Schneider RH, Staggers F, Alexander CN, Sheppard W, Rainforth
M, Kondwani K, Smith S, King CG
A randomized controlled trial of stress reduction for
hypertension in older African Americans
(Nov) 26:820-827 1995
One Holy Grail of hypertension therapy has been the pursuit of
non-pharmacologic methods of control. A key confounder in
evaluating such studies is, that a lowering of BP may be due
primarily to reduction of the "white coat" effect; 24 hour
ambulatory readings are really required to prove a benefit. In
this trial, Schneider et al applied the techniques of
Transcendental Meditation to African Americans with hypertension.
It has been alleged that elevated blood pressure in the group may
be related to chronic psychosocial stress. The intervention
group was TM versus a progressive muscle relaxation method used
as a control (PMR). The trial design was single-blind, with
follow up lasting 3 months. All patients underwent lifestyle modification
counseling. Fifty percent were taking antihypertensive
medications, and the doses of these were maintained constant.
Clinic systolic BP fell by 11 mm Hg in the TM group vs. 5 mm Hg
in the PMR group. Diastolic fell by 6.4 mm Hg in the TM group
vs. 3.3 in the PMR group. These changes were highly
statistically significant. However, home BP monitoring showed no
effect of either intervention of the home diastolic BP. The home
systolic BP did fall more in the TM group (9.6 mm Hg) than in the
PMR group (4.3 mm Hg), but whether or not this was statistically
different between the groups was not stated.
Comment: In the absence of 24-hour BP
measurements, it is very difficult to evaluate such a study.
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H: Non drug therapy :
Stress trduction and biofeedback
H: Special problems :