Abstract
Stress management and relaxation training lower the blood pressure of many mild hypertensives substantially through mechanisms that are as yet unclear but may include behavioral and cognitive change. It is almost certain that the reduction of weight in the obese, drinking in heavy drinkers, and increased exercise in the sedentary also reduces pressure usefully in hypertensives, and opportunites exist for the application of behavioral principles to improve the effectiveness of programs to alter these behavioral risk factors. It is fortunate that behavioral methods for the control of hypertension exist and are making progress since there are increasing doubts about the effectiveness of pharmacological solutions for mild hypertension.
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References
Agras, W.S., Horne, M., & Taylor, C.B. (1982). Expectation and the blood pressure lowering effects of relaxation.Psychosomatic Medicine, 44, 389–395.
Agras, W.S., Southam, M.A., & Taylor, C.B. (1983). Long-term persistence of relaxation-induced blood pressure lowering during the working day.Behavior Therapy, 15, 792–794.
Agras, W.S., Taylor, C.B., Kraemer, H.C., Allen, R.A. & Schneider, J.A. (1980). Relaxation training: Twenty-four-hour blood pressure reduction.Archives of General Psychiatry, 37, 859–863.
Agras, W.S., Taylor, C.B., Kraemer, H.C., Southam, M.A., & Schneider, J.A. (in press). Relaxation training for essential hypertension at the worksite II: The poorly controlled hypertensive.Psychosomatic Medicine.
Andersson, O.K., Fagerberg, B., & Hedner, T. (1984). Importance of dietary salt in the haemodynamic adjustment to weight reduction in obese hypertensive men.Hypertension, 6, 814–819.
Bali, L.R. (1979). Long-term effect of relaxation on blood pressure and anxiety levels in essential hypertensive males: A controlled study.Psychosomatic Medicine, 41, 637–646.
Baum, C., Kennedy, D.L., Forbes, M.B., & Jones, J.K. (1984). Drug use in the United States in 1981.Journal of the American Medical Association, 251, 1293–1297.
Beard, T.C., Cooke, H.M., Gray, W.R., & Barge, R. (1982). Randomized controlled trial of no-added-sodium diet for mild hypertension.Lancet, ii, 455–458.
Bonano, J.A., Lies, J.E. (1974). Effects of physical training on coronary risk factors.American Journal of Cardiology, 33, 760–763.
Brauer, A., Horlick, L.F., Nelson, B., Farquhar, J.U., & Agras, W.S. (1979). Relaxation therapy for essential hypertension: A Veterans Administration out-patient study.Journal of Behavioral Medicine, 2, 21–29.
Brownell, K.D. (1982). Obesity: Understanding and treating a serious, prevalent, and refractory disorder.Journal of Consulting and Clinical Psychology, 50, 820–840.
Charlesworth, E.A., Williams, B.J., & Baer P.E. (1984). Stress management at the worksite for hypertension: Compliance, cost-benefit, health care, and hypertension related variables.Psychosomatic Medicine, 46, 387–397.
Chesney, M.A., Black, G.W., Swan, G.E., & Ward, M.M. (in press). Relaxation training for essential hypertension at the worksite II: The untreated hypertensive.Psychosomatic Medicine.
Chesney, M.A., & Rosenman, R.H. (1985).Anger and Hostility in cardiovascular and behavioral disorders. Washington: Hemisphere Publishing Corporation.
Christoph, P., Luborsky L., Kron, R., & Fishman, H. (1978). Blood pressure, heart rate, and respiratory responses to a single session of relaxation: A partial replication.Journal of Psychosomatic Research, 22, 493–501.
Cooper, M.J., & Aygen, M.M. (1979). A relaxation technique in the management in the management of hypercholesterolemia.Journal of Human Stress, 5, 24–27.
Cottier, C., Shapiro, K., & Julius, S. (1984). Treatment of mild hypertension with progressive muscular relaxation: predictive value of indexes of sympathetic tone.Archives of Internal Medicine, 144, 1954–1958.
Croog, S.H., Levine, S., Testa, M.A., Brown, B., Bulpitt, C.J., Jenkins, C.D., Klerman, G.L., & Williams, G.H. (1986). The effects of antihypertensive therapy on the quality of life.New England Journal of Medicine, 314, 1657–1664.
Crowther, J.H. (1983). Stress management training and relaxation imagery in the treatment of essential hypertension.Journal of Behavioural Medicine, 6, 169–187.
Duncan, J.J., Farr, J.E., Upton, J., Hagan, R.D., Oglesby, M.E., & Blair, S.N. (1985). The effects of aerobic exercise on plasma catecholamines and blood pressure in patients with mild essential hypertension.Journal of the American Medical Association, 254, 2609–2613.
Erwteman, T.M., Nagelkerke, N., Lubsen, J., Koster, M., & Dunning, A.J. (1984). β blockade, diuretics, and salt restriction for the management of mild hypertension: A randomized double blind trial.British Medical Journal, 289, 406–409.
Fagerberg, B., Andersson, O.K., Isaksson, B., & Bjorntrop, P. (1984). Blood pressure control during weight reduction in obese hypertensive men: Separate effects of sodium and energy restriction.British Medical Journal, 288, 11–14.
Fagerberg, B., Andersson, O.K., Persson, B., & Hedner, T. (1985). Reactivity to norepinephrine and effect of sodium on blood pressure during weight loss.Hypertension, 7, 586–592.
Glasgow, M.S. Gaardner, K.R., & Engel, B.T. (1982). Behavioral treatment of high blood pressure II: Acute and sustained effects of relaxation and systolic blood pressure biofeedback.Psychosomatic Medicine, 44, 155–171.
Goldstein, I.R., Shapiro, D., Thananopavaran, C., & Sambhi M.P. (1982). Comparison of drug and behavioral treatments of essential hypertension.Health Psychology, 1, 7–26.
Goldstein, I.B., Shapiro, D., & Thananopavaran, C. (1984). Home relaxation techniques for essential hypertension.Psychosomatic Medicine, 46, 399–414.
Hafner, R.J. (1982). Psychological treatment of hypertension: A controlled comparison of meditation and meditation plus feedback.Biofeedback and Self-Regulation, 7, 305–316.
Hagberg, J.M., Goldring, D., Ehsani, A.A., Heath, L.W., Hernadez, A., Schectman, K., & Holloszy, J.O. (1983). Effect of exercise training on the blood presure and hemodynamic features of hypertensive adolescents.American Journal of Cardiology, 52, 763–768.
Hatch, J.J., Klatt, K.D., Supik, J.D., Rios, N., Fisher, J.G., Bauer, R.L., & Shimotsu, G.W. (1985). Combined behavioral and pharmacological treatment of hypertension.Biofeedback and Self-Regulation, 10, 119–138.
Haynes, R.B., Harper, A.C., Costley, S.R., Johnston, M., Logan, A.G., Flanagan, P.T., & Sackett, D.L. (1984). Failure of weight reduction to reduce mildly elevated blood pressure: A randomized trial.Journal of Hypertension, 2, 535–539.
Holmes, D.S. (1984). Meditation and somatic arousal redution: A review of the experimental evidence.American Psychologist, 39, 1–10.
Hovell, M.F. (1982). The experimental evidence for weight-loss treatment of essential hypertension: A critical review.American Journal of Public Helath, 72, 359–368.
Irvine, M.J., Johnston, D.W., Jenner, D.A., & Marie, G.V. (1986). Relaxation and stress management in the treatment of essential hypertension.Journal of Pychosomatic Research, 30, 437–450.
Jacob, R.G., Fortmann, S.P., Kraemer, H.C., Farquhar, J.W., & Agras, W.S. (1985). Combined behavioral treatments to reduce blood pressure: A controlled outcome study.Behavior Modification, 9, 32–50.
Jacob, R.G., Shapiro, A.P., Reeves, R.A., Johnsen, A.M., McDonald, R.H., & Coburn, P.C. (in press). Comparison of relaxation therapy for hypertension with placebo, diuretics, or beta blockers.Archives of General Medicine.
Jennings, G., Nelson, L., Nestel, P., Esler, M., Korner, P., Burton, D., & Bazelmans, J. (1986). The effects of changes in physical activity on major cardiovascular risk factors, haemodynamics, sympathetic function, and glucose utilization in man: A controlled study of four levels of activity.Circulation, 73, 30–40.
Johnston, D.W. (1984). Biofeedback, relaxation, and related procedures in the treatment of psychophysiological disorders. In A. Steptoe & A. Mathews (Eds.),Health care and human behaviour. London: Academic press.
Johnston, D.W. (1986). How does relaxation training reduce blood pressure in primary hypertension? In T.H. Schmidt, T.D. Dembroski, & C. Blumchen (Eds.),Biological and psychological factors in cardiovascular disease. Berlin: Springer Verlag.
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.
Jorgenson, R.G., Houston, B.K., & Zurawski, R.M. (1981). Anxiety management training in the treatment of essential hypertensives.Behaviour Research and Therapy, 19, 467–474.
Krantz, D.S., & Manuck, S.B. (1984). Acute psychophysiologic reactivity and risk of cardiovascular disease: A review and critique.Psychological Bulletin, 96, 435–464.
Langford, H.G., Blaufox, M.D., Oberman, A., Hawkins, M., Curb, J.D., Cutter, G.R., Wassertheil-Smoller, S., Pressel S., Babock, C., Abernethy, J.D., Hotchkiss, J., & Tyler, M. (1985). Dietary therapy slows the return of hypertension after stopping prolonged medication.Journal of the American Medical Association, 253, 657–664.
Little, B.E., Hayworth, J., Benson, P., Hall, F., Beard, R.W., Dewhurst, J., & Priest, R.G. (1984). Treatment of hypertension in pregnancy by relaxation and biofeedback.Lancet, i, 865–867.
Luborsky, L., Crits-Critoph, P., Brady, J.P., Kron, R.E., Weiss, T., Cohen, M., & Levy, L. (1982). Behavioral vs. pharmacological treatment for essential hypertension: A needed comparison.Psychosomatic Medicine, 44, 203–214.
McGregor, G.A. (1985). Sodium is more important than calcium in essential hypertension.Hypertension, 7, 628–237.
MacGregor, G.A., Markandu, N.D., Best, F.E., Elder, D.M., Cam, J.M., Sagnella, G.A., & Squires, M. (1982). Double-blind randomized crossover trial of moderate sodium restriction in essential hypertension.Lancet, i, 352–354.
MacMahon, S.W., MacDonald, G.J., Berenstein, D., Andrews, G., & Blackett, R.B. (1985). Comparison of weight reduction with metoprolol in the treatment of hypertension in young overweight patients.Lancet, i, 1233–1236.
MacMahon, S.W., Wilcken, D.E.L., & MacDonald, G.J. (1986). The effect of weight reduction on left ventricular mass: A randomized controlled trial in young, overweight, hypertensive patients.New England Journal of Medicine, 314, 334–339.
Maxwell, M.H., Kushiro, T., Dornfield, L.P., Tuck, M.L., & Waks, A.U. (1984). BP changes in obese hypertensive subjects during rapid weight loss: Comparison of restricted vs. unchanged salt intake.Archives of Internal Medicine, 144, 1581–1584.
McCarron, D.A. (1985). Is calcium more important than sodium in the pathogenesis of essential hypertension?Hypertension, 7, 617–627.
Medical Research Council Working Party. (1977). Randomized controlled trial of treatment for mild hypertension: design and pilot trial.British Medical Journal, ii, 1437–1440.
Medical Research Council Working Party. (1981). Adverse reactions to benedrofluazide and propranolol for the treatment of mild hypertension.Lancet, ii, 539–543.
Medical Research Council Working Party. (1985). MRC trial of mild hypertension: Principal results.British Medical Journal, 291, 97–104.
Morgan, T., Adam, W., Gillies, A., Wilson, M., Morgan, G., & Carney, S. (1978). Hypertension treated by salt restriction.Lancet, i, 227–230.
Paffenberger, R.S., Wing, A.L., Hyde, R.R., & Jung, D.L. (1983). Physical fitness and incidence of hypertension in college alumni.American Journal of Epidemiology, 117, 245–257.
Parijs, J., Joosens, J.V., Van der Linden, L., Verstreken, G., & Amery, A.K.P.C. (1973). Moderate sodium restriction and diuretics in the treatment of hypertension.American Heart Journal, 85, 22–34.
Patel, C. (1975). Yoga and biofeedback in the management of “stress” in hypertension.Clinical Science and Molecular Medicine, 2, Suppl., 171–174.
Patel, C., & North, W.R.S. (1975). Randomized controlled trial of yoga and biofeedback in the management of hypertension.Lancet, ii, 93–95.
Patel, C., Marmot, M.G., Terry, D.J. (1981). Controlled trial of biofeedback-aided behavioral methods in reducing mild hypertension.British Medical Journal, 282, 2005–2008.
Patel, C., Marmot, M.G., Terry, D.J., Caruthers, M., Hunt, B., & Patel, M. (1985). Trial of relaxation in reducing coronary risk: Four-year follow-up.British Medical Journal, 290, 1103–1106.
Peveler, R.C., & Johnston, D.W. (1986). Subjective and cognitive effects of relaxation.Behaviour Research and Therapy, 24, 413–419.
Potter, J.F., & Beevers, D.G. (1984). Pressor effect of alcohol in hypertension.Lancet, i, 119–122.
Puddey, I.B., Beilin, L.J., Vandongen, R., Rouse, I.L., & Rogers, P. (1985). Evidence for a direct effect of alcohol consumption on blood pressure in normotensive men: A randomized controlled trial.Hypertension, 7, 707–713.
Ramsey, L.E., Ramsey, M.H., Hettiarachchi, J. Davies, D.L., & Winchester, J. (1978). Weight reduction in a blood pressure clinic.British Medical Journal, ii, 244–245.
Reisin, E., Abel, R., Michaela, M., Silverberg, D.S., Eliahou, J.E., & Modan, B. (1978). Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients.New England Journal of Medicine, 298, 1–6.
Richards, A.M., Nicholls, M.G., Espiner, E.A., Ikram, H., Maslowski, A.H. Hamilton, E.J., & Wels, J.E., (1984). Blood-pressure response to moderate sodium restriction and potassium supplementation in mild hypertension.Lancet, i, 757–760.
Roberts, B., & Forester, W.E. (1979). Group relaxation: Acute and chronic effects on essential hypertension.Cardiovascular Medicine, 1, 375–380.
Roskies, E., Seraganian, P., Oseasohn, R., Hanley, J.A., Collu, R., Martin, N., Smilga, C. (in press). The Montreal Type A intervention project: Major findings.Health Psychology.
Seer, P., & Raeburn, J.M. (1980). Meditation training and essential hypertension: A methodological study.Journal of Behavioural Medicine, 3, 59–78.
Shaper, A.G., Pocock,, S.J., Walker, M., Cohen, N. M., Wale, C.J., & Thomson, A. G. (1981). British Regional Heart Study: Cardiovasuclar risk factors in middle-aged men in 24 towns.British Medical Journal, 283, 179–186.
Shoemaker, J.E., & Tasto, D.L. (1975). The effects of muscle relaxation on blood pressure of essential hypertensives.Behaviour Research and Therapy, 13, 29–43.
Southam, M.A., Agras, W.S., Taylor, C.B., & Kraemer, H.C. (1982). Relaxation training: Blood pressure during the working day.Archives of General Psychiatry, 39, 715–717.
Taylor, C.B., Farquhar, J.W., Nelson, E., & Agras, W.S. (1977). Relaxation therapy and high blood pressure.Archives of General Psychiatry, 34, 339–342.
Taylor, C.B., Argras, W.S., Schneider, J.A., Allen, R.A. (1983). Adherence to instructions to practice relaxation exercises.Journal of Consulting and Clinical Psychology, 51, 952–953.
Teasdale, J.D. (1983). Change in cognition during depression—psychopathological implications: Discussion paper.Journal of the Royal Society of Medicine, 76, 1038–1044.
Wadden, T.A. (1984). Relaxation training for essential hypertension: specific or nonspecific effects.Journal of Psychosomatic Research, 28, 53–61.
Wadden, T.A., & Stunkard, A.J. (1986). Controlled trial of very low calorie diet, behavior therapy, and their combination in the treatment of obesity.Journal of Consulting and Clinical Psychology, 54, 482–488.
Watts, G.C., Edwards, C., Hart, J.T., Hart, M., Walton, P., & Foy, C.J.W. (1983). Dietary sodium restriction for mild hypertension in general practice.Lancet, i, 432–436.
Wilson, G.T., & Brownell, K.D. (1980). Behaviour therapy for obesity: an evaluation of treatment outcome.Advances in Behaviour Research and Therapy, 3, 49–86.
Wing, R.R., Caggiula, A.W., Nowalk, M.P., Koeske, R., Lee, S., & Langford, H. (1984). Dietary approaches to the reduction of blood pressure: The independence of weight and sodium/potassium interventions.Preventive Medicine, 13, 233–244.
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Notice to Readers: This is the second in a three-part series on Health Psychology. Part I appeared in the Spring ’87 issue (vol. 6, no. 1); copies may be purchased ($15 individuals, $20 institutions) by sending a check, moneyorder, or charge card number (MasterCard, Visa, American Express; include expiration date and signature) to: Current Psychological Research & Reviews, Transaction Periodicals Consortium, Dept. 4010, Rutgers University, New Brunswick, NJ 08903.
The author was supported by the Medical Research Council during the writing of this paper.
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Johnston, D.W. The behavioral control of high blood pressure. Current Psychology 6, 99–114 (1987). https://doi.org/10.1007/BF02686615
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DOI: https://doi.org/10.1007/BF02686615