African-Americans in the United States have disproportionately high rates of cardiovascular disease and mortality. Left ventricular hypertrophy (LVH), the primary manifestation of hypertensive heart disease and a major independent predictorof cardiovascular mortality, is twice as prevalent in African-Americans with hypertension as in whites. Research has implicated chronic socio-environmental and psychological stress in the etiology of hypertension in African-Americans and of LVH. It is important to investigate directly the impact of stress reduction programs for treating hypertensive heart disease in African- Americans, since conventional antihypertensive drug therapies are less successful than expected. Moreover, these therapies frequently have adverse side effects on quality of life, and have low compliance rates, particularly in minorities. The current research team conducted the only randomized, controlled trial of stress reduction therapies for treating hypertension in older African-Americans(in Oakland, CA). After 3 months, TM reduced BP 11/7 mm Hg and Progressive Relaxation reduced BP 6/4 mm Hg relative to a usual care non-drug control. Compliance rate with TM was 97 percent. The objective of the present project is to conduct a randomized, blind, controlled trial with a one-year intervention period in a large inner-city, public hospital (Cook County Hospital, Chicago) on the effectiveness of stress reduction with TM relative to a heart disease education control group in modifying left ventricular hypertrophy (LVH) and LV function, reducing hypertension, and enhancingquality of life in African-Americans. This study randomly assigns 200 unmedicated African-American adults with mild hypertension and left ventricular hypertrophy to the active treatment and control groups. Expanding upon the Oakland study, this trial will include younger (25+), as well as older adults. After baseline, LV mass and LV monthly, ambulatory blood pressure monitoring, psychosocial stress/quality of life, andcardiovascular risk behaviors (diet, smoking, sodium excretion, exercise,weight, and alcohol consumption) will be measured at 6 and 12 months. The relationship of change in LV mass and function to changes in the other variables will be measured. Data will be pooled on clinical and ambulatory blood pressure and quality of life in black subjects from collaborator trials at Morehouse School of Medicine and Howard University Medical Center to compare effects of several behavioral programs: TM; anger management; TM plus anger management; intensive weight loss; weight loss plus exercise;and a heart disease education control common to all sites. If successful, this study will demonstrate the efficacy of new behavioral methods to treat and prevent hypertensive heart disease and improve quality of life and treatment compliance in this high-risk and undeserved minority population.
