Stress management versus lifestyle modification on systolic hypertension and medication elimination: a randomized trial.

Full 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 >or=55 years, SBP 140-159 mm Hg, DBP <90 mm Hg, and at least two antihypertensive medications. The primary outcome measure was change in SBP after 8 weeks. Patients who achieved SBP <140 mm Hg and >or=5 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 <0.0001) without group difference (p=0.75). DBP decreased 1.5 (SD 6.2) and 2.4 (SD 6.9) mm Hg (p=0.05 and 0.01, respectively) without group difference (p=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=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.

Author information

Author/s: Dusek, Jeffery A (JA); Hibberd, Patricia L (PL); Buczynski, Beverly (B); Chang, Bei-Hung (BH); Dusek, Kathryn C (KC); Johnston, Jennifer M (JM); Wohlhueter, Ann L (AL); Benson, Herbert (H); Zusman, Randall M (RM);

Affiliation: Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA 02114, USA.

Grants: H75/CCH 123424 (Agency:PHS HHS) ; H75/CCH 19124 (Agency:PHS HHS) ; K24AT003683 (Agency:NCCAM NIH HHS) ; R01 DP000339 (Agency:NCCDPHP CDC HHS)

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.

Journal: Journal of alternative and complementary medicine (New York, N.Y.) (J Altern Complement Med), published in United States. (Language: eng)

Reference: 2008-Mar; vol 14 (issue 2) : pp 129-38

Dates: Created 2008/03/10; Completed 2008/07/08; Revised 2008/11/21;

PMID: 18315510, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: 18 Feb 2009 00:00:00)

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