Applied Psychophysiology and Biofeedback

, Volume 22, Issue 4, pp 261–283 | Cite as

Stress-management training for essential hypertension: A controlled study

  • María Paz García-Vera
  • Francisco J. Labrador
  • Jesús Sanz
Original Articles


Forty three patients with essential hypertension participated in a study on the effectiveness of stress-management training for essential hypertension. After 6–9 clinic and 48 self-measured readings of systolic and diastolic blood pressures (SBP and DBP), 22 patients were treated with a program based on education, relaxation, and problem-solving training; and another 21 patients were assigned to a waiting list control group. At post-treatment, mean reductions of clinic BP (17/13 mm Hg vs. 6.9/4.7 mm Hg for SBP/DBP), percentages of subjects who achieved at least a 5 mm Hg reduction (86/86% vs. 48/48% for SBP/DBP) and percentages of subjects who in addition achieved a normotensive level (59/68% vs. 29/14% for SBP/DBP) were significantly higher in the treated group than in the control group. Concerning self-measured BP, the effectiveness of the stress-management training was not so considerable (mean reductions of 3.6/2.4 mm Hg and percentages of subjects who achieved a 5 mm Hg reduction of 52/38% for SBP/DBP), but it was significant and maintained in a 4-month follow-up assessment (mean reductions of 4/2 mm Hg and percentages of subjects who achieved a 5 mm Hg reduction of 48/33% for SBP/DBP). It is suggested that stress-management training can be beneficial for treatment of essential hypertension.

Key Words

essential hypertension behavioral treatment stress-management training self-measurement of blood pressure 


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  1. Amigo, I., Buceta, J. M., Becoña, E., & Bueno, A. (1991). Cognitive behavioural treatment for essential hypertension: A controlled study.Stress Medicine, 7, 103–108.Google Scholar
  2. Armitage, P., & Rose, G. A. (1966). The variability of measurement of casual blood pressure. I. A laboratory study.Clinical Science, 30, 325–335.PubMedGoogle Scholar
  3. Baer, P. E., Collins, F. H., Bourianoff, G. G., & Ketchel, M. F. (1979). Assessing personality factors in essential hypertension with a brief self-report instrument.Psychosomatic Medicine, 41, 321–330.PubMedGoogle Scholar
  4. Bernstein, D. A., & Borkovec, T. D. (1983).Entrenamiento en relajación progresiva [Progressive relaxation training]. Bilbao: DDB.Google Scholar
  5. Blanchard, E. B., & Schwarz, S. P. (1988). Clinically significant changes in behavioral medicine.Behavioral Assessment, 10, 171–188.CrossRefGoogle Scholar
  6. Carné, X., Moreno, V., Portaserra, M., & Vellida, E. (1989). El cálculo del número de pacientes necesarios en la planificación de un estudio clínico [The calculation of the number of patients needed to design a clinical trial].Medicina Clínica, 92, 72–77.PubMedGoogle Scholar
  7. Cottier, C., Shapiro, K., & Julius, S. (1984). Treatment of mild hypertension with progressive muscle relaxation.Archives of Internal Medicine, 144 1954–1958.PubMedCrossRefGoogle Scholar
  8. Diamond, E. L. (1982). The role of anger and hostility in essential hypertension and coronary heart disease.Psychological Bulletin, 92, 410–433.PubMedCrossRefGoogle Scholar
  9. D’Zurilla, T. J. (1986).Problem-solving therapy. New York: Springer.Google Scholar
  10. D’Zurilla, T. J. (1990). Problem-solving training for effective stress management and prevention.Journal of Cognitive Psychotherapy: An International Quarterly, 4, 327–353.Google Scholar
  11. D’Zurilla, T. J., & Nezu, A. M. (1990). Development and preliminary evaluation of the Social Problem-Solving Inventory.Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2, 156–163.Google Scholar
  12. D’Zurilla, T. J., & Sheedy, C. F. (1991). Relation between social problem-solving ability and subsequent level of psychological stress in college students.Journal of Personality and Social Psychology, 61, 841–846.PubMedCrossRefGoogle Scholar
  13. Fernández-Abascal, E. G. (1993).Hipertensión: Intervención psicológica [Hypertension: Psychological intervention]. Madrid: Eudema.Google Scholar
  14. Freestone, S., Silas, J. H., & Ramsay, L. E. (1982). Sample size for short-term trials of antihypertensive drugs.British Journal of Clinical Pharmacology, 14, 265–268.PubMedGoogle Scholar
  15. García-Vera, M. P., & Labrador, F. (1991).Su salud depende de lo que usted haga Quiere ocuparse de su salud? [Your health depends on what you do. Do you want to take care of your health?] Unpublished self-help booklet. Facultad de Psicología. Universidad Complutense de Madrid.Google Scholar
  16. García-Vera, M. P., & Labrador, F. (1996).El problema de la hipertensión ante la bata blanca en los ensayos clínicos de los tratamientos antihipertensivos [The trouble with white coat hypertension in the clinical trials on antihypertensive treatments]. Manuscript submitted for publication.Google Scholar
  17. García-Vera, M. P., Labrador, F., & Arriba, J. Mǎ. 1993. El autorregistro de la presi/’o arterial para el diagnóstico y manejo de la hipertensión arterial [Self-recorded blood pressure for the diagnosis and management of essential hypertension]. In J. Mâ. Arribas & F. Caballero (Eds.),Manual de cirugía menor y otros procedimientos en la consulta del médico de familia [Handbook of minor surgery and other procedures in family physician’s office] (pp. 517–521). Madrid: Merck Sharp & Dohme.Google Scholar
  18. García-Vera, M. P., Labrador, F., & Sanz, J. (1996).Comparison of clinic, home self-measured and work self-measured blood pressures. Manuscript submitted for publication.Google Scholar
  19. Goebel, M., Viol, G. W., & Orebaugh, C. (1993). An incremental model to isolate specific effects of behavioral treatments in essential hypertension.Biofeedback and Self-Regulation, 18, 255–280.PubMedCrossRefGoogle Scholar
  20. Gould, B. A., Hornung, R. S., Kieso, H., Cashman, P. M. M., and Raftery, E. R. (1986). An evaluation of self-recorded blood pressure during drug trials.Hypertension, 8, 267–271.PubMedGoogle Scholar
  21. Hatch, J. P., Klatt, K. D., Supik, J. D., Rios, N., Fisher, J. G., Bauer, R. L., & Shimotsu, G. W. (1985). Combined behavioral and pharmacological treatment of essential hypertension.Biofeedback and Self-Regulation, 10, 119–138.PubMedCrossRefGoogle Scholar
  22. Hollon, S. D., & Flick, S. N. (1988). On the meaning and methods of clinical significance.Behavioral Assessment, 10, 197–206.Google Scholar
  23. Jacob, R. G., Chesney, M. A., Williams, D. M., Yijun Ding, B. S., & Shapiro, A. P. (1991). Relaxation therapy for hypertension: design effects and treatment effects.Annals of Behavioral Medicine, 13, 5–17.Google Scholar
  24. Jacob, R. G., Wing, R., & Shapiro, A. P. (1987). The behavioral treatment of hypertension: Long-term effects.Behavior Therapy, 18, 325–352.CrossRefGoogle Scholar
  25. Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research.Journal of Consulting and Clinical Psychology, 59, 12–19.PubMedCrossRefGoogle Scholar
  26. James, G. D., Pickering, T. G., Yee, L. S., Harshfield, G. A., Riva, S., & Laragh, G. D. (1988). The reproducibility of average ambulatory, home, and clinic pressures.Hypertension, 11, 545–549.PubMedGoogle Scholar
  27. Johnston, D. W. (1987). The behavioral control of high blood pressure.Current Psychological Research & Reviews, 6, 99–114.Google Scholar
  28. Jurek, I., Higgins, J. T., Jr., & McGrady, A. (1992). Interaction of biofeedback-assisted relaxation and diuretic in treatment of essential hypertension.Biofeedback and Self-Regulation, 17, 125–141.PubMedCrossRefGoogle Scholar
  29. Kleinert, H. D., Harshfield, G. A., Pickering, T. G., Devereux, R. B., Sullivan, P. A., Marion, R. M., Mallory, W. K., & Laragh, J. H. (1984). What is the value of home blood pressure measurement in patients with mild hypertension?Hypertension, 6, 574–578.PubMedGoogle Scholar
  30. Luzarus, R. S. (1978). A strategy for research on psychological and social factors in hypertension.Journal of Human Stress, 4, 35–40.Google Scholar
  31. Linden, W., & Chambers, L. (1994). Clinical effectiveness of non-drug treatment for hypertension: A meta-analysis.Annals of Behavioral Medicine, 16, 35–45.Google Scholar
  32. Linden, W., & Feuerstein, M. (1981). Essential hypertension and social coping behavior.Journal of Human Stress, 7, 28–34.PubMedGoogle Scholar
  33. Linden, W., & Feuerstein, M. (1983). Essential hypertension and social coping behavior: Experimental findings.Journal of Human Stress, 9, 22–31.PubMedGoogle Scholar
  34. Llabre, M. M., Ironson, G. H., Spitzer, S. B., Gellman, M. D., Weider, D. J., & Schneiderman, N. (1988). Blood pressure stability of normotensive and mild hypertensives in different setting.Health Psychology, 7, 127–137.PubMedGoogle Scholar
  35. Markovitz, J. H., Matthews, K. A., Kannel, W. B., Cobb, J. L., & D’Agostino, R. B. (1993). Psychological predictors of hypertension in the Framingham Study: Is there tension in hypertension?Journal of the American Medical Association, 270, 2439–2443.PubMedCrossRefGoogle Scholar
  36. McGrady, A. & Higgins, J. T., Jr. (1990). Effect of repeated measurements of blood pressure on blood pressure in essential hypertension: Role of anxiety.Journal of Behavioral Medicine, 13, 93–101.PubMedCrossRefGoogle Scholar
  37. Ménard, J., Serrurier, D., Bautier, P., Plouin, P. E., & Corvol, P. (1988). Crossover design to test antihypertensive drugs with self-recorded blood pressure.Hypertension, 11, 153–159.PubMedGoogle Scholar
  38. Mengden, T., Binswanger, B., Weisser, B., & Vetter, W. (1992). An evaluation of self-measured blood pressure in a study with a calcium-channel antagonist versus a β-blocker.American Journal of Hypertension, 5, 154–160.PubMedGoogle Scholar
  39. Moon, J. R., & Eisler, R. M. (1983). Anger control: An experimental comparison of three behavioral treatments.Behavior Therapy, 14, 493–505.CrossRefGoogle Scholar
  40. Pickering, T. G. (1991).Ambulatory monitoring and blood pressure variability. London: Science Press.Google Scholar
  41. Ruoff, G. (1989). ACE inhibitors and diuretics. The benefits of combined therapy for hypertension.Postgraduate Medicine, 85(3), 127–132.PubMedGoogle Scholar
  42. Schechter, C. B. (1990). Sequential decison making with continuous disease states and measurements. II. Applications to diastolic pressure.Medical Decision Making, 10, 256–265.PubMedGoogle Scholar
  43. Sechrest, L. (1989). Métodos de investigación, fiabilidad y validez [Research methods, reliability and validity]. In A. S. Bellack & M. Hersen (Eds.),Métodos de investigación en psicología clínica [Research methods in clinical psychology] (pp. 35–65). Bilbao: DDB.Google Scholar
  44. Shapiro, A. P., Myers, T., Reiser, M. F., & Ferris, E. B. (1954). Comparison of blood pressure response to veriloid and to the doctor.Psychosomatic Medicine, 16, 478–488.PubMedGoogle Scholar
  45. Sommers-Flanagan, J., & Greenberg, R. P. (1989). Psychosocial variables and hypertension: A new look at an old controversy.Journal of Nervous and Mental Disease, 177, 15–24.PubMedGoogle Scholar
  46. Spiro, A., III, Aldwin, C. M., Ward, K. D., & Mroczek, D. K. (1995). Personality and the incidence of hypertension among older men: Longitudinal findings from the normative aging study.Health Psychology, 14, 563–569.PubMedCrossRefGoogle Scholar
  47. Verdecchia, P., Bentivoglio, M., Provvidenza, M., Savino, K., & Corea, L. (1985). Reliability of self-recorded arterial pressure in essential hypertension in relation to the stage of the disease. In G. G. Rome (Ed.),Blood pressure recording in the clinical management of hypertension (pp. 40–42). Roma: Edizioni L. Pozzi.Google Scholar
  48. Waeber, G., Beck, G., Waeber, B., Bidiville, J., Nussberger, J., & Brunner, H. R. (1988). Comparison of betaxolol with verapamil in hypertensive patients: discrepancy between office and ambulatory blood pressures.Journal of Hypertension, 6, 239–245.PubMedCrossRefGoogle Scholar
  49. Waeber, B., O’Brien, E., Camenzind, E., Cox, J., Nussberger, J., & Brunner, H. R. (1992). Efficacy assessment of antihypertensive therapy. In H. Brunner & B. Waeber (Eds.),Ambulatory blood pressure recording (pp. 145–168). New York: Raven.Google Scholar
  50. Watson, R. D. S., Lumb, R., Young, M. A., Stallard, T. J., Davies, P., & Littler, A. (1987). Variation in cuff blood pressure in untreated outpatients with mild hypertension implications for initianting antihypertensive treatment.Journal of Hypertension, 5, 207–211.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • María Paz García-Vera
    • 1
  • Francisco J. Labrador
    • 1
  • Jesús Sanz
    • 1
  1. 1.Universidad Complutense de MadridMadridSpain

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