title: Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans.
abstract: BACKGROUND
  African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease. Psychosocial stress, lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease. This study evaluated effects of stress reduction and lifestyle modification on blood pressure, telomerase gene expression and lifestyle factors in African Americans.
  
  
  METHODS
  Forty-eight African American men and women with stage I hypertension who participated in a larger randomized controlled trial volunteered for this substudy. These subjects participated in either stress reduction with the Transcendental Meditation technique and a basic health education course (SR) or an extensive health education program (EHE) for 16 weeks. Primary outcomes were telomerase gene expression (hTERT and hTR) and clinic blood pressure. Secondary outcomes included lifestyle-related factors. Data were analyzed for within-group and between-group changes.
  
  
  RESULTS
  Both groups showed increases in the two measures of telomerase gene expression, hTR mRNA levels (SR: p< 0.001; EHE: p< 0.001) and hTERT mRNA levels (SR: p = 0.055; EHE: p< 0.002). However, no statistically significant between-group changes were observed. Both groups showed reductions in systolic BP. Adjusted changes were SR = -5.7 mm Hg, p< 0.01; EHE = -9.0 mm Hg, p < 0.001 with no statistically significant difference between group difference. There was a significant reduction in diastolic BP in the EHE group (-5.3 mm Hg, p< 0.001) but not in SR (-1.2 mm Hg, p = 0.42); the between-group difference was significant (p = 0.04). The EHE group showed a greater number of changes in lifestyle behaviors.
  
  
  CONCLUSIONS
  In this pilot trial, both stress reduction (Transcendental Meditation technique plus health education) and extensive health education groups demonstrated increased telomerase gene expression and reduced BP. The association between increased telomerase gene expression and reduced BP observed in this high-risk population suggest hypotheses that telomerase gene expression may either be a biomarker for reduced BP or a mechanism by which stress reduction and lifestyle modification reduces BP.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00681200.
authors.affiliation: Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America.|Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America.|MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Duraimani
authors.affiliation: Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America.|Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Schneider
authors.affiliation: Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America.
authors.forename: Otelio S
authors.initials: OS
authors.lastname: Randall
authors.affiliation: Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America.|Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America.
authors.forename: Sanford I
authors.initials: SI
authors.lastname: Nidich
authors.affiliation: Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America.
authors.forename: Shichen
authors.initials: S
authors.lastname: Xu
authors.affiliation: Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America.
authors.forename: Muluemebet
authors.initials: M
authors.lastname: Ketete
authors.affiliation: Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America.
authors.forename: Maxwell A
authors.initials: MA
authors.lastname: Rainforth
authors.affiliation: Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Gaylord-King
authors.affiliation: Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America.
authors.forename: John W
authors.initials: JW
authors.lastname: Salerno
authors.affiliation: Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America.|MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America.
authors.forename: John
authors.initials: J
authors.lastname: Fagan
mesh_terms: D001741:Black or African American; D000368:Aged; D001794:Blood Pressure; D005260:Female; D015971:Gene Expression Regulation, Enzymologic; D006266:Health Education / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000201:enzymology* / Q000628:therapy*; D008019:Life Style; D008297:Male; D019122:Meditation; D008875:Middle Aged; D010865:Pilot Projects; D013315:Stress, Psychological; D019098:Telomerase / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: C509186:TERT protein, human; D019098:Telomerase