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

Hypertension (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. (Daugirdas)

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H: Non drug therapy : Stress trduction and biofeedback
H: Special problems : Ethnic populations