STRESS REDUCTION & PREVENTION OF HYPERTENSION IN BLACKS

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DESCRIPTION (Applicant's Abstract): African Americans suffer from disproportionate rates of hypertension and related cardiovascular morbidity and mortality due, at least in part, to excessive socioenvironmental and psychosocial stress. Furthermore, despite the substantial individual and population risk burden associated with high normal blood pressure (BP) in African Americans, to date, there have been no controlled studies to evaluate stress reduction approaches in the primary prevention of hypertension targeted to this high risk group. Therefore, recent NIH and NIMH policy committees have called for a new research focus on primary prevention of hypertension targeted to high risk populations-notably African Americans with high normal BP. In previous randomized controlled trials by the applicant, hypertension and psychosocial stress were significantly reduced in low SES African Americans who practiced stress reduction with the Transcendental Mediation (TM) program compared to relaxation or health education controls. In the most recent long-term trial, African Americans with borderline hypertension showed BP reductions that would be associated with a 17 percent decrease in prevalence of hypertension, a 15 percent reduction in stroke, and a 6 percent reduction in CHD in the population. These BP reductions compare favorably to decreases shown with sodium restriction and weight loss programs in other prevention trials. Also, recent pilot data from two clinical trials indicate that TM was associated with significantly lower cardiovascular morbidity and mortability in African Americans and in Caucasians with high BP over a 5-year and 15-year period, respectively. The current proposal responds to NIH and NIMH mandated research by extending the prior research through conducting a randomized controlled trial of stress reduction for the primary prevention of hypertension in African Americans with high normal BP. African American males and females (N-352, aged 21-75 years) with high normal BP (SBP 130-139 and/or DBP 85-89 mm Hg) will be recruited from the African American Family Heart Health Plan at the Medical College of Wisconsin, Milwaukee, which houses the nation's largest registry of African Americans with known CVD risk factors. After baseline assessment, participants will be randomized to either the TM program or to a matched health education control intervention. The primary outcome will be change in clinic BP over a 12-month follow-up. Secondary outcomes will include changes in ambulatory BP, hypertensive events, psychosocial stress and health behaviors. Also, a model of the pathways through which components of stressful experience affect high BP in African Americans will be tested.