A randomized controlled trial of stress reduction in African Americans treated for hypertension for over one year

Abstract

Background: Psychosocial stress has been implicated in the disproportionately higher rates of hypertension among African Americans. This randomized controlled trial compared the effects of two stress reduction techniques and a health education control program on hypertension during a period of 1 year in African-American men and women (N = 150, mean age 49 +/- 10 years, mean blood pressure (BP) = 142/95 mm Hg) at an urban community health center.

Methods: Interventions included 20 min twice a day of Transcendental Meditation (TM) or progressive muscle relaxation (PMR), or participation in conventional health education (HE) classes. All subjects continued usual medical care. Outcomes assessed were systolic BP and diastolic BP at 3, 6, 9, and 12 months after treatment, analyzed by repeated measures ANCOVA.

Results: The TM group showed decreases in systolic BP/diastolic BP of -3.1/-5.7 mm Hg compared to -0.5/-2.9 mm Hg for PMR or HE, (P = .12 to .17 for systolic BP, P = .01 for diastolic BP). In addition the TM group demonstrated reduced use of antihypertensive medication relative to increases for PMR (P = .001) and HE (P = .09) groups. Group analysis by gender showed that women practicing TM had decreased BP (-7.3/-6.9 mm Hg) significantly more than women practicing PMR (0.7/-2.7 mm Hg) or HE (-.07/-3.0 mm Hg) (P .01 to .03). The change in men praticing TM (0.2 /-4.7 mm Hg) was greater than men practicing HE (-0.9/-2.0 mm Hg) for diastolic BP only (P = .09,) and not different from PMR men (-2.0/-3.1).

Conclusions: A selected stress reduction approach, the Transcendental Meditation program, may be useful as an adjunct in the long-term treatment of hypertension in African Americans.

FIG. 1

Change in BP by treatment group: comparison of the Transcendental Meditation (TM), progressive muscle relaxation (PMR), and health education (HE) groups on mean adjusted change scores in clinical systolic and diastolic BP during a 12-month period. TM decreased diastolic BP more than PMR (P = .03) or HE (P = .02), but PMR and HE did not differ (P = .44). There were trends of TM decreasing systolic BP more than PMR (P = .12) and HE (P = .17), and PMR and HE did not differ (P = .44).

FIG. 2

Change in antihypertension medication by group. Compared to the Transcendental Meditation group, the other groups significantly increased their use of BP medication: PMR (P = .015) and HE (P = .006) during the 12-month period.