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(Hypertension. 1995;26:820.)
© 1995 American Heart Association, Inc.
Articles |
A Randomized Controlled Trial of Stress Reduction for Hypertension in Older African Americans
From the Center for Health and Aging Studies, Department of Physiological and Biological Sciences (R.H.S.) and Department of Psychology (C.N.A., M.R., K.K., C.G.K.), Maharishi University of Management, Fairfield, Iowa; the Hypertension and Stress Management Research Clinic, West Oakland Health Center, Oakland, Calif (F.S., W.S., K.K., S.S.); the Department of Social and Behavioral Sciences, University of Arkansas, Pine Bluff (C.G.K.); and the Haight-Ashbury Free Medical Clinic, San Francisco, Calif (F.S.).
Correspondence to Robert H. Schneider, MD, Center for Health and Aging Studies, Maharishi University of Management FB 1028, Fairfield, IA 52557-1028.
Abstract We tested the short-term efficacy and
feasibility of two stress education approaches to the treatment of mild
hypertension in older African Americans. This was a randomized,
controlled, single-blind trial with 3 months of follow-up in a
primary care, inner-city health center. Of 213 African American men
and women screened, 127 individuals (aged 55 to 85 years with initial
diastolic pressure of 90 to 109 mm Hg, systolic
pressure of 
189 mm Hg, and final baseline blood pressure of
179/104 mm Hg) were selected. Of these, 16 did not complete
follow-up blood pressure measurements. Mental and physical
stress-reduction approaches (Transcendental Meditation and
progressive muscle relaxation) were compared with a lifestyle
modification education control program and with each other. The primary
outcome measures were changes in clinic diastolic and
systolic pressures from baseline to final follow-up,
measured by blinded observers. The secondary measures were linear blood
pressure trends, changes in home blood pressure, and intervention
compliance. Adjusted for significant baseline differences and compared
with control, Transcendental Meditation reduced systolic
pressure by 10.7 mm Hg (P<.0003) and diastolic
pressure by 6.4 mm Hg (P<.00005). Progressive muscle
relaxation lowered systolic pressure by 4.7 mm Hg
(P=.054) and diastolic pressure by 3.3 mm Hg
(P<.02). The reductions in the Transcendental Meditation
group were significantly greater than in the progressive muscle
relaxation group for both systolic blood pressure
(P=.02) and diastolic blood pressure
(P=.03). Linear trend analysis confirmed these
patterns. Compliance was high in both stress-reduction groups. Home
systolic but not diastolic pressure changes were
similar to clinic changes. Selected mental and physical
stress-reduction techniques demonstrated efficacy in reducing mild
hypertension in this sample of older African Americans. Of the
two techniques Transcendental Meditation was approximately twice as
effective as progressive muscle relaxation. Long-term effects and
generalizability to other populations require further evaluation.
Key Words: hypertension, stress • relaxation • blacks • aged
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