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Comparison of Effects With Concomitant Placebo, Diuretic, and β-Blocker

Rolf G. Jacob, MD; Alvin P. Shapiro, MD; Richard A. Reeves, MD; Anna Margareta Johnsen, MD; Robert H. McDonald, MD; P. Christopher Coburn, MD

Arch Intern Med. 1986;146(12):2335-2340.

Abstract
• We compared the effects of relaxation therapy in hypertensive patients taking placebo, a β-blocker (atenolol, 100 mg/d), or a diuretic (chlorthalidone, 50 mg/d), and we also compared the effects of relaxation therapy with the effects of the latter two drugs alone. Blood pressures were measured not only in the relaxation therapists' office and at a hypertension clinic, but also in the patient's environment by means of 24-hour ambulatory blood pressure recordings. The effect of relaxation therapy, while statistically significant, was modest. There was no generalization of effect to ambulatory blood pressure. Atenolol was significantly more effective than relaxation in reducing both systolic and diastolic pressure. Chlorthalidone was significantly more effective than relaxation in reducing systolic but not diastolic pressure in the hypertension clinic only. The long-term effects of relaxation were independent of concomitant drug use, but within the actual relaxation sessions blood pressure dropped further during chlorthalidone than during

Author Affiliations
From the Department of Psychiatry (Drs Jacob and Coburn) and the Division of Hypertension/Clinical Pharmacology, Department of Medicine (Drs Shapiro, Reeves, Johnsen, and McDonald), University of Pittsburgh School of Medicine.

Footnotes
Accepted for publication Feb 24, 1986.

Presented in part at the fifth annual scientific session of the Society for Behavioral Medicine, Philadelphia, May 23-26, 1984; and at the annual meeting of the Council for High Blood Pressure Research, Cleveland, Oct 10-12, 1984.

Reprint requests to Western Psychiatric Institute and Clinic, 3811O'Hara St, Pittsburgh, PA 15213 (Dr Jacob).

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