Stress Management Versus Lifestyle Modification on Systolic Hypertension and Medication Elimination: A Randomized Trial

Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA 02114, USA.
The Journal of Alternative and Complementary Medicine (Impact Factor: 1.59). 04/2008; 14(2):129-38. DOI: 10.1089/acm.2007.0623
Source: PubMed

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.

Download full-text


Available from: Jeffery A Dusek, Sep 26, 2015
135 Reads
  • Source
    • "Relaxation techniques can be divided into two categories: (1) The first includes techniques that focus on muscles to mind techniques, including breathing exercises and Jacobson's progressive muscular relaxation falls in this category; (2) The second category involves techniques that work from mind to muscle, including meditation, autogenic and imagery approaches, each of which is unique, but have the same effect on physiological variables in the body. Procedures like progressive muscular relaxation techniques, autogenic, imagery and meditation will decrease oxygen consumption, heart rate and respiration (Stefano et al., 2001; Cox, 2007; Dusek et al., 2008). "
  • Source
    • "Previous studies have investigated pathways for explaining the health effects of the RR. The physiological effects associated with the RR, such as reduced oxygen consumption , heart and respiratory rates, increased exhaled nitric oxide and lowered blood pressure, have been proposed as possible mechanisms for the beneficial effects [7] [8] [9]. Our study team has also been exploring the pathway through genomic alterations and recently reported that RR practice elicits specific gene expression changes [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies have shown beneficial effects from practicing the relaxation response (RR). Various pathways for these effects have been investigated. Previous small studies suggest that spirituality might be a pathway for the health effects of the RR. In this study, we tested the hypothesis that increased spiritual well-being by eliciting the RR is one pathway resulting in improved psychological outcomes. This observational study included 845 outpatients who completed a 13-week mind/body Cardiac Rehabilitation Program. Patients self-reported RR practice time in a questionnaire before and after the 13-week program. Similarly, data on spiritual well-being, measured by the subscale of Spiritual Growth of the Health-Promoting Lifestyle Profile II, were collected. The psychological distress levels were measured by the Symptom Checklist-90-Revised. We tested the mediation effect of spiritual well-being using regression analyses. Significant increases in RR practice time (75 min/week, effect size/ES=1.05) and spiritual well-being scores (ES=0.71) were observed after participants completed the program (P<.0001). Patients also improved on measures of depression, anxiety, hostility and the global severity index with medium effect sizes (0.25 to 0.48, P<.0001). Greater increases in RR practice time were associated with enhanced spiritual well-being (beta=.08, P=.01); and enhanced spiritual well-being was associated with improvements in psychological outcomes (beta=-0.14 to -0.22, P<.0001). Our data demonstrated a possible dose-response relationship among RR practice, spiritual and psychological well-being. Furthermore, the data support the hypothesis that spiritual well-being may serve as a pathway of how RR elicitation improves psychological outcomes. These findings might contribute to improved psychological care of cardiac patients.
    Journal of psychosomatic research 08/2010; 69(2):93-100. DOI:10.1016/j.jpsychores.2010.01.007 · 2.74 Impact Factor
  • Source
    • "Hanley et al. conducted a randomized controlled trial of therapeutic massage versus relaxation in stressed patients and found that both interventions were effective at reducing stress, with no significant difference between the intervention and control groups. More recently, Dusek et al. (2008) examined the effects of stress management, specifically, relaxation response, in hypertensive patients and found that relaxation techniques are more efficient than control in maintaining healthy blood pressure. An extensive search of the literature yielded no evidence of any evaluation of relaxation in stroke survivors (other than the report of our own trial by Mead et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study was set up to explore unexpected findings emergent from a randomized controlled trial of exercise versus relaxation post-stroke. Stroke survivors' experiences of taking part in exercise and relaxation classes were explored. In-depth, semi-structured interviews carried out with 14 community-dwelling stroke survivors in Edinburgh. The informants previously participated in a randomized exploratory trial of exercise versus relaxation. The classes motivated participants to take part in other purposeful activities, to continue to practice what they had learned, and/or to attend another class in the community. Class participation also led to an improvement of self-perceived quality of life, specifically, improved confidence, physical ability, psychosocial functioning, and a sense of empowerment. Taking part in either exercise or relaxation classes after stroke can contribute to improved self-perceived quality of life, improved psychosocial functioning, and improved motivation to take an active role in the recovery process.
    Canadian Journal of Occupational Therapy 05/2009; 76(2):73-80. DOI:10.1177/000841740907600204 · 0.92 Impact Factor
Show more