Stress Management Versus Lifestyle Modification on Systolic Hypertension and Medication Elimination: A Randomized Trial

Abstract

Isolated systolic hypertension is common in the elderly, but decreasing systolic blood pressure (SBP) without lowering diastolic blood pressure (DBP) remains a therapeutic challenge. Although stress management training, in particular eliciting the relaxation response, reduces essential hypertension its efficacy in treating isolated systolic hypertension has not been evaluated. We conducted a double-blind, randomized trial comparing 8 weeks of stress management, specifically relaxation response training (61 patients), versus lifestyle modification (control, 61 patients). Inclusion criteria were Ն55 years, SBP 140-159 mm Hg, DBP Ͻ90 mm Hg, and at least two antihypertensive medications. The primary outcome measure was change in SBP after 8 weeks. Patients who achieved SBP Ͻ140 mm Hg and Ն5 mm Hg reduction in SBP were eligible for 8 additional weeks of training with supervised medication elimination. SBP decreased 9.4 (standard deviation [SD] 11.4) and 8.8 (SD 13.0) mm Hg in relaxation response and control groups, respectively (both ps Ͻ 0.0001) without group difference (p ϭ 0.75). DBP decreased 1.5 (SD 6.2) and 2.4 (SD 6.9) mm Hg (p ϭ 0.05 and 0.01, respectively) without group difference (p ϭ 0.48). Forty-four (44) in the relaxation response group and 36 in the control group were eligible for supervised antihypertensive medication elimination. After controlling for differences in characteristics at the start of medication elimination, patients in the relaxation response group were more likely to successfully eliminate an antihypertensive medication (odds ratio 4.3, 95% confidence interval 1.2-15.9, p ϭ 0.03). Although both groups had similar reductions in SBP, significantly more participants in the relaxation response group eliminated an antihypertensive medication while maintaining adequate blood pressure control. 129

Perfil dos pacientes com hipertensão arterial incluídos em uma coorte com HIV/AIDS em Pernambuco, Brasil

“…Among these, the most important lifestyle factors are excess body fat (overweight/obesity), alcohol consumption, insufficient physical activity, smoking, stress and a variety of dietary components 17 , such as inadequate consumption of fruits and vegetables 18 .…”

From Relaxation Response, Building Power for Health to an Advanced Self-Cultivation Practice: Genuine Well-Being

“…NO was shown to play a central role in the development of atherosclerotic plaque, and the regulation of platelet function, vascular smooth muscle cell proliferation, and leukocyte interactions with vascular endothelial cells, as well as to mediate diverse physiological processes including neuronal function and neurotoxicity, immune and cardiovascular functions [39]. Studies from this group also reported that 8 weeks of RR training was an effective therapeutic intervention to counteract the adverse clinical effects of stress in individuals with systolic hypertension, with 8 more weeks training, elicitation of the RR made 32% of participants be able to eliminate one or more of their antihypertensive medications [40].…”

Relaksasi Untuk Mengurangi Stres Pada Penderita Hipertensi Esensial

“…Keluhan fisik menjadi berkurang, terlebih reaksireaksi psikis dapat diatasi. Relaksasi dapat mengatasi emosi-emosi negatif dan menimbulkan efek tenang pada individu terlebih dengan keluhan-keluhan fisik (Zusman, 2008;Saeki, 2000).…”