Telephone-based mindfulness training to reduce blood pressure in Black women with hypertension in the Jackson Heart Study

杰克逊心脏研究中基于电话的正念训练可降低患有高血压的黑人女性的血压

• 批准号: 10678779
• 负责人: TANYA M Spruill
• 金额: $ 73.55万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-07 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10678779
• 关键词: Address; Adverse effects; Affect; American Heart Association; Ancillary Study; Attention; Awareness; Behavioral; Black Populations; Black race; Blood Pressure; Cardiovascular Diseases; Cause of Death; Characteristics; Chronic; Chronic stress; Clinic; Clinical Trials; Cognitive; Cohort Studies; Compassion; Conflict (Psychology); Consent; Coping Skills; Data; Diet; Discrimination; Disease Outcome; Disparity; Educational process of instructing; Effectiveness; Eligibility Determination; Emotions; Enrollment; Ethnic Population; Evidence based program; Exposure to; Family; Female; Financial Hardship; Funding; Gender; Health; Health behavior; Heart Diseases; High Prevalence; Home; Home Blood Pressure Monitoring; Hypertension; Infrastructure; Intervention; Jackson Heart Study; Life Style; Longitudinal cohort study; Measures; Mediator; Meditation; Mental Health; Mindfulness Training; Morbidity - disease rate; Myocardial Infarction; Nature; Outcome; Participant; Patient Self-Report; Persons; Physical activity; Population; Prevalence; Psychological Factors; Psychosocial Factor; Psychosocial Stress; Qualitative Research; Questionnaires; Race; Randomized; Reporting; Research Design; Research Support; Risk Factors; Sampling; Schedule; Self Care; Sexism; Sleep; Social support; Stress; Stressful Event; Subgroup; Support Groups; Telephone; Testing; Therapeutic; Time; Training; Trust; United States; Woman; Work; behavior change; behavioral outcome; black women; blood pressure control; blood pressure reduction; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; caregiving; cohesion; cohort; coping; depressive symptoms; eligible participant; emotion regulation; experience; follow-up; high risk; hypertension control; improved; innovation; intervention effect; medication compliance; men; mindfulness; mindfulness based cognitive therapy; mindfulness intervention; mortality; novel; novel strategies; perceived stress; physical conditioning; prehypertension; primary outcome; programs; psychologic; psychological outcomes; psychosocial; racial population; real time monitoring; resilience; rumination; secondary outcome; social; social expectations; social factors; stress symptom; stressor; telephone based; telephone delivery; telephone session; transmission process; treatment response; wireless; wireless electronic

ABSTRACT Black women experience disproportionately high rates of hypertension compared to women of other racial and ethnic groups, and their blood pressure (BP) control rates are well below targets despite high levels of awareness and treatment. There is an urgent need for effective nonpharmacological strategies beyond lifestyle behavior change to improve hypertension and cardiovascular disease (CVD) outcomes in this understudied population. Chronic psychosocial stress is associated with hypertension and CVD. Black women are exposed to both race- and gender-based stressors and may employ coping strategies (e.g., emotion suppression, self- care postponement) that increase vulnerability to stress. While many stressful events and circumstances cannot be avoided, adaptive coping can mitigate adverse effects of stress exposure. Mindfulness-based cognitive therapy (MBCT) is an evidence-based program that teaches meditation practices and cognitive strategies to reduce perceived stress and negative emotions. Qualitative research supports the cultural relevance of mindfulness interventions for Black women but clinical trial evidence in this population is limited. Further, the burdensome nature of traditional in-person MBCT poses a significant barrier to participation. We have adapted MBCT for delivery to small groups by telephone (MBCT-T) and our preliminary data support the feasibility, acceptability and effects of the intervention. We propose an RCT to evaluate effects of MBCT-T on BP and psychological outcomes in Black women with uncontrolled hypertension in the Jackson Heart Study (JHS) - a longitudinal cohort study designed to investigate the causes of CVD in Blacks. A sample of 300 female JHS participants with uncontrolled hypertension will be enrolled and randomized to MBCT-T or telephone-based support groups (TSG), an active comparison condition. Both programs involve 8 weekly group-based phone sessions. The primary outcome is home (HBP), a better predictor of CVD risk than clinic BP, measured for 7 days at baseline and 3- and 6-month follow-up with validated wireless devices. Secondary outcomes are perceived stress and depressive symptoms. Measures of chronic stress, coping, resilience and potential psychological, social and behavioral mediators of intervention effects will be assessed. Data from the three prior JHS exams and 20 years of annual follow-up data will also be used to characterize long-term levels of psychosocial factors that may help to explain variability in treatment response. The specific aims are to: (1) Test the hypothesis that MBCT-T will be associated with greater 6-month reductions in systolic BP vs. TSG; (2) Test the hypothesis that MBCT-T will be associated with greater 6-month reductions in perceived stress and depressive symptoms vs. TSG; and (3) Explore potential mediators and moderators of intervention effects on BP and secondary outcomes. Findings will advance understanding of stress, coping and effects of mindfulness training in Black women. If effective, this scalable psychosocial intervention has the potential to positively impact hypertension and other health outcomes among Black women in the JHS cohort and beyond.

摘要 与其他种族和种族的女性相比，黑人女性患高血压的比例高得不成比例 尽管他们的血压水平很高，但他们的血压控制率仍远低于目标 意识和治疗。除了生活方式之外，迫切需要有效的非药物策略 行为改变以改善高血压和心血管疾病(CVD)结局的研究尚未完成 人口。慢性心理社会压力与高血压和心血管疾病有关。黑人女性被暴露在 对基于种族和性别的压力源都有影响，并可能采用应对策略(例如，情绪抑制、自我 护理延迟)，这会增加对压力的脆弱性。虽然许多令人紧张的事件和情况 无法避免，适应性应对可以减轻压力暴露的不利影响。以正念为基础 认知疗法(MBCT)是一个以循证为基础的项目，教授冥想练习和认知 减少感受到的压力和负面情绪的策略。定性研究支持文化 正念干预与黑人女性的相关性，但在这一人群中的临床试验证据有限。 此外，传统面对面MBCT的繁重性质对参与构成了重大障碍。我们 已将MBCT调整为通过电话交付给小团体(MBCT-T)，我们的初步数据支持 干预的可行性、可接受性和效果。我们提出了一种随机对照试验来评估MBCT-T的疗效 杰克逊心脏研究中未控制高血压的黑人女性的血压和心理结果 (JHS)-一项旨在调查黑人心血管疾病原因的纵向队列研究。300个样本 患有未控制高血压的女性JHS参与者将被纳入并随机接受MBCT-T或 基于电话的支持小组(TSG)，一种积极的比较条件。这两个项目都是每周8次。 基于组的电话会话。主要结果是家庭(HBP)，比临床更能预测心血管疾病的风险 BP，在基线时测量7天，并使用经过验证的无线设备进行3个月和6个月的随访。次要的 结果是感觉到的压力和抑郁症状。测量慢性压力、应对、复原力和 将对干预效果的潜在心理、社会和行为中介进行评估。数据来自 还将使用之前的三次JHS考试和20年的年度跟踪数据来表征长期水平 可能有助于解释治疗反应的变异性的心理社会因素。具体目标是：(1) 测试MBCT-T与TSG相比6个月的收缩压下降幅度更大的假设；(2) 测试以下假设：MBCT-T将与6个月内感知压力的更大减少相关，并且 抑郁症状与TSG的比较；以及(3)探索干预效果的潜在中介和调节因素 BP和次要结果。这些发现将促进对压力、应对和正念影响的理解 培训黑人女性。如果有效，这种可扩展的心理社会干预有可能对 影响JHS队列中及以上黑人女性的高血压和其他健康结果。