Mechanisms of the Relaxation Response in Elderly Hypertensives

老年高血压患者松弛反应的机制

• 批准号: 7392943
• 负责人: Jeffery A Dusek
• 金额: $ 16.83万
• 依托单位: ALLINA HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7392943
• 关键词: Acute; Adult; Adverse effects; Affect; Age; Age-Years; Antihypertensive Agents; Anxiety; Arousal; Attention; Audiotape; Blood Pressure; Blood Vessels; Cardiovascular Diseases; Cardiovascular system; Clinical; Condition; Daily; Data; Diastolic Hypertension; Diastolic blood pressure; Disease; Economics; Elderly; Elevation; Epinephrine; Essential Hypertension; Event; Exhalation; Female; Foundations; Functional disorder; Health education; High Blood Pressure; Home environment; Hormonal; Hormones; Hydrocortisone; Imagery; Incidence; Individual; Intervention; Left; Mediation; Meditation; Mind-Body Intervention; Myocardial Infarction; Nitric Oxide; Numbers; Outcome; Patients; Pharmaceutical Preparations; Physicians; Plasma; Population; Populations at Risk; Prevalence; Production; Pulse Pressure; Qi Gong; Randomized; Randomized Clinical Trials; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Relaxation; Risk; Severities; Stress; Stroke; Tai Ji; Testing; Therapeutic; Time; Training; Transcendental Meditation; Vasodilator Agents; Week; Well in self; Yoga; aged; biological adaptation to stress; body-mind; cardiovascular risk factor; clinical effect; clinically significant; cost; deep breathing exercises; hypertension treatment; improved; indexing; pressure; research study; response; systolic hypertension; volunteer; young adult

DESCRIPTION (provided by applicant): Systolic Hypertension is a disorder which is characterized by significant elevations in systolic blood pressure in association with normal diastolic blood pressure. Typically, this develops in individuals >50 years of age and is associated with an increased risk of stroke and myocardial infarction. While there are many effective therapies for essential/diastolic hypertension, the treatment of systolic hypertension is complicated by side effects from traditional therapies. This limits therapeutic options and has resulted in a number of at-risk individuals being left untreated. We have recently completed a preliminary study showing that 8-weeks of relaxation response (RR) training significantly reduced systolic blood pressure in individuals with SH. Systolic blood pressure was significantly decreased by 9.4 mmHg and pulse pressure by 7.9 mmHg. This finding would suggest that the RR may be an effective intervention with few to no adverse consequences in this patient population. In other experiments, we found that the RR increased exhaled nitric oxide in young adult volunteers and plasma nitric oxide in female volunteers. Since nitric oxide levels are low in some patients with essential hypertension, abnormalities in nitric oxide availability could be contributing to SH and might be altered by the RR. However, the actual mechanism by which the RR affects SH remains undetermined. Since the RR is known to alter sympathetic responses, this may be one mechanism which explains the effect of the RR on SH. Other mechanisms contributing to this effect could include alteration of vascular function via changes in nitric oxide production or hormonal alterations in sympathetic arousal (i.e., stress response). We hypothesize that the RR reduces systolic blood pressure and pulse pressure without significant side effects and that this occurs by increasing nitric oxide production and/or by reducing stress hormone levels (epinephrine and cortisol). To examine this hypothesis, we propose conducting a randomized, controlled trial (n=90) in which older adults with SH will receive either 8-weeks of RR intervention or Health Education (HE). The primary outcome is change in systolic blood pressure and pulse pressure. Secondary outcomes are changes in nitric oxide, stress hormones and psychological well-being. Additional analyses will be conducted to assess for other confounding effects on BP and PP. Aim 1: Assess if an 8-week RR intervention will decrease systolic blood pressure and pulse pressure compared with HE (control) without significant side effects. Aim 2: Evaluate whether 8-weeks of RR training increases levels of nitric oxide compared with HE. Aim 3: Assess whether 8-weeks of RR training decreases stress hormones (epinephrine and cortisol) and improves psychological well-being (global severity index and anxiety) compared with HE. While elevated systolic blood pressure and pulse pressure are important risk factors for cardiovascular events, concerns about side effects leave many physicians reluctant to treat this condition. Given the challenges of controlling systolic blood pressure pharmacologically and the prevalence of side effects produced by many antihypertensive agents, identification of non-pharmacologic approaches to decrease systolic blood pressure in older Systolic Hypertension (defined as SBP >140 mm Hg with normal diastolic blood pressure (DBP <90 mm Hg) patients could contribute significantly to the treatment of this condition. These positive effects could have significant economic implications by providing a low-cost adjunctive therapy to current pharmacologic approaches and potentially reduce the incidence of cardiovascular events.

描述（由申请人提供）：收缩压是一种疾病，其特征是收缩压的显着升高与正常的舒张压相关。通常，这会在50岁以上的个体中发展，并且与中风和心肌梗塞的风险增加有关。虽然有许多有效的疗法用于基本/舒张期高血压，但收缩高压的治疗对传统疗法的副作用变得复杂。这限制了治疗选择，并导致许多处于危险的人未经治疗。我们最近完成了一项初步研究，表明8周的松弛反应（RR）训练显着降低了SH患者的收缩压。收缩压显着降低9.4 mmHg，脉压减少7.9 mmHg。这一发现表明，RR可能是一种有效的干预措施，在该患者人群中几乎没有不利后果。在其他实验中，我们发现在女性志愿者中，RR增加了年轻成人志愿者和血浆一氧化氮的呼出一氧化氮。由于某些基本高血压患者的一氧化氮水平较低，因此一氧化氮的可用性异常可能会导致SH，RR可能会改变。但是，RR影响SH的实际机制仍然不确定。由于RR已知会改变交感反应，因此这可能是一种解释RR对SH的影响的机制。导致这种作用的其他机制可能包括通过一氧化氮产生或交感神经唤醒的激素改变（即应力反应）的变化来改变血管功能。我们假设RR降低了收缩压和脉搏压力而没有明显的副作用，并且通过增加一氧化氮的产生和/或通过降低应激激素水平（肾上腺素和皮质醇）而发生。为了审查这一假设，我们建议进行一项随机，对照试验（n = 90），其中SH的老年人将接受8周的RR干预或健康教育（HE）。主要结果是收缩压和脉压变化。次要结果是一氧化氮，应激激素和心理健康的变化。将进行其他分析以评估对BP和PP的其他混杂作用。 AIM 1：评估与HE（对照）相比，8周的RR干预是否会降低收缩压和脉搏压力，而没有明显的副作用。 AIM 2：评估与HE相比，8周的RR训练是否增加了一氧化氮的水平。 AIM 3：评估8周的RR训练是否减少了压力激素（肾上腺素和皮质醇），并改善与HE相比的心理健康（全球严重程度指数和焦虑）。尽管收缩压和脉压升高是心血管事件的重要危险因素，但对副作用的担忧使许多医生不愿治疗这种情况。鉴于在药理学上控制收缩压的挑战以及许多抗高血压剂产生的副作用的流行，因此鉴定了非药理学方法以降低较旧的收缩压高血压中的收缩压（定义为SBP> 140 mm Hg具有正常的分解性血压<90 mm Hg <90 mM HG）可能会造成这种贡献的情况，这些造成了这些贡献。通过为当前的药理方法提供低成本的辅助疗法，并有可能减少心血管事件的发生率。