The remarkable decline in cardiovascular disease (CVD) experienced in developed countries over the last 40 years appears to have abated. Currently, many CVD patients continue to show cardiac events despite optimal treatment of traditional risk factors. This evidence suggests that additional interventions, particularly those aimed at nontraditional factors, might be useful for continuing the decline. Psychosocial stress is a newly recognized (nontraditional) risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, (a) clustering of traditional cardiovascular risk factors, (b) endothelial dysfunction, (c) myocardial ischemia, (d) plaque rupture, (e) thrombosis, and (f) malignant arrhythmias. A better understanding of the behavioral and physiologic associations between psychosocial stress and CVD will assist researchers in identifying effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality.

Our objective was to identify endocrine-related mechanisms capable of mediating preventive effects of stress reduction in hypertensive heart disease. Since beneficial effects of stress reduction accrue over time, this cross-sectional, descriptive study sought differences between healthy students not practicing a systematic technique for reducing stress (the average stress, or AS, group, n = 33) and a similar group who for 8.5 years had practiced the Transcendental Meditation (TM) technique, used widely to reduce stress (the low stress, or LS, group, n = 22). The two groups of students, matched for age and area of study, performed timed collections of urine that included (separately) the entire waking and sleeping portions of 1 day. They also completed the Profile of Mood States and the State-Trait Anxiety Inventory, selfreport instruments sensitive to subjective level of stress. Urine samples were analyzed for adrenocortical steroids by radioimmunoassay, for Na⁺, K⁺, Mg²⁺, Ca²⁺, and Zn²⁺ by atomic absorption spectrometry, and for neurotransmitter metabolites by reverse-phase, high-performance, liquid chromatography, and spectrophotometry. The two groups differed significantly on most measures. Specifically, the LS group was lower in Cortisol and aldosterone and higher in dehydroepiandrosterone sulfate (DS) and the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA). Excretion of sodium, calcium, zinc, and the norepinephrine metabolite, vanillylmandelic acid (VMA), was also lower in this group, as were Na⁺/K⁺ ratio, mood disturbance, and anxiety. In women practicing TM, Cortisol correlated inversely and DS directly with number of months of TM practice. The results identify improvements in mood state, adrenocortical activity, and kidney function as probable factors in the preventive and treatment effects of stress reduction. Because suboptimal levels of these parameters result from chronic, subjective stress, the findings add mechanistic support to the contention that hypertensive heart disease is avoidable, even in modem industrialized societies.

Standard ambulatory night sleep electroencephalograph (EEG) of 11 long-term practitioners of the Transcendental Meditation (TM)® program reporting “higher states of consciousness” during sleep (the experimental group) was compared to that of nine short-term practitioners and 11 non-practitioners. EEG tracings during stages 3 and 4 sleep showed the experimental group to have: 1) theta-alpha activity simultaneously with delta activity and 2) decreased chin electromyograph (EMG) during deep sleep (p = 0.002) compared to short-term practitioners. Spectral analysis fast Fourier transform (FFT) data of the first three cycles showed that: 3) the experimental subjects had significantly greater theta2 (6–8 Hz)-alphal (8–10 Hz) relative power during stages 3 and 4 than the combined control groups [t(30) = 5.5, p = 0.0000008] with no difference in time in delta; 4) there was a graded difference across groups during stages 3 and 4 in theta2-alphal power, with experimentais having greater power than short-term practitioners, who in turn had greater power than non-practitioners [t(30) = 5.08, p = 0.00002]; and 5) experimentais also had increased rapid eye movement (REM) density during REM periods compared to short-term practitioners (p = 0.04). Previous studies have found increased theta-alpha EEG activity during reported periods of “transcendental consciousness” during the TM technique. In the Vedic tradition, as described by Maharishi Mahesh Yogi, transcendental consciousness is the first of a sequence of higher states. The maintenance of transcendental consciousness along with deep sleep is said to be a distinctive criterion of further, stabilized higher states of consciousness. The findings of this study are interpreted as physiological support for this model.

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 lifestyle 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.

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 stresses 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 control. 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.