Telephone-based mindfulness training to reduce blood pressure in Black women with hypertension in the Jackson Heart Study

杰克逊心脏研究中基于电话的正念训练可降低患有高血压的黑人女性的血压

• 批准号: 10678779
• 负责人: TANYA M Spruill
• 金额: $ 73.55万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-07 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10678779
• 关键词: Address; Adverse effects; Affect; American Heart Association; Ancillary Study; Attention; Awareness; Behavioral; Black Populations; Black race; Blood Pressure; Cardiovascular Diseases; Cause of Death; Characteristics; Chronic; Chronic stress; Clinic; Clinical Trials; Cognitive; Cohort Studies; Compassion; Conflict (Psychology); Consent; Coping Skills; Data; Diet; Discrimination; Disease Outcome; Disparity; Educational process of instructing; Effectiveness; Eligibility Determination; Emotions; Enrollment; Ethnic Population; Evidence based program; Exposure to; Family; Female; Financial Hardship; Funding; Gender; Health; Health behavior; Heart Diseases; High Prevalence; Home; Home Blood Pressure Monitoring; Hypertension; Infrastructure; Intervention; Jackson Heart Study; Life Style; Longitudinal cohort study; Measures; Mediator; Meditation; Mental Health; Mindfulness Training; Morbidity - disease rate; Myocardial Infarction; Nature; Outcome; Participant; Patient Self-Report; Persons; Physical activity; Population; Prevalence; Psychological Factors; Psychosocial Factor; Psychosocial Stress; Qualitative Research; Questionnaires; Race; Randomized; Reporting; Research Design; Research Support; Risk Factors; Sampling; Schedule; Self Care; Sexism; Sleep; Social support; Stress; Stressful Event; Subgroup; Support Groups; Telephone; Testing; Therapeutic; Time; Training; Trust; United States; Woman; Work; behavior change; behavioral outcome; black women; blood pressure control; blood pressure reduction; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; caregiving; cohesion; cohort; coping; depressive symptoms; eligible participant; emotion regulation; experience; follow-up; high risk; hypertension control; improved; innovation; intervention effect; medication compliance; men; mindfulness; mindfulness based cognitive therapy; mindfulness intervention; mortality; novel; novel strategies; perceived stress; physical conditioning; prehypertension; primary outcome; programs; psychologic; psychological outcomes; psychosocial; racial population; real time monitoring; resilience; rumination; secondary outcome; social; social expectations; social factors; stress symptom; stressor; telephone based; telephone delivery; telephone session; transmission process; treatment response; wireless; wireless electronic

ABSTRACT Black women experience disproportionately high rates of hypertension compared to women of other racial and ethnic groups, and their blood pressure (BP) control rates are well below targets despite high levels of awareness and treatment. There is an urgent need for effective nonpharmacological strategies beyond lifestyle behavior change to improve hypertension and cardiovascular disease (CVD) outcomes in this understudied population. Chronic psychosocial stress is associated with hypertension and CVD. Black women are exposed to both race- and gender-based stressors and may employ coping strategies (e.g., emotion suppression, self- care postponement) that increase vulnerability to stress. While many stressful events and circumstances cannot be avoided, adaptive coping can mitigate adverse effects of stress exposure. Mindfulness-based cognitive therapy (MBCT) is an evidence-based program that teaches meditation practices and cognitive strategies to reduce perceived stress and negative emotions. Qualitative research supports the cultural relevance of mindfulness interventions for Black women but clinical trial evidence in this population is limited. Further, the burdensome nature of traditional in-person MBCT poses a significant barrier to participation. We have adapted MBCT for delivery to small groups by telephone (MBCT-T) and our preliminary data support the feasibility, acceptability and effects of the intervention. We propose an RCT to evaluate effects of MBCT-T on BP and psychological outcomes in Black women with uncontrolled hypertension in the Jackson Heart Study (JHS) - a longitudinal cohort study designed to investigate the causes of CVD in Blacks. A sample of 300 female JHS participants with uncontrolled hypertension will be enrolled and randomized to MBCT-T or telephone-based support groups (TSG), an active comparison condition. Both programs involve 8 weekly group-based phone sessions. The primary outcome is home (HBP), a better predictor of CVD risk than clinic BP, measured for 7 days at baseline and 3- and 6-month follow-up with validated wireless devices. Secondary outcomes are perceived stress and depressive symptoms. Measures of chronic stress, coping, resilience and potential psychological, social and behavioral mediators of intervention effects will be assessed. Data from the three prior JHS exams and 20 years of annual follow-up data will also be used to characterize long-term levels of psychosocial factors that may help to explain variability in treatment response. The specific aims are to: (1) Test the hypothesis that MBCT-T will be associated with greater 6-month reductions in systolic BP vs. TSG; (2) Test the hypothesis that MBCT-T will be associated with greater 6-month reductions in perceived stress and depressive symptoms vs. TSG; and (3) Explore potential mediators and moderators of intervention effects on BP and secondary outcomes. Findings will advance understanding of stress, coping and effects of mindfulness training in Black women. If effective, this scalable psychosocial intervention has the potential to positively impact hypertension and other health outcomes among Black women in the JHS cohort and beyond.

抽象的 与其他种族和地区的女性相比，黑人女性的高血压发病率高得不成比例。 尽管血压水平很高，但他们的血压 (BP) 控制率仍远低于目标 意识和治疗。迫切需要生活方式以外的有效非药物策略 行为改变可改善高血压和心血管疾病 (CVD) 的结果 人口。慢性社会心理压力与高血压和心血管疾病有关。黑人女性暴露了 应对基于种族和性别的压力源，并可能采取应对策略（例如情绪抑制、自我 护理推迟）会增加人们对压力的脆弱性。虽然许多有压力的事件和情况 无法避免，适应性应对可以减轻压力暴露的不利影响。以正念为基础 认知疗法（MBCT）是一种循证疗法，教授冥想练习和认知疗法。 减少感知压力和负面情绪的策略。定性研究支持文化 正念干预措施与黑人女性的相关性，但针对该人群的临床试验证据有限。 此外，传统面对面 MBCT 的繁琐性质对参与构成了重大障碍。我们 已采用 MBCT 通过电话向小组提供服务 (MBCT-T)，我们的初步数据支持 干预措施的可行性、可接受性和效果。我们提出了一项随机对照试验来评估 MBCT-T 对 杰克逊心脏研究中高血压未受控制的黑人女性的血压和心理结果 (JHS) - 一项纵向队列研究，旨在调查黑人 CVD 的原因。样本300个 高血压未受控制的女性 JHS 参与者将被纳入并随机分配至 MBCT-T 或 基于电话的支持小组（TSG），一种主动比较条件。这两个项目都包含 8 周 基于小组的电话会议。主要结局是家庭 (HBP)，比诊所更好地预测 CVD 风险 血压，使用经过验证的无线设备进行 7 天的基线测量和 3 个月和 6 个月的随访。中学 结果是感知到的压力和抑郁症状。慢性压力、应对、复原力和 将评估干预效果的潜在心理、社会和行为中介因素。数据来自 之前的三项 JHS 检查和 20 年的年度跟踪数据也将用于表征长期水平 可能有助于解释治疗反应变异性的心理社会因素。具体目标是：（1） 检验 MBCT-T 与 TSG 相比与 6 个月收缩压更大程度降低相关的假设； (2) 检验 MBCT-T 与 6 个月内感知压力和感知压力的更大程度减少相关的假设 抑郁症状与 TSG； (3) 探索干预效应的潜在中介因素和调节因素 血压和次要结果。研究结果将增进对压力、应对方式和正念影响的理解 对黑人妇女进行培训。如果有效，这种可扩展的心理社会干预措施有可能积极促进 影响 JHS 队列及其他黑人女性的高血压和其他健康结果。