Autonomic and Immuno-vascular Mechanisms of Antihypertensive Effects of Taichi

 描述（申请人提供）：这是1 R 01 HL 126056 -01的修订版。作为对评审员的回应，我们更好地描绘了太极拳（TC）降低血压（BP）的潜在途径，增强了我们的控制条件以增加积极参与，缩小了我们的BP入选标准（1期和轻度2期高血压），并将随访时间延长至9个月。高血压（HTN）是美国和世界范围内普遍存在的问题。超过30%的美国成年人患有HTN，发病率随着年龄的增长而大幅增加; 65岁以上的男性和女性中有64%和78%患有HTN。HTN是全球过早死亡的最重要原因之一，也是最重要的可预防死亡原因之一。许多临床试验显示，降低血压有利于减少心血管（CV）疾病、CV相关死亡和卒中。虽然药物治疗经常强调HTN管理，非药物方法的重要性是公认的疾病中断，并承担巨大的公共卫生意义。越来越多的证据表明TC可有效降低HTN患者的血压，文献中的SBP范围为7 - 32 mm Hg，但由于现有研究的方法学质量降低，因此被认为是不确定的。严格设计的随机和对照试验是非常必要的。此外，TC训练降低BP的机制尚不清楚。HTN的“神经源性假说”描述了由于HTN中交感神经系统（SNS）激活和副交感神经系统（PNS）受损而导致的不平衡。TC实践被证明可以减少心理困扰，如焦虑和抑郁症状，并减少生理唤醒，这可能会改善自主神经平衡，从而降低血压。然而，之前的研究尚未描述TC降低HTN血压的途径。因此，我们计划研究与健康老龄化实践为中心的教育（HAP-E）对照条件相比，自主神经，血管动力学，免疫血管和心理变化与12周TC前后BP变化之间的潜在途径。将招募250名患有1期和轻度2期HTN的老年人（60-80岁），并测量压力反射敏感性、心率和BP变异性以及运动后HR恢复，以检查自主调节。假设TC后自主神经“再调节”介导TC对通过脉搏波速度（Aim 1）测量的BP和血管健康的影响以及通过交感-肾上腺素能系统（Aim 2）测量的炎症调节。最后，TC对自主调节的影响被假设为由心理因素介导（目的3）。我们的随机对照干预研究结果将揭示TC降压疗效的心理-神经-血管-免疫学基础。此外，我们将澄清TC（“冥想运动”）在老年人中的独特作用，“难以治疗”的高血压人群将特别受益于这种行为治疗。

 DESCRIPTION (provided by applicant): This is a revised version of 1R01HL126056-01. In response to reviewers we have better delineated potential pathways of blood pressure (BP) reduction by Tai Chi (TC), enhanced our control condition to increase active participation, narrowed our BP enrollment criteria (stage 1 and mild stage 2 hypertension) and extended our follow-up to 9 months. Hypertension (HTN) is a pervasive problem in the US and worldwide. Over 30% of American adults have HTN, with the incidence increasing substantially with age; 64% of men and 78% of women over 65 having HTN. HTN is one of the most important causes of premature death worldwide and one of the most significant preventable causes of death. Numerous clinical trials have revealed benefits of lowering BP for reductions in cardiovascular (CV) disease, CV-related death and stroke. Although pharmacologic therapy is often emphasized for HTN management, the importance of non-pharmacologic approaches is recognized for disease interruption and bears vast public health significance. There is growing evidence that TC is effective in lowering BP for patients with HTN, ranging 7 - 32 mm Hg SBP in the literature but is considered inconclusive due to reduced methodological quality of existing studies. Rigorously designed randomized and controlled trials are in great need. Furthermore, the mechanisms by which TC training reduces BP are unknown. The `neurogenic hypothesis' of HTN describes the imbalance owing to elevated sympathetic nervous system (SNS) activation and parasympathetic nervous system (PNS) impairment in HTN. TC practice is shown to reduce psychological distress such as anxiety and depression symptoms and reduce physiological arousal which can potentially improve autonomic balance, resulting in reduced BP. However, no prior studies have delineated the pathways through which TC reduces BP in HTN. Thus, we plan to investigate the underlying pathways among autonomic, vascular-dynamic, immuno-vascular and psychological alterations in relation to BP changes pre to post 12-week TC compared to a Healthy Aging Practice-centered Education (HAP-E) control condition. 250 older adults (60-80 years old) with stage 1 and mild stage 2 HTN will be enrolled, and baroreflex sensitivity, heart rate and BP variability and post-exercise HR recovery will be measured to examine autonomic regulation. Post TC autonomic "re-regulation" is hypothesized to mediate TC effects on BP and vascular health measured by pulse wave velocity (Aim 1) and inflammation regulation by sympatho-adrenergic system (Aim 2). Lastly, TC effects on autonomic regulation is hypothesized to be mediated by psychological factors (Aim 3). Findings from our randomized and controlled intervention study will shed light on the psycho-neuro-vasculo-immunological underpinnings of antihypertensive efficacy of TC. Also, we would clarify the unique effects of TC ("meditative movement") in an older, "hard-to-treat" hypertensive population that would particularly benefit from this behavioral therapeutic.