STRESS REDUCTION & CVD MORBIDITY & MORTALITY IN BLACKS

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• 批准号: 2028709
• 负责人: ROBERT SCHNEIDER
• 金额: $ 28.34万
• 依托单位: MAHARISHI UNIVERSITY OF MANAGEMENT
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-07-01 至 2001-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2028709
• 关键词: African American; behavior modification; behavioral /social science research tag; blood pressure; cardiovascular disorder education; cardiovascular disorder epidemiology; cardiovascular disorder prevention; clinical research; clinical trials; coronary disorder; disease /disorder proneness /risk; environmental stressor; health care cost /financing; health services research tag; human morbidity; human mortality; human subject; human therapy evaluation; hypertension; longitudinal human study; meditation; outcomes research; psychological stressor; quality of life; social support network; stress management

DESCRIPTION (Adapted from the applicant's abstract): 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.

描述（改编自申请人摘要）：心血管疾病