Systemic hypertension
Long-Term Effects of Stress Reduction on Mortality in Persons ≥55 Years of Age With Systemic Hypertension

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Psychosocial stress contributes to high blood pressure and subsequent cardiovascular morbidity and mortality. Previous controlled studies have associated decreasing stress with the Transcendental Meditation (TM) program with lower blood pressure. The objective of the present study was to evaluate, over the long term, all-cause and cause-specific mortality in older subjects who had high blood pressure and who participated in randomized controlled trials that included the TM program and other behavioral stress-decreasing interventions. Patient data were pooled from 2 published randomized controlled trials that compared TM, other behavioral interventions, and usual therapy for high blood pressure. There were 202 subjects, including 77 whites (mean age 81 years) and 125 African-American (mean age 66 years) men and women. In these studies, average baseline blood pressure was in the prehypertensive or stage I hypertension range. Follow-up of vital status and cause of death over a maximum of 18.8 years was determined from the National Death Index. Survival analysis was used to compare intervention groups on mortality rates after adjusting for study location. Mean follow-up was 7.6 ± 3.5 years. Compared with combined controls, the TM group showed a 23% decrease in the primary outcome of all-cause mortality after maximum follow-up (relative risk 0.77, p = 0.039). Secondary analyses showed a 30% decrease in the rate of cardiovascular mortality (relative risk 0.70, p = 0.045) and a 49% decrease in the rate of mortality due to cancer (relative risk 0.49, p = 0.16) in the TM group compared with combined controls. These results suggest that a specific stress-decreasing approach used in the prevention and control of high blood pressure, such as the TM program, may contribute to decreased mortality from all causes and cardiovascular disease in older subjects who have systemic hypertension.

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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).

    Dr. Alexander died on May 21, 1998.

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