Stress Reduction: Impact on BP in African American Youth

减轻压力：对非裔美国青年血压的影响

• 批准号: 6838043
• 负责人: Frank A Treiber
• 金额: $ 35.64万
• 依托单位: AUGUSTA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-01-16 至 2009-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6838043
• 关键词: African American; adolescence (12-20); alternative medicine; angers; behavioral /social science research tag; blood pressure; cardiovascular disorder prevention; cardiovascular disorder therapy; clinical research; cognitive behavior therapy; coping; creatinine; electrocardiography; environmental stressor; essential hypertension; heart function; heart ventricle; human subject; human therapy evaluation; kidney function; meditation; patient oriented research; psychological stressor; questionnaires; reactive hyperemia; stress management; sympathetic nervous system; vasodilation

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.

描述（由申请人提供）：非裔美国人 (AA) 的原发性高血压 (EH) 患病率高且发病早，部分原因是暴露于慢性环境压力。 AA 青年的静息血压高于白人。由于血压排名从儿童晚期开始进行跟踪，具有正常高血压的 AA 青少年患 EH 的风险增加。由于近期青少年患病率增加，EH 现在已成为一个儿科问题，这一事实凸显了制定有效的 EH 初级预防计划的必要性。迄今为止，还没有对照研究评估减压方法对 AA 青少年血压控制的影响，特别是在压力诱发 EH 的潜在心理和生理模型框架内。该提案将研究 2 个行为减压计划、正念冥想 (MM) 和生活技能计划 (LP) 以及健康教育控制计划 (CTL) 对休息时、实验室压力期间和自然环境中心血管功能的影响。受试者为 320 名九年级学生（50% 为男性），具有正常高收缩压（即 SBP 3 次从大于或等于 85% 到小于或等于 95%）。在血压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 周随访时再次评估。 具体目标是确定 MM 和/或 LP 是否导致：(1) 静息 SBP 和 24 小时动态 SBP 的主要结果变量降低； (2)交感神经系统（SNS）张力降低（即隔夜尿去甲肾上腺素[NE]排泄减少）和钠摄入量减少（即隔夜钠排泄减少）； (3) 收缩压对行为压力源的反应性降低； (4) 对行为应激源的 SNS 唤醒减少（即尿 NE 排泄减少）和肾功能更大程度增加（即尿钠排泄增加）； (5) 自我报告的敌意和愤怒减少； (6)血管功能改善（即，内皮依赖性动脉血管舒张百分比增加至反应性充血）； (7)心室结构和功能的改善(即左心室质量指数和静息心率的降低)。预计 MM 和 LP 的结合将产生比单独治疗更大的积极影响。该研究将由教师在学校健康课期间进行。如果证明是成功的，将这些项目纳入常规学校课程是相当可行的。