Stress management vs lifestyle modification for systolic hypertension.

Dusek JA, Hibberd PL, Buczynski B, Chang BH, Dusek KC, Johnston JM, Wohlhueter AL, Benson H, Zusman RM. Stress management versus lifestyle modification on systolic hypertension and medication elimination: a randomized trial. Journal of Alternative and Complementary Medicine 2008;14(2):129-138.

Aim Of This Study

This study was conducted to compare the effects of relaxation response techniques with lifestyle modification in elderly patients with systolic hypertension.

Method

One hundred and twenty-two participants aged 55 or older were enrolled into this study and randomised into two groups: the relaxation response group (RR) and the lifestyle modification group (control). Of these, 55 participants in the RR group and 49 participants in the control group completed the study.

To be eligible to take part in this study, participants must not have changed their medication in the four weeks prior to screening, had no major illness in the past six months, be non-smokers, and must not have had any previous experience with mind/body techniques.

The study period consisted of eight consecutive weeks of intervention that involved a one-hour weekly training session. Participants in the RR group spent 15 minutes of their weekly training learning relaxation techniques and subsequently spent 20 minutes being led through a guided relaxation. The remaining 25 minutes were spent listening to talks about cardiac risk factors and mind/body methods for stress management. A 20-minute guided relaxation audio tape was supplied to this group for home practice every day.

The control group spent their weekly training session listening to talks about how stress impacts health and identifying cardiac risk factors. These talks were accompanied by written information. The control group were also provided with a series of 20-minute audio tapes about lifestyle modification for daily listening.

Measurements

Blood pressure measurements were taken before intervention, at the end of intervention (week 8) and at week 12 for a follow-up. During these visits participants were seated for five minutes before the first measurement. A total of three measurements were taken with a minimum two-minute interval between each. An average of the three measurements was used to determine blood pressure.

The same study nurse took all the blood pressure measurements for all participants. She also completed a questionnaire at each visit to ascertain whether or not the participant experienced any adverse effects as a result of the blood pressure assessments.

Those participants whose SBP measured <140 mm Hg, whose DBP measured <90 mm Hg, who had a [greater than or equal to] 5 mm Hg reduction in SBP at 8 or 12 weeks and who had not altered their hypertensive medication during intervention, were eligible for supervised elimination of medication.

Results

Participants in the RR group reduced their SBP by an average of 10.2 mm Hg and those in the control group had similar results with a decrease of 9.4mm Hg. The DBP for both groups reduced modestly by 1.6 and 2.6 for the RR group and the control group respectively. Both groups lost a minimal amount of weight: 0.65 kg for the RR group and 0.33 kg for the control group.

Sixty-six per cent of all study participants were able to reduce their medication at either 8 or 12 weeks: 44 in the RR group and 36 in the control group.

Conclusions

The researchers concluded that:

   eight weeks of stress management training (via elicitation
   of the RR) and lifestyle modification resulted in
   SBP reduction of more than 9 mm Hg in elderly patients
   with systolic hypertension.

Limitations Of This Study

The researchers noted that one of the limitations of this study was that different patients took different types and amounts of hypertensive medication which would affect their ability to reduce or eliminate their medication. These different regimes highlight the question of whether RR is more effective with central nervous system agents or peripheral acting drugs.