Among African-American adults the prevalence of hypertension is on average 200% that of the majority population. Whereas the mechanisms underlying the higher prevalence of hypertension are not well understood, research suggests that repeated exposure to psychological and chronic stress results in autonomic nervous system arousal, hyperreactivity and the eventual development of hypertension. Therefore, the major objective of the proposed research is to conduct a randomized, blinded, controlled clinical trial in a community health center of two different classes of stress reduction techniques compared to an education control program in middle age (25-50 years) and older (>50 years) blacks with mild hypertension. This study is part of a multi-site collaboration where the major objective is to investigate the short- and long-term effects of non- pharmacologic therapies, as adjuncts to drug therapy and as the sole treatment, in managing hypertension among African-American adults.
The specific aims of the project are: 1. To determine the short- and long-term effects of stress reduction techniques (Transcendental Meditation, Anger Management Therapy, and a combination of Meditation and Anger Management) relative to an educational control on blood pressure in the clinic. Participants will be assessed during a well designed baseline period and at a 3, 6, 12 and 18 month follow-up for average blood pressure in the clinic. 2. To determine the short- and long-term effects of these four treatments on reducing blood pressure outside of the clinic under real life circumstances. At the end of the baseline and after the 3, 12 and 18 months of intervention, all subjects will undergo 24-hour ambulatory blood pressure monitoring. 3. To determine the effects of stress reduction techniques on reducing cardiovascular reactivity to laboratory stressors. Since physiological reactivity may be related to cardiovascular risk, subjects will be evaluated (pre- and post treatment 3, 12 and 18 months) for blood pressure and heart rate responsiveness during a stress interview and during other laboratory tasks that are alpha adrenergic (cold pressor test) and beta adrenergic (math challenge) in nature. 4. To determine the effects of stress reduction techniques on reducing forearm vascular resistance which is elevated in hypertensive patients and the resistance to flow reflects the structural properties of the vessel. Subjects will be pretested and examined at 3, 12 and 18 months follow-up. 5. To determine the effects of stress reduction treatment regimens on reducing emotional reactivity. Since emotional reactivity (especially anger and irritability) are believed to be related to cardiovascular risk, subjects emotional states will be rated on verbal content and behavior during the stress interview, by self-report psychological questionnaires, pretreatment treatment and at the 3, 12 and 18 month follow-up. 6. To determine the effects of stress reduction on enhancing psychosocial factors, especially relevant to African-Americans. Subjects will be pretested and posttested at various intervals (Baseline, 3, 12, and 18 months follow-up) on a battery of psychosocial, life style and health quality of life measures. 7. To assess possible psychological, physiological and life style predictors of responsiveness to treatment. Data will be collected on a number of life style, psychological and physiological factors which may influence the results of treatment, and these effects will be statistically evaluated.
