Autonomic and Immuno-vascular Mechanisms of Antihypertensive Effects of Taichi

太极拳降压作用的自主神经和免疫血管机制

• 批准号: 9273603
• 负责人: Suzi Hong
• 金额: $ 71.98万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9273603
• 关键词: Acute; Adrenergic Agents; Adult; Age; American; Antihypertensive Agents; Anxiety; Arousal; Attenuated; Autonomic Pathways; Baroreflex; Behavioral; Blood Pressure; Blood Vessels; Cardiovascular Diseases; Cardiovascular system; Catecholamines; Cause of Death; Cessation of life; Clinical Trials; Diastolic blood pressure; Disease; Education; Elderly; Enrollment; Equilibrium; Exercise; Future; Health; Heart Rate; Hypertension; Immune; Immunologics; Impairment; Incidence; Individual; Inflammation; Inflammatory; Interruption; Intervention; Intervention Studies; Light; Literature; Measures; Mediating; Meditation; Methodology; Moods; Movement; Nature; Outcome; Parasympathetic Nervous System; Participant; Pathway interactions; Patients; Pharmacology; Physiologic pulse; Physiological; Population; Primary Prevention; Psychological Factors; Public Health; Randomized; Randomized Controlled Trials; Recovery; Regulation; Reporting; Rest; Role; Stroke; Sympathetic Nervous System; System; Tai Ji; Therapeutic; Training; Urine; Ursidae Family; Woman; anxiety symptoms; blood pressure reduction; depressive symptoms; design; follow-up; healthy aging; hemodynamics; immune activation; immunoregulation; improved; indexing; inflammatory marker; insight; men; premature; psychologic; psychological distress; public health relevance; randomized trial; rate of change; response

 DESCRIPTION (provided by applicant): This is a revised version of 1R01HL126056-01. In response to reviewers we have better delineated potential pathways of blood pressure (BP) reduction by Tai Chi (TC), enhanced our control condition to increase active participation, narrowed our BP enrollment criteria (stage 1 and mild stage 2 hypertension) and extended our follow-up to 9 months. Hypertension (HTN) is a pervasive problem in the US and worldwide. Over 30% of American adults have HTN, with the incidence increasing substantially with age; 64% of men and 78% of women over 65 having HTN. HTN is one of the most important causes of premature death worldwide and one of the most significant preventable causes of death. Numerous clinical trials have revealed benefits of lowering BP for reductions in cardiovascular (CV) disease, CV-related death and stroke. Although pharmacologic therapy is often emphasized for HTN management, the importance of non-pharmacologic approaches is recognized for disease interruption and bears vast public health significance. There is growing evidence that TC is effective in lowering BP for patients with HTN, ranging 7 - 32 mm Hg SBP in the literature but is considered inconclusive due to reduced methodological quality of existing studies. Rigorously designed randomized and controlled trials are in great need. Furthermore, the mechanisms by which TC training reduces BP are unknown. The `neurogenic hypothesis' of HTN describes the imbalance owing to elevated sympathetic nervous system (SNS) activation and parasympathetic nervous system (PNS) impairment in HTN. TC practice is shown to reduce psychological distress such as anxiety and depression symptoms and reduce physiological arousal which can potentially improve autonomic balance, resulting in reduced BP. However, no prior studies have delineated the pathways through which TC reduces BP in HTN. Thus, we plan to investigate the underlying pathways among autonomic, vascular-dynamic, immuno-vascular and psychological alterations in relation to BP changes pre to post 12-week TC compared to a Healthy Aging Practice-centered Education (HAP-E) control condition. 250 older adults (60-80 years old) with stage 1 and mild stage 2 HTN will be enrolled, and baroreflex sensitivity, heart rate and BP variability and post-exercise HR recovery will be measured to examine autonomic regulation. Post TC autonomic "re-regulation" is hypothesized to mediate TC effects on BP and vascular health measured by pulse wave velocity (Aim 1) and inflammation regulation by sympatho-adrenergic system (Aim 2). Lastly, TC effects on autonomic regulation is hypothesized to be mediated by psychological factors (Aim 3). Findings from our randomized and controlled intervention study will shed light on the psycho-neuro-vasculo-immunological underpinnings of antihypertensive efficacy of TC. Also, we would clarify the unique effects of TC ("meditative movement") in an older, "hard-to-treat" hypertensive population that would particularly benefit from this behavioral therapeutic.

 描述（由适用提供）：这是1R01HL126056-01的修订版。为了响应审阅者，我们更好地描绘了Tai Chi（TC）降低血压（BP）的潜在途径，增强了我们的控制条件以增加积极参与，缩小了我们的BP入学标准（第1阶段和轻度2期高血压），并将我们的随访扩展到9个月。在美国和世界范围内，高血压（HTN）是一个普遍的问题。超过30％的美国成年人患有HTN，事件随着年龄的增长而大大增加。 64％的男性和78％的女性超过65岁。 HTN是全球过早死亡的最重要原因之一，也是最重要的预防死亡原因之一。许多临床试验揭示了降低BP来减少心血管（CV）疾病，与CV相关的死亡和中风的好处。尽管经常强调HTN管理的药理疗法，但非药物方法的重要性在疾病中断中得到认可，并且具有广泛的公共健康意义。越来越多的证据表明，TC有效地降低了HTN患者的BP，在文献中介于7-32 mM Hg SBP范围内，但由于降低了现有研究的方法学质量，因此被认为尚无定论。严格设计的随机和对照试验非常需要。此外，TC培训降低BP的机制尚不清楚。 HTN的“神经源性假设”描述了HTN中的交感神经系统（SNS）激活和副交感神经系统（PNS）损害，这是由于HTN的较高的不平衡。 TC实践显示可减少心理困扰，例如焦虑和抑郁症状，并减少可能改善自主平衡的身体唤醒，从而减少BP。但是，先前的研究还没有描述TC在HTN中降低BP的途径。这是我们计划调查自主神经，血管动力，免疫 - 血管和心理变化的基本途径，而与健康的以衰老为中心的练习（HAP-E）控制条件相比，与BP变化有关。将招募250名具有第1阶段和轻度阶段HTN的老年人（60-80岁），将测量体力反射敏感性，心率和BP的变异性以及运动后HR恢复以检查自治调节。假设TC后自主神经“重新调节”可以介导通过脉冲波速度（AIM 1）（AIM 1）和通过交感形肾上腺素能系统调节的TC对BP和血管健康的影响（AIM 2）。最后，假设TC对自主法规的影响是由心理因素介导的（AIM 3）。我们随机和受控干预研究的发现将揭示出TC的降压效率的心理 - Neuro-neuro-debas-wastulo-dromunologic基础。此外，我们将阐明TC（“冥想运动”）在较旧的“难以治疗”高血压人群中的独特作用，这将从这种行为疗法中尤其受益。