Effectiveness of Yoga on Ambulatory Blood Pressure in Patients with Pre- and Stag

描述(由申请人提供)：高血压在美国影响着5000万人，是中风、心肌梗死、心力衰竭和肾脏疾病的重要危险因素。在多项研究中，有普遍的证据表明，瑜伽项目可能在降低血压方面有效。然而，这些研究中的大多数都是非随机和/或非对照的，检查的是健康的参与者，而不是高血压患者，而且许多研究使用了多种模式的基于瑜伽的干预措施，其中不可能确定瑜伽的单独影响。这些研究中的另一个实质性问题是，对于什么是被贴上“瑜伽”标签的干预措施缺乏共识。因此，仍然需要明确定义代表常见瑜伽练习的瑜伽干预，并确定这种干预对血压控制的效果。在西方文化中，有一个合理的共识，即最常见的瑜伽练习是由三个综合要素定义的：身体姿势、呼吸控制和冥想。瑜伽追随者认为，这些元素的整合会产生比简单地添加这些元素的独立影响所产生的更大的健康结果。然而，这一建议没有得到任何研究。有证据表明，呼吸控制和冥想的瑜伽元素在临床上对血压有显著的独立影响，而没有证据表明瑜伽的身体姿势(体式)对血压有独立影响。此应用程序的目标是定义综合瑜伽练习的标准化要素，并确定综合瑜伽练习与单一练习元素(身体姿势)对动态血压(ABP)的影响。中心假设是，瑜伽元素(身体姿势/呼吸控制/冥想)的整合将产生比单一练习元素(身体姿势)更大的ABP降低。我们计划通过对90名高血压前期和I期参与者进行为期12周的随机对照试验来检验我们的论点。我们还将检查与自主神经系统相关的各种次级心理和生理指标：心率、心率变异性、压力感受器敏感性、感知压力、应对、不确定耐受性、控制感和体重指数，我们预计这些指标将与ABP的改善相关。该研究还将确定与干预措施相关的招募、保留、遵从性、期望值、接受度和感知有效性。这项研究中获得的信息将产生积极的影响，提供关键的初步和可行性数据，以支持关于瑜伽对I期高血压患者个人影响的更大规模的多种族随机对照试验。 与公共健康相关：拟议的研究将比较明确和综合的瑜伽练习(姿势/呼吸控制/冥想)和该练习的单一元素(瑜伽姿势(体位))在降低高血压方面的作用。预期结果包括瑜伽对前期和I期高血压患者的动态血压、心理社会压力和自主神经系统的影响的数据。这项研究中获得的信息将产生积极的影响，提供关键的初步和可行性数据，以支持关于瑜伽对高血压患者个人影响的更大规模的多种族随机临床试验。

DESCRIPTION (provided by applicant): Hypertension affects 50 million people in the US and is a significant risk factor for stroke, cardiac infarction, heart failure, and kidney disease. There is general evidence across multiple studies that yoga programs may be effective in the reduction of blood pressure. However, most of these studies are non-randomized and/or uncontrolled, examine healthy rather than hypertensive participants, and many use multi-modal "yoga-based" interventions in which it is impossible to determine the isolated effects of yoga. An additional substantive problem across these studies is the lack of agreement regarding what constitutes the intervention labeled "yoga." Consequently, there remains a need to clearly define a yoga intervention that represents common yoga practice and to determine the effects of such an intervention on blood pressure control. In western cultures, there is reasonable agreement that the most common yoga practice is defined by three integrated elements: physical postures, breath control, and meditation. Yoga adherents suggest that the integration of these elements produces greater health outcomes than would be expected through the simple addition of the independent effects of these elements. However, this suggestion has received no study. There is evidence that the yoga elements of breath control and meditation have clinically significant independent effects on blood pressure, while there is no evidence demonstrating that the physical postures (asana) of yoga have independent effects on blood pressure. The objectives of this application are to define standardized elements of an integrated yoga practice and determine the effects of the integrated practice compared to a single element of the practice (physical postures) on ambulatory blood pressure (ABP). The central hypothesis is that the integration of the elements of yoga (physical postures/breath control/meditation) will produce greater reductions in ABP than are produced through a single element of that practice (physical postures). We plan to test our thesis by performing a 12 week, RCT of 90 pre- and Stage I hypertensive participants. We will also examine a variety of secondary psychosocial and physiological measures related to the autonomic system: heart rate, heart rate variability, baroreceptor sensitivity, perceived stress, coping, tolerance of uncertainty, sense of control, and body mass index, which we expect to be correlated to improvements in ABP. The study will also determine the recruitment, retention, compliance, expectations, acceptance, and perceived effectiveness relative to the interventions. The information gained in this study will have a positive impact by providing critical preliminary and feasibility data to support a larger multi-ethnic RCT on the effects of yoga on individuals with Stage I hypertension. PUBLIC HEALTH RELEVANCE: The proposed study will compare a well defined and integrated yoga practice (postures/breath control/meditation) to a single element of that practice (yoga postures (asana)) in reducing hypertension. The expected outcomes include data on the effects of yoga on ambulatory blood pressure, psychosocial stress, and the autonomic system in individuals with pre- and Stage I hypertension. The information gained in this study will have a positive impact by providing critical preliminary and feasibility data to support a larger multi-ethnic randomized clinical trial on the effects of yoga on individuals with hypertension.