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. The) 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.