A Randomized Controlled Trial of Stress Reduction for Hypertension in Older African Americans

Abstract

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.