Tension Tamer Randomized Control Trial

180 stage 1 or 2 pre-hypertensive adults, will be randomly assigned to 2x daily TT at
scheduled decreasing doses or enhanced standard of care lifestyle education program delivered
via smartphone (SPCTL) for 12 months. Subjects will participate in 5 study visits at
baseline/enrollment, 1, 3, 6 , and 12 months

TT subjects will be given the TT app. The app provides instructions on breathing awareness
meditation (BAM): focusing upon the moment by sustaining one's attention upon diaphragm
movements and related sensations while breathing in a slow, deep, relaxed manner. One learns
to passively observe thoughts, images and extraneous sounds without making judgments about
them. BAM doesn't involve analysis of historical or recent stressful experiences, but instead
centers upon learning to stay in the present moment while meditating. The app will also
collect heart rate (HR) values during each session using the phone's camera. The duration of
the TT sessions will begin at 15 min., decrease to 10 min., and finally decrease to 5 min.
Adherence will be monitored by the receipt of date-stamped heart rate values collected during
each meditation session.

SPCTL subjects will be provided Runkeeper app and taught how to record physical activity they
perform. Recommended dosage of using SPCTL media and/or app will be that of the TT group.
Adherence to SPCTL will be assessed using server file analyses of modules used and activity
recorded in Runkeeper.

Inclusion Criteria:

1. 18-90 years old, male or female, African American (AA) or White;

2. Stage 1 or 2 pre-hypertensive (i.e., SBP 120-139/DBP<90) based upon 2 consecutive
clinic evaluations;

3. Body Mass Index (BMI) 18.5 -45 Kg/m2;

4. legally competent;

5. able to use a smart phone.

Exclusion Criteria:

1. failure to meet any inclusion criteria;

2. type two diabetes or chronic kidney disease (GFR<50 mL/1.7 m2/min.);

3. cancer diagnosis or treatment in past 2 years;

4. prior cardiovascular event, congestive heart failure or angina;

5. prior or current psychiatric illness;

6. ongoing substance abuse (e.g., >21 drinks/week);

7. pharmacologic medications which may influence blood pressure (BP);

8. planned pregnancy;

9. vulnerable populations such as pregnant or nursing women, prisoners, and
institutionalized individuals.