Abstract
Fifty-two pharmacologically treated hypertensive patients were randomized to one of four treatment groups: (1) diastolic blood pressure biofeedback, (2) progressive deep muscle relaxation training, (3) self-directed relaxation training, or (4) medication alone. Data collection occurred during baseline, treatment, and 1-year follow-up phases in a laboratory, a medical clinic, and the patient's own home. Patients from all four groups combined showed mean blood pressure reductions of −10.2/−5.5 mm Hg on clinic recordings and −2.4/−.7 mm Hg on home recordings, which were maintained throughout the follow-up period. There were no significant differences among the four groups in terms of blood pressure reduction. Patients given adjunctive behavioral treatment showed significantly larger reductions in medication usage compared to patients treated with medication alone, but there were no significant differences among the three behaviorally treated groups. Patients who showed medication reductions did not show subsequent blood pressure elevation. The results suggest that combined behavioral and pharmacological therapy may be superior to pharmacological therapy alone in the treatment of essential hypertension.
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References
Andrews, G., Macmahon, S. W., Austin, A., & Byrne, D. G. (1982). Hypertension: Comparison of drug and non-drug treatments.British Medical Journal, 284, 1523–1526.
Bernstein, D. A., & Borkovec, T. D. (1973).Progressive relaxation training: A manual for the helping professions. Champaign, Illinois: Research Press.
Brandt, E. N. (1983). Assistant secretary for health's advisory on treatment of mild hypertension.FDA Drug Bulletin, 13 24–25.
Doyle, A. E. (1983). Response to placebo treatment in hypertension.Hypertension 5(Suppl. III), III-3–III-4.
Engel, B. T., Gaarder, K. R., & Glasgow, M. S. (1981). Behavioral treatment of high blood pressure I. Analyses of intra- and interdaily variations of blood pressure during a one month, baseline period.Psychosomatic Medicine, 43 255–270.
Glasgow, M. S., Gaarder, K. R., & Engel, B. T. (1982). Behavioral treatment of high blood pressure II. Acute and sustained effects of relaxation and systolic blood pressure biofeed-back.Psychosomatic Medicine, 44 155–170.
Goldstein, I. B., Shapiro, D., Thananopavarn, C., & Sambhi, M. P. (1982). Comparison of drug and behavioral treatments of essential hypertension.Health Psychology, 1 7–26.
Huynh, H., & Feldt, L. S. (1976). Estimation of the Box correction for degrees of freedom from sample data in the randomized block and split-plot designs.Journal of Educational Statistics, 1 69–82.
Hypertension Detection and Follow-Up Program (1979). Five-year findings of the hypertension detection and follow-program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension.Journal of the American Medical Association, 242 2562–2571.
Kirkendall, W. M., Feinleib, M., Freis, E. D., & Mark, A. L. (1981). Recommendations for human blood pressure determination by sphygmomanometers.Stroke, 3 510A-519A.
Lasser, N. L., Grandits, G., Caggiula, A. W., Cutler, J. A., Grimm, R. H., Kuller, L. H. Sherwin, R. W., & Stamler, J. (1984). Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial.American Journal of Medicine, 76(2A), 52–66.
Luborsky, L., Ancona, L., Masoni, A., Scolari, G., & Longoni, A. (1980–1981). Behavioral versus pharmacological treatments for essential hypertension: A pilot study.International Journal of Psychiatry in Medicine, 10 33–40.
Luborsky, L., Crits-Christoph, P., Brady, J. P., Kron, R. E., Weiss, T., Cohen, M., & Levy, L. (1982). Behavioral versus pharmacological treatments for essential hypertension — A needed comparison.Psychosomatic Medicine, 44 203–213.
Luborsky, L., Crits-Christoph, P., Brady, J. P., Kron, R. E., Weiss, T., & Engelman, K. (1980). Antihypertensive effects of behavioral treatments and medications compared.New England Journal of Medicine, 303 586.
Maland, L. J., Lutz, L. J., & Castle, C. H. (1983). Effects of withdrawing diuretic therapy on blood pressure in mild hypertension.Hypertension, 5 539–544.
Multiple Risk Factor Intervention Trial Research Group (1982). Risk factor changes and mortality results.Journal of the American Medical Association, 248 1465–1477.
Pickering, T. G., Harshfield, G. A., Kleinert, H. D., & Laraugh, J. H. (1982). Ambulatory monitoring in the evaluation of blood pressure in patients with borderline hypertension and the role of the defense reflex.Clinical Experimental Hypertension, A4 675–693.
Richter-Heinrich E., Homuth, V., Heinrich, B., Schmidt, K.-H., Wiedemann, R., & Gohlke, H.-R. (1981). Long term application of behavioral treatments in essential hypertensives.Physiology and Behavior, 26 915–920.
Shapiro, D., Greenstadt, L., Lane, J. D., & Rubinstein, E. (1981). Tracking-cuff system for beat-to-beat recording of blood pressure.Psychophysiology, 18 129–136.
Surwit, R. S., Shapiro, D., & Good, M. I. (1978). Comparison of cardiovascular biofeedback, neuromuscular biofeedback, and meditation in the treatment of borderline essential hypertension.Journal of Consulting and Clinical Psychology, 46 252–263.
The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (1984). The 1984 report of The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.Archives of Internal Medicine, 144 1045–1057.
Vaitl, D. (1982). Psychological management of essential hypertension.Contributions to Nephrology, 30 87–91.
Weiss, S. M. (1980). Biobehavioral approaches to the treatment of hypertension.Journal of the South Carolina Medical Association, 76(Suppl.), 38–43.
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This research was supported in part by NIH research grant number HL27698. The contribution of Jacquelyn Bain is gratefully acknowledged. We thank Merrell-National Laboratories for providing Metahydrin that was used by some of the patients in this study.
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Hatch, J.P., Klatt, K.D., Supik, J.D. et al. Combined behavioral and pharmacological treatment of essential hypertension. Biofeedback and Self-Regulation 10, 119–138 (1985). https://doi.org/10.1007/BF01000749
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DOI: https://doi.org/10.1007/BF01000749