Meditate or Medicate? Teens and Hypertension
When Peggy Therieault saw the list of students, she wavered. As chair of the Life Sciences Department, she was fascinated by Dr. Vernon Barnes’ study on how meditation would affect teens with elevated blood pressure. As a biology instructor, she saw the teaching possibilities and was eager to supervise a clinical research project.
But now, looking at the list of subjects Dr. Barnes handed her, Therieault shook her head. These were not the most self-disciplined kids in the school, not the highest academic achievers or the standout sports competitors. They were not student government leaders or high school club organizers. Dr. Barnes had selected them because they were pre-hypertensive. With higher-than-normal blood pressure, all were well on their way to full-blown hypertension.
How would she even get them to sit still?
Teens with overstressed arteries make sound subjects for high blood pressure research, but how would that work in the classroom, Therieault wondered. How on earth was she going to get these 20 students to meditate for 15 minutes a day, twice a day? How would she even get them to sit still?
“Are you sure you want to go through with this?” she asked Dr. Barnes. “I know these kids. We may be in for trouble.”
“Let’s just wait and see,” Dr. Barnes replied.
Peggy Therieault’s Life Sciences room at Butler High School in Augusta, Georgia, is an active place. The bulletin boards teem with collages of living organisms. The shelves boast a myriad of rocks, bones, beakers, and lab equipment. Two skeletons grin from their metal stands at the back of the room. A pair of zebra finches chirps from a cage atop the file cabinet, while fish and turtles splash in the aquariums. Yet during the meditation research project this hub of activity fell quiet every morning when Therieault turned off the lights. Only the dust stirred in the dim morning rays.
Looking from student to student on just respond so quickly to the silence? Observing their closed eyes and their deep, measured breathing, her concerns were banished. The students had listened attentively when Dr. Barnes introduced them to Transcendental Meditation. Then when a trained TM instructor selected a Vedic mantra for each teenager, they carefully learned the mantra’s intonation and how to reflect on it silently in the mind. They meditated regularly, once in the morning at school for 15 to 20 minutes and a second time later at home for 15 minutes.
“They were surprisingly settled for teens,” Therieault said. Not that no one ever broke the silence; just that interruption was strikingly rare. The class was the most efficient and the easiest homeroom class she’d ever had in her 32 years of teaching.
“There were a couple of kids who found meditation boring, but most of them went into it comfortably and willingly. This was not drudgery to them, so apparently they were seeing some benefits to it; otherwise—you know teenagers—they would not have cooperated,” she said.
Admittedly, the cooperation may have had something to do with the $50 stipend each student was given during the research. Yet the money also went to the control group whose blood pressure remained elevated despite diet and exercise classes. And the stipend doesn’t explain why the teenagers continued to practice meditation when no one was watching and no money was involved.
Personal experience speaks louder than theory, and the clinical trial was an ideal illustration for the classroom.
Personal experience speaks louder than theory, and the clinical trial was an ideal illustration for the classroom. The students learned to measure their blood pressure and weight frequently during the research and then to evaluate their health based on the results.
“I was excited,” Therieault said. “I teach anatomy and physiology, and this research project put into practical use the things we were already reading about. This was a demonstration for them. They are beginning to realize they’re not going to last forever, that they need to take better care of themselves. In fact, I suggested to Dr. Barnes more than once that it was not just teenagers who need this.”
Indeed, the participants themselves spoke of unexpected benefits. Julius Young, 17 at the time, knew a change had come over him when friends started asking if he was all right. “I had a really bad temper,” he said. “But I learned that with meditation my temper could be drastically reduced. Some of my friends noticed. They asked, ‘Are you okay? You usually get mad a lot.’”
In the two years that have elapsed since the clinical trial, Young has graduated from high school and now works for the Augusta Recreation Department, where he supervises children. He finds that meditating a couple of times a week makes his job easier. “I still meditate,” he said. “I work with kids. It can be very stressful at the recreation center with all the interactions. But at my job, I’m calm.”
Johnny Beard, now 19 years old, at first felt the opportunity to be involved in the study was nothing more than a chance to make a few bucks and to coast through class. “I thought, ‘Okay, let’s go! An easy class, and I get money,’ but meditation turned out to be useful,” he said. “It calmed me down, kept me out of trouble. I was really hyper. I used to walk all over the classroom talking to people. It got me in a lot of trouble. Meditation helped me to chill.”
The meditation research also had some important spin-off benefits, Barnes said. A brief side study conducted on the first 40 students showed behavior improvement. Meditation reduced absenteeism, rule violations, and suspensions during the four-month segment of the clinical trial in which these factors were monitored. The clinical trial also brought a number of anecdotal benefits—many teens reported increased concentration in class, higher grades, better sports performances, and less anger.
Participating in the research slowly brought meditation into the students’ worldview, said Therieault. The practice became a tool they used for addressing daily challenges. “In the future, when they are up against various life issues in terms of stress,” she said, “I think they are going to resort to meditation as a means of coping.”
Drugged for Life?
The number of physical and emotional stresses that affect young people has grown in recent years to include a whole catalog of modern ailments, such as attention deficit disorder, eating disorders, anxiety disorder, and bipolar disorder. At the same time, young people are developing a growing susceptibility to illnesses usually associated with adulthood, such as hypertension, depression, diabetes, and sleep disorders. And as the list of ailments lengthens, the search for cures, or at least for options to manage these diseases, widens as well.
One of the fastest growing markets for prescription drugs today is the youth market. Yet the U.S. Food and Drug Administration has admitted that up to 80 percent of the prescription drugs available in the U.S. has not been tested for use on children—even though the drugs are heavily prescribed for them. Health advocates are raising concerns about how adult medicines affect a growing child’s body and mind. Will these drugs impair physical development, damage a maturing intellect, or blunt an evolving awareness? The debate has led to lawsuits, federal regulatory hearings, and a host of scientific experiments.
Parents, the medical community, teachers, counselors, and government regulators are reexamining everything from the drugs prescribed to the basic attitudes behind the prescriptions. And some, like Dr. Barnes, a physiologist, and Dr. Frank Treiber, a clinical psychologist, both pediatric research scientists at the Medical College of Georgia, have found success with alternative and complementary medicine—practices that may either replace drugs or work in tandem with a prescription. Their Augusta research may offer an important model for treating illness in young people, and it may provide food for thought about the power of meditation in unexpected places—like a science classroom in a public school.
“We don’t really know what the long-term effects of taking medications an entire life span are going to be,” said Barnes. “We don’t know if it is safe for children, what the dosage should be, and which ones should be prescribed for which child.”
High blood pressure treatment for young people is further complicated because it sometimes combines with other ailments like attention deficit disorder and hyperactivity, not to mention a sedentary lifestyle and diets heavy in food that is high in sodium and low in nutrients, he pointed out.
Why not research natural alternatives like meditation?
With all the dangers and unknowns, the team from the Prevention Institute of the Medical College of Georgia set out to forge a different response. Why not research natural alternatives like meditation? Why not take a scientific look at the body and mind’s innate powers to regulate its own blood pressure in young people? If meditation could reduce high blood pressure in teenagers, perhaps those at risk for hypertension could be helped before their hearts and circulatory systems suffered damage. The National Heart, Lung, and Blood Institute, a division of the National Institutes of Health (NIH), and an American Heart Association Scientist Development Grant funded their research.
The Augusta Experiment
The Medical College of Georgia research team tested 5,000 inner-city teenagers from five high schools in Augusta from 1999 through 2003 to come up with the best 156 subjects for the clinical trial on meditation. In each of the schools tested, Barnes, who was project manager and principal author of the study, introduced the students to Transcendental Meditation. “This method is effortless,” he said. “There is no concentration or straining. The mind goes to whatever is the most charming, the thing that interests you. The mind finds the mantra charming and is attracted to it. The mantra is then the vehicle which takes the mind inward to deeper levels where you transcend, go beyond, and reach a state of peace, free from activity.”
Research subjects in both the health education control group and the meditation test group were monitored for ambulatory blood pressure, which is the most accurate measure available because it tests the individual throughout the day, not just during an appearance in the doctor’s office. The monitors were affixed to the waist with a hose connected to a blood pressure cuff. The equipment was programmed to check blood pressure every 20 to 30 minutes over a 24-hour period to give a full measure of a typical day, logging the teens’ blood pressure through everything from an argument with their parents to deep sleep at night.
The students meditated once in the morning in class for 15 to 20 minutes and later at home on their own for a second 15 minutes. At nights and on weekends the young people were on a self-reporting system to continue the practice. An unusually high number of the students reported they kept up with their meditation schedule. “For a self-report monitoring, you don’t often get a 70 percent compliance rate outside the clinical supervision like we did in this case,” Dr. Barnes said. The validity of the self-reports was evident from the study results, he said.
For each four-month segment of the trial, the teens wore the blood pressure monitors for 24 hours at the beginning of the segment, at the two-month mark, at the end of the four-month period, and again as a follow-up session at the eight-month mark. The students were paid a $50 stipend every time they wore the cuff. Two different schools were tested each semester until the 156 sampling figure was reached.
In trial after trial, the four-year research project showed that young people who practiced meditation for 15 minutes twice a day over a four-month period experienced an average 3.5 point drop in blood pressure; this increased to an average of 4 points in the follow-up at eight months. Meanwhile, there was no change in the high blood pressure of students in control groups who were given the standard NIH sessions in exercise and nutrition for the same period.
“A blood pressure drop of four points doesn’t seem like a whole lot, but it is clinically significant,” said Barnes. “A blood pressure drop of one to two points in an adolescent translates into a 10 percent decreased risk in developing hypertension as an adult.” The study, entitled “Impact of Transcendental Meditation on Ambulatory Blood Pressure in African-American Adolescents,” was published in the April 2004 issue of the American Journal of Hypertension. (Black students were chosen for the clinical trial because African-Americans have higher rates of hypertension, heart attack, and stroke.)
“This research is important, first off because it offers proof, empirical support, along with other research studies that meditation does help decrease blood pressure levels,” said Dr. Treiber, coauthor and principal investigator of the study.
Secondly, the Augusta research was one of the few studies in which the participants kept up the health-improvement practices after clinical research supervision was withdrawn, he said. “We did a follow-up four months later,” he reports, “and the kids were still meditating after we stopped the trial at school. Past the intervention, there was still a high level of adherence to meditation, and they still showed a decreased level of blood pressure. Other lifestyle intervention studies, like those with diet and exercise, have shown difficulty continuing past the time of the trial. I think they continued meditating because they enjoyed it and it was easy.”
Self-help for Seventh Graders
The simplicity and success of the meditation program attracted interest from outside the research group even before the clinical trial was completed. Tutt Middle School’s science teacher, James Murzynowski, heard about the practice and thought it might be just the thing for a six-week unit in his seventh graders’ study of the heart.
In the summer of 2003 Murzynowski had joined the Guest Scholar Program at the Medical College of Georgia, a program designed to help science teachers absorb information from the field and apply that experience to the classroom. He was paired with a scientist of vascular biology. The lab work was about the effects of stress on the nephrons in the kidney system. Instead of trying to design a complicated project for seventh graders on nephrons, however, Murzynowski’s mentor suggested he work with Barnes and Treiber. “It was easier and more doable to take their work and devise a cardiac study that we could do in class,” Murzynowski said.
Barnes explained the meditation study to Murzynowski and helped him develop a meditation unit for his classes, which included a form of mindfulness meditation, lessons on the heart, how stress is involved in cardiovascular health, and the effects of exercise. A total of 105 students in Murzynowski’s four classes participated in the seventh grade Life Sciences meditation unit. During the class, they were taught to close their eyes, sit upright, put their hands on their abdomen, and remain aware of the rise and fall of their breath for 10 minutes. They practiced once during class and were asked to practice again when they got home.
“Picture this in the seventh grade world!” said Murzynowski. “I would turn the lights off. We would start in one or two minutes, have eight to ten minutes of meditation, then they would open their eyes. Everybody was quiet. It was easier to start class. Meditation cut down on a lot of problems. Everybody was focused, starting at the same point.”
As part of the project, students measured their own blood pressure before and after meditation, put the results on the board and compared the mean average. “There was a big difference before meditation and after,” Murzynowski said. “I showed them that they reported a better breathing rate after meditation, that it was lower. I showed them how they were slowing the body down a bit, giving it a chance to refresh.”
Murzynowski also used the study as a way to talk with his students about peer pressure and self-esteem, and how slowing down their reactions and having more control over their minds would help them. “I said the only way to avoid becoming a victim of peer pressure and bad feelings is a high sense of self-esteem, to be able to say no to things that will harm the body and mind,” he said.
"...breathing slower showed them right then and there that they could slow down their heart rate.”
Murzynowski was impressed with the depth of responses from his students. Many said meditation helped their concentration in other areas as well. Some found less friction in family relationships. Others reported being happier with themselves, he said. “These are things I didn’t mention to the kids. They wrote them down as some of the benefits of meditation. And, of course, breathing slower showed them right then and there that they could slow down their heart rate.”
Caitlin Collier, who had the highest blood pressure in her class, said she wasn’t expecting much out of meditation when Murzynowski introduced the unit. The 13-year-old said she didn’t know what to make of the idea—this being-aware-of-her-breath concept. It was uncomfortable to her at first, but soon she discovered a restfulness “like sleeping, but I wasn’t asleep,” she said. Then slowly, over the next six weeks, she found small gains in her ability to endure everyday frustrations. She and her stepsister and stepbrother had been quarreling quite a bit, she said, so she was happy when she started to find herself arguing less.
Collier had been troubled to find her blood pressure measured so high, but she was thrilled when that number dropped by the end of the six weeks. “My mom has high cholesterol and high blood pressure,” she said. “My dad has heart problems, high cholesterol, and high blood pressure. I want to keep them down. I don’t want any heart problems,” she said.
Collier still meditates about 15 minutes before she goes to bed, though she doesn’t always make it in the morning when she’s in a rush. Both she and her 13-year-old stepsister, Audrey Ziegler, kept meditating even into the summer, long after their science grades had been recorded.
“I do it at night,” said Ziegler. “Sometimes in the morning, when I’m really tired, I take a meditation break. It makes me feel more light from all the stress going on. Before I was feeling weighed down; now I feel I can jump up in the air when I want to. I don’t have to feel so down.”
In 1999, when Barnes and Treiber began their research, high blood pressure in teenagers was something of a lonely field. Now they find themselves in the middle of what suddenly has become a hot topic. When the NIH recently announced its interest in pediatric studies on preventing heart disease, these two were already hard at work on new cardiac research involving Murzynowski. Will their findings persuade government health officials to place meditation on the national plan of attack against heart disease? Who knows?
The burden of proof remains with the researchers, and neither meditation nor even “stress reduction” was placed in the NIH recommendations for blood pressure treatment released this past July. Yet Barnes and Treiber were not discouraged by the omission. “Translating research into real life takes a long time,” said Barnes. “We have known for 30 to 40 years that smoking causes cancer and other lung diseases, but it is only recently that the research has become policy through smoking bans in public places like airplanes.
“For anyone interested in the health effects of meditation,” Barnes continued, “I wouldn’t hold my breath waiting for policymakers to include meditation in their recommendations. This is research that can be used on a personal level. All that is required is a commitment and some lessons from a reputable source.” The result may literally be a lifesaver and, for young people, a whole new lease on the future.
Hypertension: The Next Epidemic?
High blood pressure, medically known as hypertension, affects one in four adults in the United States. Hypertension is a major risk factor for developing heart attack or stroke, both of which are leading causes of death in this country. Yet hypertension is not a sudden onset disease, not something that arises full-blown in adulthood. It begins in childhood and rises with age, and, increasingly, today high blood pressure is showing up at a younger age.
Statistics from the International Pediatrics Hypertension Association show that up to 5 percent of U.S. children may have high blood pressure, a statistic that rises as high as 11 percent in minority populations. The numbers continue to climb. The Journal of the American Medical Association this past May published research showing what the NIH called a “substantial” and “worrisome” rise in hypertension in young people as well as adults.
“In the last ten years the incidence of high blood pressure has risen dramatically, sevenfold in the young minority population,” said Barnes. “And these rates are not expected to go down. They are going up because of the rising rates of obesity.
A Healthy Heart
Meditation is effective in reducing blood pressure because it decreases the sympathetic nervous system response to stress...
Meditation is effective in reducing blood pressure because it decreases the sympathetic nervous system response to stress and slows the breathing and pulse rates. Thus meditation holds promise not only with hypertension, but also with cardiovascular health in general.
“In the last ten years the incidence of high blood pressure has risen dramatically, sevenfold in the young minority population,” said Barnes. “And these rates are not expected to go down. They are going up because of the rising rates of obesity.”