Behavioral Treatment of High Blood Pressure: III. Follow-Up Results and Treatment Recommendations

A multidimensional behavioral program was developed for the treatment of essential hypertension. Over a course of 6 weeks, 108 patients of a rehabilitation center were treated with this program consisting of health education, self-monitoring of blood pressure, relaxation techniques, and a social skill training in addition to standard medical treatment alone. Blood pressure and other cardiovascular risk factors were monitored for a period of 12 months. Blood pressure levels became normotensive in both groups at the end of the 6-week training program. However, the blood pressure reduction in the behavioral treatment group was achieved with fewer patients taking antihypertensive medication than in the control group. The number of patients taking antihypertensive drugs in the treatment group was 60.2% prior to treatment and 44.4% after treatment; figures for the control group were 68% and 73.8%, respectively (p less than or equal to 0.01). Almost identical data were obtained at the 6- and 23-month follow-up examinations. No consistent changes were observed in weight, smoking, or blood lipids. These results demonstrate beneficial and long-lasting effects of a combined medical and psychologic treatment of essential hypertension as compared to medical treatment alone.

Section: Discussionsupporting

confidence: 85%

“…Techniques such a biofeedback (9)(10)(11), meditation (12)(13)(14), relaxation (15)(16)(17) or a combination of two of these (18)(19)(20) primarily have been used. Most of these studies indicated success in lowering blood pressure for several weeks, but only a minority of them demonstrated effectiveness for a longer period of time.…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of a complex behavioral treatment of essential hypertension.

Lehnert¹,

Kaluza²,

Vetter³

et al. 1987

“…Control group. The control group provided a source of comparison for nonspecific influences of the therapeutic methods (34), such as anticipation of change (35), attention and care of therapeutic agents (36), therapeutic effect of frequent blood pressure measurements (37), habituation to the measure situation (38), and also the nonspecific therapeutic effects of group pressure and group support (23. 35).…”

Section: Treatmentsmentioning

confidence: 99%

Behavioral treatment of essential hypertension: a comparison between cognitive therapy and biofeedback of heart rate.

Achmon

Granek

Golomb

et al. 1989

The efficacy and the mechanisms of action of two behavioral treatments for essential hypertension were compared: cognitive group therapy for anger control and biofeedback for heart rate control. The cognitive therapy aimed at lowering the "general anger" level and helping overt expression of "anger out;" heart rate biofeedback aimed at slowing heart rate in stress situations. Ninety-seven essential hypertensive patients were randomly assigned to three groups; after 20 dropouts, 77 patients fully participated in the study: cognitive treatment (N = 30), biofeedback (N = 27), and control (no treatment, N = 20). The treatments were held in 17 weekly sessions; during treatment, blood pressure was measured once a month, and during follow-up after 1 and 6 months. The anger level and heart rate control were assessed at the beginning and the end of treatment. The main results were: 1) a significant decrease of blood pressure for both treatments as compared with control, 2) a significant decrease of blood pressure with heart rate biofeedback as compared with cognitive therapy, and 3) a better control in anger achieved with cognitive therapy and a lesser control in heart rate as compared with biofeedback.

“…Less is known about the long-term effectiveness of relaxation training since few investigators have followed their patients for as long as 1 year after treatment. However those studies reporting follow up of patients, have, on the whole, found maintenance of blood pressure lowering (7,8,(10)(11)(12)(17)(18)(19).…”

Section: Relaxation Training For Workite Hypertension-iimentioning

confidence: 99%

Relaxation training for essential hypertension at the worksite: II. The poorly controlled hypertensive.

Agras¹,

Taylor²,

Kraemer³

et al. 1987

This article reports the findings of a study designed to evaluate the long-term effectiveness of an industry-based relaxation training program in the treatment of hypertensives whose blood pressures were not well controlled by antihypertensive medication. Following a three-stage screening process, 137 participants were randomly allocated to either relaxation training (RT) or to blood pressure monitoring (BPM) at two worksites. Participants continued to receive medical care from their primary physicians during the course of the study. The advantage for participants receiving RT, in terms of mean blood pressure changes, was modest and of short duration. However, a larger proportion of participants in the RT group came into good control (blood pressures below 90 mm Hg) than in the BPM group following treatment (69.4% vs 41.5%, p less than 0.001). This advantage continued to 24 months' follow-up (63.9% vs 47.7%, p less than 0.05). At 30 months' follow-up there was no significant difference between the groups (75.0% vs 70.8%). Within-group analyses revealed that the BPM group also achieved significant blood pressure lowering which was maintained during the study. The largest initial difference between the two groups was for individuals whose entry diastolic blood pressures were most out of control despite several years of pharmacologic treatment. No difference was found between the two groups in the prescription of antihypertensive medication.