***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Meditation training appears to be a promising psychological approach to the control of hypertension . However , most studies to date have had serious deficiencies . This study attempted to correct many of these deficiencies . Forty-one unmedicated hypertensives referred by general practitioners were r and omly allocated to three groups . The treatment group ( SRELAX ) underwent training procedures based on Transcendental Meditation ; a placebo control group ( NSRELAX ) underwent identical training but without a mantra . Both procedures were compared with a no-treatment control group . The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups , compared with the no-treatment controls , with diastolic percentage reductions reaching significance ( p<0.05 ) . There was considerable subject variation in response , with overall a mean decline in diastolic blood pressure of 8–10 % on 3-month follow-up . Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed OBJECTIVE This study examined the impact of the Transcendental Meditation ( TM ) program on cardiovascular ( CV ) reactivity in adolescents with high normal BP . METHOD Thirty-five adolescents [ 34 African Americans ( AAs ) , 1 Caucasian American ( CA ) ; ages 15 - 18 years ] with resting systolic blood pressure ( SBP ) between the 85th and 95th percentile for their age and gender on three consecutive occasions , were r and omly assigned to either TM ( n=17 ) or health education control ( CTL , n=18 ) groups . The TM group engaged in 15-min meditation twice each day for 2 months including sessions during school lunch break . Primary CV outcome measures were changes in blood pressure ( BP ) , heart rate ( HR ) , and cardiac output ( CO ) at rest and in response to two laboratory stressors , a simulated car driving stressor and an interpersonal social stressor interview . RESULTS The TM group exhibited greater decreases in resting SBP ( P<.03 ) from pre- to postintervention , compared to the CTL group . The TM group exhibited greater decreases from pre- to postintervention in SBP , HR , and CO reactivity ( P's<.03 ) to the simulated car driving stressor , and in SBP reactivity ( P<.03 ) to the social stressor interview . CONCLUSION The TM program appears to have a beneficial impact upon CV functioning at rest and during acute laboratory stress in adolescents at-risk for hypertension 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 r and omized 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 & NA ; We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication . The effect was assessed in multiple setting s , including the relaxation therapist 's office , the Hypertension Clinic , and the patient 's natural environment , the latter using 24‐hour automated ambulatory blood pressure measures . Nineteen patients were r and omized  either to temperature biofeedback‐assisted relaxation or to an attention control , “ stress education . ” Antihypertensive medication was kept constant . In the behavioral therapist 's office , blood pressure decreased in equivalent amounts with both treatments . Hypertension Clinic nurse blood pressure remained stable or increased with both treatments , but again there was no difference between treatments . Ambulatory blood pressure increased with relaxation therapy and decreased with stress education , the effect being significant for diastolic pressure . The effects on ambulatory blood pressure were limited to the waking hours . The only variable that showed superior effects for relaxation therapy was physician‐determined blood pressure . These results call into question the generalizability of the effects of relaxation therapy from one setting to another Thirty-three moderate hypertensives were converted to a 2-drug regimen of metoprolol and diuretic and BPs stabilized at a well-controlled level . They then completed one of three conditions over an 8-week interval : ( I ) 16 sessions of TBF ( h and and foot warming ) ; ( II ) 16 sessions of frontal EMG-BF ; ( III ) regular home monitoring of BP . Attempts were then made to withdraw the patients from the sympatholytic medication . Those successfully withdrawn were followed up for one year . There were no significant advantages for TBF over the other two conditions in the short term or with long-term follow-up . Only 27 % of treated patients ( including Condition III failures who were remedicated and treated with TBF ) were successfully off of the sympatholytic at a one-year follow-up . The generally poor results on clinical outcome were confirmed by clinic BPs , home BPs by patients , and 24-hour ambulatory BPs We have conducted a cross-cultural ( USA and USSR ) comparison of thermal biofeedback ( TBF ) and autogenic training ( AT ) to a self-relaxation control condition in 59 unmedicated males with mild hypertension . Identical assessment and treatment protocol s were carried out in both setting s ( Albany , New York , and Moscow ) . Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks . Results showed comparable , significant ( p less than .05 ) , short-term decreases ( M = 8.5 mm Hg ) in diastolic blood pressure ( DBP ) for both treatments at both sites . However , the Soviet patients , starting with significantly ( p less than .01 ) higher systolic blood pressures ( SBPs ) , showed significant decreases ( M = 12.8 mm Hg ) in SBP , whereas the American patients did not change appreciably ( M = 4.6 mm Hg ) . During follow-up , the treated Soviet patients showed significantly ( p less than .05 ) better maintenance of treatment effects , from 3 months to 1 year , than did the American patients . At 1 year , 75 % of the treated Soviet patients had DBPs less than 90 mm Hg , whereas only 24 % of the American patients had comparable DBPs & NA ; This industry‐based r and omized study compared the effects of behavioral treatment ( BT ) and blood pressure monitoring ( BPM ) on blood pressure ( BP ) change in 158 unmedicated persons with mild hypertension ( diastolic blood pressure 90 to 104 mm Hg ) . Participants recruited by a three‐stage screening were r and omly assigned to BT or BPM groups and stratified by entry diastolic blood pressure ( DBP ) , age , and sex . BT participants received relaxation training , with or without the addition of biofeedback , cognitive restructuring , and health behavior change components . During the study , all participants were followed by their usual care physicians and received medical advice . At 18 weeks into the study , after the BT groups completed training , both the BT and BPM groups showed significant reductions in systolic blood pressure ( SBP ) and DBP assessed in the company medical clinic ( 7.4 and 9.0 mm Hg SBP and 4.5 and 5.9 mm Hg DBP , respectively ) . These reductions were maintained throughout the 36‐week follow‐up period . Reductions in BP assessed at the participants ' worksite were similar for BT and BPM participants throughout most of the trial , indicating little advantage to the inclusion of behavioral interventions over monitoring alone . Differences in BP changes observed among participants receiving various combinations of behavioral treatment components indicated that the cognitive restructuring component reduced SBP in the worksite by an additional 5.4 mm Hg ( p less than 0.05 ) . Possible explanations for the BP changes observed in the BPM group and implication s of the results for the treatment of unmedicated mild hypertensives are discussed OBJECTIVE --To establish whether stress management had a larger effect than a control treatment on resting blood pressure , ambulatory blood pressure , and left ventricular mass . DESIGN --A 12 week baseline period of habituation to measurement of blood pressure was followed by r and omisation to either stress management or mild exercise for six months and follow up six months later . SETTING --General practice , district general hospital , and medical school . PATIENTS --Of the 184 patients aged under 60 with mild primary hypertension who entered the baseline habituation period , 88 were excluded because they failed to meet the entry criteria or they withdrew from the study . The remaining 46 men and 50 women underwent treatment . INTERVENTIONS --10 clinical sessions and daily practice at home of either stress management based on relaxation or non-aerobic stretching exercises . Mildly stressful 15 minute interviews before and after treatment . MAIN OUTCOME MEASURES --Diastolic and systolic blood pressure in the clinic and during 12 hours of ambulatory recording , and left ventricular mass measured by echocardiography . RESULTS --The patients ' blood pressure fell during habituation ( systolic pressure from 152 mmHg to 140 mmHg , diastolic pressure from 98 to 93 mm Hg ) , but neither resting nor ambulatory blood pressure was changed by the treatments . Left ventricular mass was also unchanged . Blood pressure rose during the stressful interview , but this rise was reduced by stress management ( systolic pressure rose by 7.4 mmHg before treatment and by 3.7 mmHg after treatment ) . CONCLUSION --Stress management of a type advocated for treating mild primary hypertension is ineffective in lowering blood pressure in patients who are well habituated to measuring blood pressure Psychosocial stress contributes to high blood pressure and subsequent cardiovascular morbidity and mortality . Previous controlled studies have associated decreasing stress with the Transcendental Meditation ( TM ) program with lower blood pressure . The objective of the present study was to evaluate , over the long term , all-cause and cause-specific mortality in older subjects who had high blood pressure and who participated in r and omized controlled trials that included the TM program and other behavioral stress-decreasing interventions .  Patient data were pooled from 2 published r and omized controlled trials that compared TM , other behavioral interventions , and usual therapy for high blood pressure .  There were 202 subjects , including 77 whites ( mean age 81 years ) and 125 African-American ( mean age 66 years ) men and women . In these studies , average baseline blood pressure was in the prehypertensive or stage I hypertension range . Follow-up of vital status and cause of death over a maximum of 18.8 years was determined from the National Death Index . Survival analysis was used to compare intervention groups on mortality rates after adjusting for study location . Mean follow-up was 7.6 + /- 3.5 years . Compared with combined controls , the TM group showed a 23 % decrease in the primary outcome of all-cause mortality after maximum follow-up ( relative risk 0.77 , p = 0.039 ) . Secondary analyses showed a 30 % decrease in the rate of cardiovascular mortality ( relative risk 0.70 , p = 0.045 ) and a 49 % decrease in the rate of mortality due to cancer ( relative risk 0.49 , p = 0.16 ) in the TM group compared with combined controls . These results suggest that a specific stress-decreasing approach used in the prevention and control of high blood pressure , such as the TM program , may contribute to decreased mortality from all causes and cardiovascular disease in older subjects who have systemic hypertension Thirty-two male and female hypertensives , 34 to 65 yr of age , systolic blood pressure ( SBP ) less than 200 mmHg and diastolic blood pressure ( DBP ) between 90 and 109 mmHg , were r and omly allocated to receive either relaxation and stress management ( experimental condition ) or mild physical exercise ( control condition ) . Half the participants were taking antihypertensive drugs , which were constant for six months prior to the study and controlled during the study . Outcome measures included various measures of blood pressure in the clinic and at home , cardiovascular responsiveness , moods and 24-hr urinary adrenaline and noradrenaline . The study schedule consisted of 3-months baseline , 10 weeks treatment and 3-months follow-up . Rel 
    Output:
    
Available evidence indicates that among stress reduction approaches , the Transcendental Meditation program is associated with significant reductions in BP .
Related data suggest improvements in other CVD risk factors and clinical outcomes