Behavioral Methods in the Treatment of Hypertension

doi:10.1059/0003-4819-86-5-626

Behavioral Methods in the Treatment of Hypertension

A Review of Their Clinical Status

Abstract

Behavioral methods to lower blood pressure include biofeedback, relaxation, psychotherapy, suggestion and placebo, and environmental modification. Reported data for each method have been examined applying the clinical pharmacologic format used to study other therapeutic agents. Most studies have been Phase I type, small numbers of subjects in acute (short-term) treatment situations. Phase II studies, controlled trials with comparison with known effective agents, are sparse, and Phase III studies are not yet appropriate. These Phase I studies indicate blood pressure effects that are small, with minimal data about their duration and their relation to the use of pharmacologic agents. The methods are adjunctive and not alternative, while the compliance problem is similar to that with pharmacologic agents. The major differences between the methods are the ease with which they can be used. Widespread application of the nonpharmacologic methods cannot currently be recommended, but further basic and clinical research into mechanisms and outcomes is encouraged.

Article and Author Information

▸The authors are members of an Ad Hoc Committee appointed and supported by the Office of Prevention, Control, and Education, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health, Education, and Welfare; Bethesda, Maryland.
Committee members are Donald C. E. Ferguson, Ph.D. (Coordinator), Consultant, National Heart, Lung, and Blood Institute; Daniel P. Redmond, M.D., Division of Neuropsychiatry, Walter Reed Army Institute of Research; Gary E. Schwartz, Ph.D., Department of Psychology, Yale University, and Department of Psychiatry, Yale University School of Medicine; Alvin P. Shapiro, M.D., Department of Medicine, University of Pittsburgh School of Medicine; Stephen M. Weiss, Ph.D., National Heart, Lung, and Blood Institute; and David R. Ragland, Ph.D. (Research Associate), Consultant, National, Heart, Lung, and Blood Institute, whom the authors thank for his assistance.
The authors appreciate the help of the following investigators and clinicians who gave generously of their time in interviews and discussions during the preparation of this review: Herbert Benson, M.D., Harvard University; Keith Connors, Ph.D., University of Pittsburgh; Barry Dworkin, Ph.D., Rockefeller University; Bernard Engel, Ph.D., Gerontology Research Center, Baltimore, Maryland; Kenneth Kleinman, Ph.D., Southern Illinois University; David Kupfer, M.D., University of Pittsburgh; Neal Miller, Ph.D., Rockefeller University; Chandra Patel, M.D., London, England; David Shapiro, Ph.D., University of California at Los Angeles; Johann Stovya, Ph.D., University of Colorado; and Charles Vaughan, Ph.D., University of Pittsburgh.
▸Requests for reprints should be addressed to Alvin P. Shapiro, M.D.; 1183 Scaife Hall, University of Pittsburgh; Pittsburgh, PA 15261.
- Received May 20, 1976.
- Accepted October 18, 1976.