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

摘要 与其他种族和族裔的妇女相比，黑人妇女患高血压的比例不成比例地高。 少数民族，他们的血压（BP）控制率远低于目标，尽管高水平的 认识和治疗。迫切需要有效的非药物策略超越生活方式 行为改变，以改善高血压和心血管疾病（CVD）的结果， 人口慢性心理社会压力与高血压和心血管疾病有关。黑人女性暴露在 种族和性别的压力源，并可能采用应对策略（例如，情绪抑制，自我， 照顾推迟），增加了对压力的脆弱性。虽然许多压力事件和环境 不能避免，适应性应对可以减轻压力暴露的不利影响。正念 认知疗法（MBCT）是一个以证据为基础的计划，教授冥想练习和认知 减少感知压力和负面情绪的策略。定性研究支持文化 正念干预对黑人妇女的相关性，但在这一人群中的临床试验证据是有限的。 此外，传统的面对面MBCT的负担性质对参与构成了重大障碍。我们 我们已经调整了MBCT，通过电话（MBCT-T）向小团体提供服务，我们的初步数据支持 干预的可行性、可接受性和效果。我们提出了一项随机对照试验，以评估MBCT-T对 杰克逊心脏研究中高血压未控制的黑人女性的血压和心理结局 (JHS)- 一项旨在调查黑人CVD原因的纵向队列研究。300个样本 将招募患有不受控制的高血压的女性JHS受试者，并随机接受MBCT-T或 基于电话的支持团体（TSG），一个积极的比较条件。这两个项目每周都有8个 基于群组的电话会话。主要结局是家庭（HBP），这是比诊所更好的CVD风险预测因子 使用经验证的无线设备在基线和3个月和6个月随访时测量7天的BP。二次 结果是感知的压力和抑郁症状。慢性压力、应对、复原力和 将评估干预效果的潜在心理、社会和行为介导因素。的数据 三次先前的JHS检查和20年的年度随访数据也将用于表征长期水平 心理社会因素可能有助于解释治疗反应的变异性。具体目标是：（1） 检验MBCT-T与6个月收缩压降低幅度大于TSG相关的假设;（2） 测试MBCT-T与6个月内感知压力的更大减少相关的假设， 抑郁症状与TSG;和（3）探索潜在的中介和调解人的干预效果， BP和次要结局。研究结果将促进对压力，应对和正念影响的理解 训练黑人女性。如果有效，这种可扩展的心理社会干预有可能积极地 影响高血压和其他健康结果的黑人妇女在JHS队列和超越。

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.