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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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