Stress Reduction: Impact on BP in African American Youth

描述（由申请人提供）：非洲裔美国人（AAs）具有高患病率和早发性原发性高血压（EH），其部分原因是暴露于慢性环境压力。AA青年的静息血压高于白人。由于血压排名从童年后期开始，正常血压高的AA青少年发展为EH的风险增加。由于最近在青少年中患病率增加，EH现在是一个儿科问题，因此需要制定有效的EH初级预防计划。到目前为止，还没有对照研究评估减压方法对AA青年血压控制的影响，特别是在基于压力诱发的EH的潜在心理和生理模型的框架内。本研究将研究正念冥想（MM）、生活技能计划（LP）和健康教育控制计划（CTL）对静息、实验室压力和自然环境下心血管功能的影响。受试者为320名正常收缩压高的九年级学生（50%为男性）（即收缩压从大于或等于第85百分位到小于或等于第95百分位3次）。在进行血压筛查和基线评估后，受试者将被分配到CTL、MM、LP或MM和LP组。受试者将在12周的干预和12周的随访后进行重新评估。

DESCRIPTION (provided by applicant): African Americans (AAs) experience a high prevalence and early onset of essential hypertension (EH), which has been partly attributed to exposure to chronic environmental stress. AA youth exhibit higher resting BP than Whites. Since BP ranking tracks from late childhood onward, AA adolescents with high normal BP are at increased risk for development of EH. Need for development of effective primary prevention programs for EH is highlighted by the fact that EH is now a pediatric problem due to recent increased prevalence among youth. To date, there have been no controlled studies evaluating stress reduction approaches on BP control in AA youth, particularly within the framework of an underlying psychological and physiological based model of stress-induced EH. This proposal will examine the effects of 2 behavioral stress reduction programs, mindfulness meditation (MM) and the Lifeskills Program (LP), and a health education control program (CTL) on cardiovascular function at rest, during laboratory stress and in the natural environment. Subjects will be 320 ninth graders (50% male) with high normal systolic BP (i.e., SBP from greater than or equal to 85th percentile to less than or equal to 95th percentile on 3 occasions). Following BP screenings and baseline evaluation, subjects will be assigned to a CTL, MM, LP or MM and LP group. Subjects will be reevaluated after a 12-week intervention and again at a 12 week follow-up. Specific aims are to determine whether MM and/or LP results in:(1) decreases in the primary outcome variables of resting SBP and 24-hour ambulatory SBP; (2) decreases in sympathetic nervous system (SNS) tone (i.e., decreased overnight urine norepinephrine [NE] excretion) and decreases in sodium intake (i.e., decreased overnight sodium excretion); (3) decreases in SBP reactivity to behavioral stressors; (4) decreases in SNS arousal (i.e., decreased urinary NE excretion) and greater increases in renal function (i.e., increased urinary sodium excretion) to the behavioral stressors; (5) decreases in self-reported hostility and anger; (6) improvement in vascular function (i.e., increases in % endothelium dependent arterial vasodilation to reactive hyperemia); (7) improvement in ventricular structure and function (i.e., decreases in left ventricular mass index and resting heart rate). It is anticipated that the combination of MM and LP will result in even greater positive impacts than either treatment alone. The study will be conducted during health classes at school by teachers. If shown to be successful, incorporation of these programs into the regular school curriculum is quite feasible.