Hypertension in Older African Americans — Part I
Reference
Schneider, R.H., Staggers, F., Alexander, C.N., Sheppard, W., Rainforth, M., Kondwani, K., Smith, S., and King, C. A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension 26, pp. 820-827, 1995.
Summary
Objective:To test the short-term efficacy and feasibility of two stress reduction approaches for the treatment of mild hypertension in older African Americans.
Design:Randomized controlled, single-blind trial with three months of follow-up.
Setting: Primary care, inner city health center.
Participants: Of 213 African American men and women screened, 127 individuals, aged 55-85 years with initial diastolic blood pressure of 90-109 mm Hg and systolic blood pressure of ¾189 mm Hg and final baseline blood pressure of ¾179/104 mm Hg were selected. Of these, 16 did not complete follow-up blood pressure measurements.
Interventions: Mental and physical stress reduction approaches&emdash;Transcendental Meditation® (TM) and progressive muscle relaxation (PMR), respectively&emdash;were compared to a lifestyle modification education control and to each other.
Main Outcome Measures: Primary: changes in clinic diastolic and systolic blood pressure from baseline to final follow-up, measured by blinded observers. Secondary: linear blood pressure trends, changes in home blood pressure and intervention compliance.
Results: Adjusted for significant baseline differences and compared to control, the Transcendental Meditation program reduced systolic blood pressure by 10.7 mm Hg (P<.0005) and diastolic blood pressure by 6.4 mm Hg (P<.00005). Progressive muscle relaxation lowered systolic blood pressure by 4.7 mm Hg (P =.054) and diastolic blood pressure by 3.3 mm Hg (P<.025). The Transcendental Meditation program lowered systolic blood pressure (P<.025) and diastolic blood pressure more significantly than progressive muscle relaxation (P< .05). Linear trend analysis confirmed these patterns. Compliance was high in both stress reduction groups. Home systolic, but not diastolic, blood pressure changes were similar to clinic changes.
Mean changes in clinic systolic (above) and diastolic (below) BP (follow-up minus baseline), with standard errors of means. P values are for repeated measures ANCOVA comparing each experimental group (TM or PMR) to control (EC). TM, Transcendental Meditation (n=36); PMR, progressive muscle relaxation (n=33); EC, lifestyle modification education controls (n=35).
Conclusions: Selected mental and physical stress reduction techniques demonstrated efficacy in reducing mild hypertension in this sample of older African Americans. Of the two techniques, The Transcendental Meditation® program was approximately twice as effective as progressive muscle relaxation. Long-term effects and generalizability to other populations require further evaluation.
This work was supported by grants from the Retirement Research Foundation, Chicago, Ill, and the Lancaster Foundation, Bethesda, Md. Preparation of this publication was supported in part by the National Institutes of Health.
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