Individualized stress management for primary hypertension: a randomized trial.
OBJECTIVE
To test the efficacy of individualized stress management for primary hypertension in a randomized clinical trial with the use of ambulatory blood pressure (BP) measures.


METHODS
Men and women aged 28 to 75 years with mean ambulatory BP greater than 140/90 mm Hg received 10 hours of individualized stress management by means of semistandardized treatment components. They were randomly assigned to immediate treatment (n = 27) or a wait list control group (n = 33). Participants on the wait list were subsequently offered treatment. Six-month follow-up data were available from 36 of the 45 participants who completed treatment. Measures were 24-hour ambulatory BP, lipid levels, weight, and psychological measures.


RESULTS
Blood pressure was significantly reduced in the immediate treatment group and did not change in control subjects (-6.1 vs +0.9 mm Hg for systolic and -4.3 vs +0.0 mm Hg for diastolic pressure). When the wait list control group was later treated, BP was similarly reduced by -7.8 and -5.2 mm Hg, and for the combined sample, total change at follow-up was -10.8 and -8.5 mm Hg. Level of BP at the beginning of treatment was correlated with BP change (r = 0.45 [P<.001] and 0.51 [P<.001], respectively), and amount of systolic BP change was positively correlated with reduction in psychological stress (r = 0.34) and change in anger coping styles (r = 0.35-0.41).


CONCLUSIONS
Individualized stress management is associated with ambulatory BP reduction. The effects were replicated and further improved by follow-up. Reductions in psychological stress and improved anger coping appear to mediate the reductions in BP change.
Linden
W
W
Psychology/UBC 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4. wlinden@cortex.psych.ubc.ca
Lenz
J W
JW
Con
A H
AH
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000465:Algorithms; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D013315:Stress, Psychological / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
D008055:Lipids