Mechanisms of the Relaxation Response in Elderly Hypertensives

老年高血压患者松弛反应的机制

• 批准号: 7686903
• 负责人: Jeffery A Dusek
• 金额: $ 16.55万
• 依托单位: ALLINA HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7686903
• 关键词: Acute; Adult; Adverse effects; Affect; Age; Age-Years; Antihypertensive Agents; Anxiety; Arousal; Attention; Audiotape; Blood Pressure; Blood Vessels; Cardiovascular Diseases; Cardiovascular system; Clinical; Data; Diastolic Hypertension; Diastolic blood pressure; Disease; Elderly; Epinephrine; Essential Hypertension; Event; Exhalation; Female; Foundations; Functional disorder; Health education; Home environment; Hormonal; Hormones; Hydrocortisone; Hypertension; Imagery; Incidence; Individual; Intervention; Left; Mediation; Mind-Body Intervention; Myocardial Infarction; Nitric Oxide; Patients; Pharmaceutical Preparations; Physicians; Plasma; Populations at Risk; Prevalence; Production; Pulse Pressure; Qi Gong; Randomized; Randomized Clinical Trials; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Relaxation; Risk; Severities; Stress; Stroke; Tai Ji; Testing; Therapeutic; Time; Training; Transcendental Meditation; Vasodilator Agents; Well in self; Yoga; aged; biological adaptation to stress; body-mind; cardiovascular risk factor; clinical effect; clinically significant; cost; deep breathing exercises; economic implication; effective intervention; effective therapy; hypertension treatment; improved; indexing; mindfulness; patient population; primary outcome; research study; response; secondary outcome; systolic hypertension; traditional therapy; volunteer; young adult

DESCRIPTION (provided by applicant): Systolic Hypertension is a disorder which is characterized by significant elevations in systolic blood pressure in association with normal diastolic blood pressure. Typically, this develops in individuals >50 years of age and is associated with an increased risk of stroke and myocardial infarction. While there are many effective therapies for essential/diastolic hypertension, the treatment of systolic hypertension is complicated by side effects from traditional therapies. This limits therapeutic options and has resulted in a number of at-risk individuals being left untreated. We have recently completed a preliminary study showing that 8-weeks of relaxation response (RR) training significantly reduced systolic blood pressure in individuals with SH. Systolic blood pressure was significantly decreased by 9.4 mmHg and pulse pressure by 7.9 mmHg. This finding would suggest that the RR may be an effective intervention with few to no adverse consequences in this patient population. In other experiments, we found that the RR increased exhaled nitric oxide in young adult volunteers and plasma nitric oxide in female volunteers. Since nitric oxide levels are low in some patients with essential hypertension, abnormalities in nitric oxide availability could be contributing to SH and might be altered by the RR. However, the actual mechanism by which the RR affects SH remains undetermined. Since the RR is known to alter sympathetic responses, this may be one mechanism which explains the effect of the RR on SH. Other mechanisms contributing to this effect could include alteration of vascular function via changes in nitric oxide production or hormonal alterations in sympathetic arousal (i.e., stress response). We hypothesize that the RR reduces systolic blood pressure and pulse pressure without significant side effects and that this occurs by increasing nitric oxide production and/or by reducing stress hormone levels (epinephrine and cortisol). To examine this hypothesis, we propose conducting a randomized, controlled trial (n=90) in which older adults with SH will receive either 8-weeks of RR intervention or Health Education (HE). The primary outcome is change in systolic blood pressure and pulse pressure. Secondary outcomes are changes in nitric oxide, stress hormones and psychological well-being. Additional analyses will be conducted to assess for other confounding effects on BP and PP. Aim 1: Assess if an 8-week RR intervention will decrease systolic blood pressure and pulse pressure compared with HE (control) without significant side effects. Aim 2: Evaluate whether 8-weeks of RR training increases levels of nitric oxide compared with HE. Aim 3: Assess whether 8-weeks of RR training decreases stress hormones (epinephrine and cortisol) and improves psychological well-being (global severity index and anxiety) compared with HE. While elevated systolic blood pressure and pulse pressure are important risk factors for cardiovascular events, concerns about side effects leave many physicians reluctant to treat this condition. Given the challenges of controlling systolic blood pressure pharmacologically and the prevalence of side effects produced by many antihypertensive agents, identification of non-pharmacologic approaches to decrease systolic blood pressure in older Systolic Hypertension (defined as SBP >140 mm Hg with normal diastolic blood pressure (DBP <90 mm Hg) patients could contribute significantly to the treatment of this condition. These positive effects could have significant economic implications by providing a low-cost adjunctive therapy to current pharmacologic approaches and potentially reduce the incidence of cardiovascular events.

描述（由申请人提供）：收缩性高血压是一种以收缩压显着升高而舒张压正常为特征的疾病。通常，这种情况发生在 50 岁以上的个体中，并且与中风和心肌梗塞的风险增加相关。虽然对于原发性/舒张期高血压有许多有效的治疗方法，但传统疗法的副作用使收缩期高血压的治疗变得复杂。这限制了治疗选择，并导致许多高危人群得不到治疗。我们最近完成的一项初步研究表明，为期 8 周的放松反应 (RR) 训练可显着降低 SH 患者的收缩压。收缩压显着降低 9.4 mmHg，脉压显着降低 7.9 mmHg。这一发现表明，RR 可能是一种有效的干预措施，对该患者群体几乎没有不良后果。在其他实验中，我们发现 RR 增加了年轻成年志愿者的呼出一氧化氮和女性志愿者的血浆一氧化氮。由于某些原发性高血压患者的一氧化氮水平较低，一氧化氮可用性异常可能会导致 SH，并且可能会被 RR 改变。然而，RR 影响 SH 的实际机制仍未确定。由于已知 RR 会改变交感神经反应，这可能是解释 RR 对 SH 影响的一种机制。促成这种效应的其他机制可能包括通过一氧化氮产生的变化或交感神经兴奋（即应激反应）的激素变化来改变血管功能。我们假设 RR 可以降低收缩压和脉压，而没有明显的副作用，并且这是通过增加一氧化氮的产生和/或降低应激激素水平（肾上腺素和皮质醇）来实现的。为了检验这一假设，我们建议进行一项随机对照试验 (n=90)，其中患有 SH 的老年人将接受为期 8 周的 RR 干预或健康教育 (HE)。主要结果是收缩压和脉压的变化。次要结果是一氧化氮、应激激素和心理健康的变化。将进行额外的分析以评估对 BP 和 PP 的其他混杂影响。目标 1：评估 8 周 RR 干预是否会比 HE（对照）降低收缩压和脉压，且没有明显副作用。目标 2：评估与 HE 相比，8 周的 RR 训练是否会增加一氧化氮水平。目标 3：评估与 HE 相比，8 周的 RR 训练是否可以降低压力激素（肾上腺素和皮质醇）并改善心理健康（整体严重指数和焦虑）。虽然收缩压和脉压升高是心血管事件的重要危险因素，但对副作用的担忧使许多医生不愿意治疗这种情况。鉴于药物控制收缩压的挑战以及许多抗高血压药物产生的副作用普遍存在，确定降低老年收缩期高血压（定义为收缩压 >140 mm Hg，舒张压正常）的非药物方法DBP <90 mm Hg）患者可以为这种疾病的治疗做出重大贡献，通过为当前的情况提供低成本的辅助治疗，这些积极效果可能会产生重大的经济影响。药物方法并可能降低心血管事件的发生率。