Stress Reduction: Impact on BP in African American Youth

描述（由申请人提供）：非裔美国人（AAs）的原发性高血压（EH）患病率高且发病早，部分原因是暴露于慢性环境压力。AA青年表现出比白人更高的静息血压。由于BP等级从儿童晚期开始跟踪，具有正常高血压的AA青少年患EH的风险增加。由于近年来年轻人患病率的增加，EH现在是一个儿科问题，这一事实突出了制定有效的EH一级预防计划的必要性。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，特别是在基于心理和生理的应激诱导EH模型框架内。该提案将研究2个行为减压计划，正念冥想（MM）和生活技能计划（LP），以及健康教育控制计划（CTL）在休息时，实验室压力和自然环境中对心血管功能的影响。受试者将是320名具有高正常收缩压（即，3次SBP从大于或等于第85百分位数至小于或等于第95百分位数）。BP筛选和基线评价后，受试者将被分配至CTL、MM、LP或MM和LP组。受试者将在12周干预后重新评估，并在12周随访时再次评估。 具体目的是确定MM和/或LP是否导致：（1）静息SBP和24小时动态SBP的主要结局变量降低;（2）交感神经系统（SNS）张力降低（即，减少的夜间尿去甲肾上腺素[NE]排泄）和钠摄入的减少（即，减少的夜间钠排泄）;（3）SBP对行为应激源的反应性的减少;（4）SNS唤醒的减少（即，尿NE排泄减少）和肾功能的更大增加（即，增加的尿钠排泄）对行为应激源的反应;（5）自我报告的敌意和愤怒的减少;（6）血管功能的改善（即，内皮依赖性动脉血管舒张至反应性充血的百分比增加）;（7）心室结构和功能的改善（即，左心室质量指数和静息心率降低）。预计MM和LP的组合将产生比单独治疗更大的积极影响。这项研究将由教师在学校的卫生课上进行。如果证明是成功的，将这些方案纳入正规学校课程是完全可行的。

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.