality and improving quality of life in this high risk, underserved minority population.
