b'A D V A N C I N G I N N O V A T I O N S I N H E A L T H C A R E P O L I C Y A N T I D O T ETMF O C U S O F R E S E A R C H : B L A C K A D U L T SO ver the past 30 years, a series of twelve clinical trials with a focus on Black adults, mostly funded by the National Institutes of Health, demonstrated that stress reduction with the Transcendental Meditation program reduces hypertension, risk of heart attack, stroke, and death; reduces carotid atherosclerosis in hypertensive patients; improves functional capacity in heart failure patients; reduces metabolic syndrome; and improves myocardial flow reserve. (See pages 26-32.)T M R E S E A R C H F I E L D S I T E S New York-Presbyterian/Columbia University Morehouse College School of Medicine, Medical Center, New York, NY Atlanta, GAMedical College of Wisconsin, Milwaukee, WI Cedars-Sinai Hospital, Los Angeles, CA Howard University Medical Center, Charles R. Drew University of Medicine and Washington, DC Science, Los Angeles, CA P R O P O S E D P H A S E 3 C L I N I C A L T R I A LThis Phase 3 clinical trial will further investigate TM as an effective approach for reducing major racial/ethnic disparities in hypertension and cardiovascular disease and thus provide support for reimbursement from Medicare, Medicaid, and private insurance for TM practice. The trial will be a four-year, single-blinded, randomized controlled study with a total of 1,020 patients at six to eight field sites. The primary outcome will be change in blood pressure over the four-year intervention period. Data will be collected on clinical endpoints, including allcause and cardiovascular mortality, myocardial infarction, stroke, coronary revascularization, unstable angina, and hospitalization from other CVD causes. Secondary outcomes will also include other CVD risk factors, e.g., body mass index (BMI), substance use, lipids, inflammatory factors, biomarkers for diabetes, and psychosocial stress factors (e.g., exposure and reactivity to racial and gender discrimination, anxiety, depression, anger expression, and social isolation). (Protocol available upon request.)23'