Systemic hypertensionLong-Term Effects of Stress Reduction on Mortality in Persons ≥55 Years of Age With Systemic Hypertension
Section snippets
Clinical trials
Computerized and manual searches of the literature were used to locate published reports that met the following criteria: (1) randomized controlled trial design, (2) blood pressure as a primary outcome, and (3) studies that compared the effects of the TM program with those of other behavioral control interventions. Two trials met the search criteria and provided data for the present pooled analysis.6, 7, 8
The methods of the trial by Alexander et al8 have been described in detail. In brief, the
Results
For all subjects in the pooled study, mean age ± SD was 72.0 ± 10.6 years, 67% were women, and systolic blood pressure was 144 ± 15.6 mm Hg. Mean follow-up times were 8.45 ± 4.83 years in study 1, 7.13 ± 2.15 years in study 2, and 7.63 ± 3.48 years for studies 1 and 2. Table 1 presents the number of all-cause and disease-specific mortality events in each study for the on-trial analysis. Table 2 presents the number of mortality events for the intention-to-treat analysis. Table 3 presents the
Discussion
The results of this retrospective long-term follow-up of 2 randomized controlled trials of decreasing stress and high blood pressure in older subjects suggest that a selected behavioral approach, the TM program, is associated with significantly lower mortality rates compared with other behavioral interventions and usual care. The decreases in risk were 23% for all-cause mortality and 30% for cardiovascular mortality, and there was a trend for cancer mortality over the 7.6-year mean, 18.8-year
Acknowledgment
The investigators are grateful to William Sheppard, PhD, and Marcelino Aguilar-Cervantes, MS, for technical assistance and editorial consultation.
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This study was supported in part by a Specialized Center of Research grant from the National Institutes of Health, Bethesda, Maryland (Grant 1P50AT00082 from the National Center for Complementary and Alternative Medicine).
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Dr. Alexander died on May 21, 1998.