Individualized Stress Management for Primary Hypertension
A Randomized Trial
Wolfgang Linden, PhD;
Joseph W. Lenz, PhD;
Andrea H. Con, MA
Arch Intern Med. 2001;161:1071-1080.
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 than140/90
mm Hg received 10 hours of individualized stress management by means of semistandardized
treatment components. They 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.
From the Department of Psychology, University of British Columbia,
Vancouver.
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