Stress Reduction: Impact on BP in African American Youth

描述(由申请人提供)：非裔美国人(AA)经历了高血压(EH)的高患病率和早期发病，这在一定程度上是由于暴露在慢性环境压力下。AA级青年的静息血压高于白人。由于血压排名从儿童后期开始跟踪，血压正常的AA青少年患EH的风险增加。由于最近在年轻人中的发病率增加，EH现在是一个儿科问题，这一事实突显了制定有效的EH初级预防方案的必要性。到目前为止，还没有在AA青少年中评估减压方法对血压控制的对照研究，特别是在基于应激诱导EH的潜在心理学和生理学模型的框架内。这项提案将考察两种行为压力缓解计划，正念冥想(MM)和生命杀死计划(LP)，以及健康教育控制计划(CTL)对休息、实验室压力期间和自然环境中心血管功能的影响。研究对象为320名正常收缩压较高的九年级学生(男性占50%)(即SBP有3次从大于或等于第85个百分位数到小于或等于第95个百分位数)。在BP筛查和基线评估之后，受试者将被分配到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周的随访中再次进行评估。 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的主要结果变量减少；(2)交感神经系统(SNS)张力降低(即夜间尿去甲肾上腺素[NE]排泄减少)和钠摄取减少(即夜间钠排泄减少)；(3)SBP对行为应激源的反应性降低；(4)SNS唤醒(即尿NE排泄减少)和肾功能(即尿钠排泄增加)对行为应激源的更大增加；(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对反应性充血的扩张百分率的增加)；(7)心脏结构和功能的改善(即左心室质量指数和静息心率的下降)。预计MM和LP的结合将产生比任何一种单独治疗更大的积极影响。这项研究将由教师在学校的健康课上进行。如果被证明是成功的，将这些方案纳入常规学校课程是相当可行的。

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.