Maxwell Rainforth

A Randomized Controlled Trial of Stress Reduction for Hypertension in Older African Americans

We tested the short-term efficacy and feasibility of two stress education approaches toe the treatment of mild hypertension in older African Americans. This was a randomized, controlled, single-blind trial with 3 months of follow-up in primary care, inner-city health center. Of 213 African American men and women screened, 127 individuals (aged 55 to 85 years with initial diastolic pressure of 90 to 109 mm Hg, systolic pressure of < or = 189 mm Hg, and final baseline blood pressure of < or = 179/104 mm Hg) were selected. Of these, 16 did not complete follow-up blood pressure measurements. Mental and physical stress reduction approaches (Transcendental Meditation and progressive muscle relaxation) were compared with a lifestyle modification education control program and with each other. The primary outcome measures were changes in clinic diastolic and systolic pressures from baseline to final follow-up, measured by blinded observers. The secondary measures were linear blood pressure trends, changes in home blood pressure, and intervention compliance. Adjusted for significant baseline differences and compared with control, Transcendental Meditation reduced systolic pressure by 10.7 mm Hg (P < .0003) and diastolic pressure by 6.4 mm Hg (P <.00005). Progressive muscle relaxation lowered systolic pressure by 4.7 mm Hg (P = 0054) and diastolic pressure by 3.3 mm Hg (P <.02). The reductions in the Transcendental Meditation group were significantly greater than in the progressive muscle relaxation group for both systolic blood pressure (P = .02) and diastolic blood pressure (P = .03). Linear trend analysis confirmed these patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of Stress Reduction on Carotid Atherosclerosis in Hypertensive African Americans

BACKGROUND AND PURPOSE African Americans suffer disproportionately higher cardiovascular disease mortality rates than do whites. Psychosocial stress influences the development and progression of atherosclerosis. Carotid intima-media thickness (IMT) is a valid surrogate measure for coronary atherosclerosis, is a predictor of coronary outcomes and stroke, and is associated with psychosocial stress factors. Stress reduction with the Transcendental Meditation (TM) program decreases coronary heart disease risk factors and cardiovascular mortality in African Americans. B-mode ultrasound is useful for the noninvasive evaluation of carotid atherosclerosis. METHODS This randomized controlled clinical trial evaluated the effects of the TM program on carotid IMT in hypertensive African American men and women, aged >20 years, over a 6- to 9-month period. From the initially enrolled 138 volunteers, 60 subjects completed pretest and posttest carotid IMT data. The assigned interventions were either the TM program or a health education group. By use of B-mode ultrasound, mean maximum IMT from 6 carotid segments was used to determine pretest and posttest IMT values. Regression analysis and ANCOVA were performed. RESULTS Age and pretest IMT were found to be predictors of posttest IMT values and were used as covariates. The TM group showed a significant decrease of -0.098 mm (95% CI -0. 198 to 0.003 mm) compared with an increase of 0.054 mm (95% CI -0.05 to 0.158 mm) in the control group (P=0.038, 2-tailed). CONCLUSIONS Stress reduction with the TM program is associated with reduced carotid atherosclerosis compared with health education in hypertensive African Americans. Further research with this stress-reduction technique is warranted to confirm these preliminary findings.

Trial of Stress Reduction for Hypertension in Older African Americans II. Sex and Risk Subgroup Analysis

Our objective was to test the short-term efficacy and feasibility of two stress-reduction approaches for the treatment of hypertension in older African Americans, focusing on subgroup analysis by sex and by high and low risk on six measures of hypertension risk: psychosocial stress, obesity, alcohol use, physical inactivity, dietary sodium-potassium ratio, and a composite measure. The study involved a follow-up subgroup analysis of a 3-month randomized, controlled, single-blind trial conducted in a primary care, inner-city health center. Subjects were 127 African American men and women, aged 55 to 85 years, with diastolic pressure of 90 to 104 mm Hg and systolic pressure less than or equal to 179 mm Hg. Of these, 16 did not complete follow-up blood pressure measurements. Mental and physical stress-reduction approaches-the Transcendental Meditation technique and progressive muscle relaxation, respectively-were compared with a life-style modification education control and with each other. Both systolic and diastolic pressures changed from baseline to follow-up for both sexes and for high and low risk level (defined by median split) on the six measures of hypertension risk. Compared with education control subjects, women practicing the Transcendental Meditation technique showed adjusted declines in systolic (10.4 mm Hg, P < .01) and diastolic (5.9 mm Hg, P < .01) pressures. Men in this treatment group also declined in both systolic (12.7 mm Hg, P < .01) and diastolic (8.1 mm Hg, P < .001) pressures compared with control subjects. Women practicing muscle relaxation did not show a significant decrease compared with control subjects, and men declined significantly in diastolic pressure only (6.2 mm Hg, P < .01). For the measure of psychosocial stress, both the high and low risk subgroups using the Transcendental Meditation technique declined in systolic (high risk, P = .0003; low, P = .06) and diastolic (high risk, P = .001; low, P = .008) pressures compared with control subjects, whereas for muscle relaxation, blood pressure dropped significantly only in the high risk subgroup and only for systolic pressure (P = .03) compared with control subjects. For each of the other five risk measures, Transcendental Meditation subjects in both the high and low risk groups declined significantly in systolic and diastolic pressures compared with control subjects. Effects of stress reduction on blood pressure were found to generalize to both sexes and diverse risk factor subgroups and were significantly greater in the Transcendental Meditation treatment group. These effects (along with high compliance) even in individuals with multiple risk factors for hypertension clearly warrant longer-term investigation in this and other populations.

A Controlled Study of the Effects of the Transcendental Meditation® Program on Cardiovascular Reactivity and Ambulatory Blood Pressure

Cardiovascular responses to stress reactivity has been proposed as a risk factor for hypertension. In this study, we evaluated the effects of stress reduction on both laboratory cardiovascular reactivity and ambulatory blood pressure in real life on 39 normotensive male subjects who were pretested for ambulatory blood pressure and cardiovascular reactivity to stress using a battery of laboratory stressors. Thereafter, subjects were randomly assigned to practice either the Transcendental Meditation (TM) technique or a cognitive-based stress education control (SEC) for four months. After 4 months, there was no change in cardiovascular response to stressors between the TM and control groups. However, the subjects regularly practicing TM demonstrated a significant reduction of 9 mm Hg (p < .04) in average ambulatory DBP compared to controls. Since ambulatory BP monitoring has been shown to be a better predictor of cardiovascular complications of hypertension than clinic BP, this finding may have important implications for primary prevention of CVD in normotensive subjects.

Stress Reduction in the Secondary Prevention of Cardiovascular Disease Randomized, Controlled Trial of Transcendental Meditation and Health Education in Blacks

Background—Blacks have disproportionately high rates of cardiovascular disease. Psychosocial stress may contribute to this disparity. Previous trials on stress reduction with the Transcendental Meditation (TM) program have reported improvements in cardiovascular disease risk factors, surrogate end points, and mortality in blacks and other populations. Methods and Results—This was a randomized, controlled trial of 201 black men and women with coronary heart disease who were randomized to the TM program or health education. The primary end point was the composite of all-cause mortality, myocardial infarction, or stroke. Secondary end points included the composite of cardiovascular mortality, revascularizations, and cardiovascular hospitalizations; blood pressure; psychosocial stress factors; and lifestyle behaviors. During an average follow-up of 5.4 years, there was a 48% risk reduction in the primary end point in the TM group (hazard ratio, 0.52; 95% confidence interval, 0.29–0.92; P=0.025). The TM group also showed a 24% risk reduction in the secondary end point (hazard ratio, 0.76; 95% confidence interval, 0.51–0.1.13; P=0.17). There were reductions of 4.9 mmHg in systolic blood pressure (95% confidence interval −8.3 to –1.5 mmHg; P=0.01) and anger expression (P<0.05 for all scales). Adherence was associated with survival. Conclusions—A selected mind–body intervention, the TM program, significantly reduced risk for mortality, myocardial infarction, and stroke in coronary heart disease patients. These changes were associated with lower blood pressure and psychosocial stress factors. Therefore, this practice may be clinically useful in the secondary prevention of cardiovascular disease. Clinical Trial Registration—URL: www.clinicaltrials.gov Unique identifier: NCT01299935.

Effects of the transcendental meditation program on stress reduction, health, and employee development: A prospective study in two occupational settings

Abstract Despite the high cost of occupational stress, few studies have empirically documented effective methods for alleviating stress and promoting employee development. This three-month prospective study evaluated the effects of the Transcendental meditation (TM) technique on stress reduction, health and employee development in two settings in the automotive industry: a large manufacturing plant of a Fortune 100 corporation, and a small distribution sales company. Employees who learned TM were compared to controls similar in worksite, job position, demographic, and pretest characteristics. Regular meditators improved significantly more than controls (with irregular meditators scoring in between) on multiple measures of stress and employee development, including: reduced physiological arousal (measured by skin conductance levels) during and outside TM practice; decreased trait anxiety, job tension, insomnia and fatigue, cigarette and hard liquor use; improved general health (and fewer health complaints)...

Effects of Transcendental Meditation practice on brain functioning and stress reactivity in college students

This randomized controlled trial investigated effects of Transcendental Meditation (TM) practice on Brain Integration Scale scores (broadband frontal coherence, power ratios, and preparatory brain responses), electrodermal habituation to 85-dB tones, sleepiness, heart rate, respiratory sinus arrhythmia, and P300 latencies in 50 college students. After pretest, students were randomly assigned to learn TM immediately or learn after the 10-week posttest. There were no significant pretest group differences. A MANOVA of students with complete data (N=38) yielded significant group vs treatment interactions for Brain Integration Scale scores, sleepiness, and habituation rates (all p<.007). Post hoc analyses revealed significant increases in Brain Integration Scale scores for Immediate-start students but decreases in Delayed-start students; significant reductions in sleepiness in Immediate-start students with no change in Delayed-start students; and no changes in habituation rates in Immediate-start students, but significant increases in Delayed-start students. These data support the value of TM practice for college students.

A Randomized Controlled Trial on Effects of the Transcendental Meditation Program on Blood Pressure, Psychological Distress, and Coping in Young Adults

BACKGROUND Psychological distress contributes to the development of hypertension in young adults. This trial assessed the effects of a mind-body intervention on blood pressure (BP), psychological distress, and coping in college students. METHODS This was a randomized controlled trial (RCT) of 298 university students randomly allocated to either the Transcendental Meditation (TM) program or wait-list control. At baseline and after 3 months, BP, psychological distress, and coping ability were assessed. A subgroup of 159 subjects at risk for hypertension was analyzed similarly. RESULTS Changes in systolic BP (SBP)/diastolic BP (DBP) for the overall sample were -2.0/-1.2 mm Hg for the TM group compared to +0.4/+0.5 mm Hg for controls (P = 0.15, P = 0.15, respectively). Changes in SBP/DBP for the hypertension risk subgroup were -5.0/-2.8 mm Hg for the TM group compared to +1.3/+1.2 mm Hg for controls (P = 0.014, P = 0.028, respectively). Significant improvements were found in total psychological distress, anxiety, depression, anger/hostility, and coping (P values < 0.05). Changes in psychological distress and coping correlated with changes in SBP (P values < 0.05) and DBP (P values < 0.08). CONCLUSIONS This is the first RCT to demonstrate that a selected mind-body intervention, the TM program, decreased BP in association with decreased psychological distress, and increased coping in young adults at risk for hypertension. This mind-body program may reduce the risk for future development of hypertension in young adults.

Effects of Group Practice of the Transcendental Meditation Program on Preventing Violent Crime in Washington, D.C.: Results of the National Demonstration Project, June--July 1993

This paper reports the results of a prospective experiment in which a group of approximately 4,000 participants in the Transcendental Meditation and TM-Sidhi programs of Maharishi Mahesh Yogi assembled in Washington, D.C., from June 7 to July 30, 1993. It was hypothesized that levels of violent crime in the District of Columbia would fall substantially during the Demonstration Project, as a result of the groups effect of increasing coherence and reducing stress in the collective consciousness of the District. A 27-member Project Review Board comprising independent scientists and leading citizens approved the research protocol and monitored the research process. Weekly crime data was derived from database records provided by the District of Columbia Metropolitan Police Department (DCMPD), which are used in the FBI Uniform Crime Reports. Statistical analysis considered the effect of weather variables, daylight, historical crime trends and annual patterns in the District of Columbia, as well as trends in neighboring cities. Consistent with previous research, levels of homicides, rapes and assaults (HRA crimes) correlated with average weekly temperature. Robberies approximately followed an annually recurring cycle. Time series analysis of 1993 data, controlling for temperature, showed that HRA crimes dropped significantly during the Demonstration Project, corresponding with increases in the size of the group; the maximum decrease was 23.3% (p < 2 × 10−9) [24.6% using a longer baseline, with 1988--1993 data (p < 3 × 10−5)], coincident with the peak number of participants in the group during the final week of the assembly. When the same period in each of the five previous years was examined, no significant decreases in HRA crimes were found. Robberies did not decrease significantly. However, a model that jointly estimated the effect of the Demonstration Project on both HRA crimes and robberies showed a significant reduction in violent crimes overall of 15.6% (p = 0.0008). Further analysis showed that the effect of the coherence-creating group on reducing HRA crimes could not be accounted for by additional police staffing. The time series analysis for HRA crimes gave results that are highly robust to alternative model specifications, and showed that the effect of the group size was cumulative and persisted after the Demonstration Project ended. Also, calculation of the steady state gain based on the time series model predicted that a permanent group of 4,000 coherence-creating experts in the District would have a long-term effect of reducing HRA crimes by 48%.

A Randomized Controlled Trial of the Effects of Transcendental Meditation on Quality of Life in Older Breast Cancer Patients

This single-blind, randomized controlled trial evaluated the impact of the Transcendental Meditation program plus standard care as compared with standard care alone on the quality of life (QOL) of older women (≥55 years) with stage II to IV breast cancer. One hundred and thirty women (mean age = 63.8) were randomly assigned to either experimental (n = 64) or control (n = 66) groups. Functional Assessment of Cancer Therapy—Breast (FACT-B), Functional Assessment of Chronic Illness Therapy— Spiritual Well-Being (FACIT-SP), and Short-Form (SF)-36 mental health and vitality scales were administered every 6 months over an average 18-month intervention period. Significant improvements were found in the Transcendental Meditation group compared with controls in overall QOL, measured by the FACT-B total score (P = .037), emotional well-being (P = .046), and social well-being (P = .003) subscales, and SF-36 mental health ( P = .017). Results indicate that the Transcendental Meditation technique improves the QOL of older breast cancer patients. It is recommended that this stress reduction program, with its ease of implementation and home practice, be adopted in public health programs.