Effects of education and relaxation training with essential hypertension patients

Thirty subjects with essential hypertension were assigned randomly to either a no treatment control, education, or education with relaxation training group. Independent blood pressure recordings were collected by medical staff at pretest, posttest, and 8-week follow-up. Results suggest a significant interaction between treatment and time for the dependent physiological measure, systolic blood pressure. During the pretest to follow-up period, the control group averaged a 5.9 mm. Hg. increase, the education with relaxation group an 8.8 mm. Hg. decrease, and the education group a 14.9 mm. Hg. decrease in systolic blood pressure. There was no significant difference in group means for diastolic blood pressure within groups over time. As measured at follow-up, education appeared more effective in reducing systolic blood pressure than education with relaxation training. More than one-third of subjects associated unpleasant side effects with their antihypertensive medication. Almost all treatment subjects rated the education and relaxation as helpful for understanding and managing their hypertension.     

Systolic Blood Pressure and Heart Rate Changes During Three Sessions Involving Biofeedback or No Feedback

Two groups of normotensive human subjects of both sexes received contingent feedback for increases or decreases in systolic blood pressure, and two additional groups received random (non-contingent) feedback or no feedback. Subjects in all groups served fur three 1-hr sessions separated by intervals of 24 hrs. Reliable decreases in blood pressure, reaching a maximum of 9.5 mm Hg at the end of the third session, were observed in the decrease group. No systematic changes in blood pressure were observed in the increase, random, or no-feedback groups. Heart rate increased or decreased in the groups receiving contingent feedback for increasing or decreasing blood pressure, respectively. It is concluded that contingent feedback is effective in lowering blood pressure and that decreases are augmented by extended training. The covariance of heart rate and blood pressure is discussed with reference lo curlier experiments.     

Relationship Between Essential Hypertension and Cognitive Functioning: Effects of Biofeedback

Seven malt essential hypertensives underwent 9 weekly 2-hr biofeedback training sessions in an attempt to produce decreases in blood pressure. Feedback, contingent Upon heart bent by heart beat decreases in systolic pressure, was provided by an automated blood pressure monitoring system. The subjects were administered the Category Test (a subtest of the HaLstead-Reitan Neuropsychological test Battery) both before and after biofeedback training. As controls, 4 male hypertensives underwent 3 weekly sessions in which blood pressure was monitored without feedback being provided. Prior to training, a significant positive correlation was otained between systolic blood pressure and number of errors made on the Category Test, Biofeedback training produced significant decreases in systolic pressure within sessions and in diastolic pressure between sessions, in the control subjects, no significant changes in pressure were observed. For both systolic and diastolic pressures, significant correlations w-ere obtained between magnitude of decrease during biofeedback training and improvement in Category Test scores subsequent to training.     

Relaxation therapy for essential hypertension: A veterans administration outpatient study

Twenty-nine patients who had been treated with antihypertensive medication for at least the preceding 6 months were randomly assigned to (1) therapistconducted, face-to-face progressive, deep-muscle relaxation training for 10 weekly sessions, or (2) progressive deep-muscle relaxation therapy conducted mainly by home use of audio cassettes, or (3) nonspecific individual psychotherapy for 10 weekly sessions. No differences between the groups were found immediately after therapy; however, the therapist-conducted relaxation therapy group showed the greatest changes: –17.8 mm Hg systolic, –9.7 mm Hg diastolic at 6 months follow-up. Some significant trends in results among the three therapists were also found. No correlation existed between blood pressure changes and changes in dopamine--hydroxylase (DbH) levels.     

Biofeedback and Progressive Relaxation: Effects on Systolic and Diastolic Blood Pressure and Heart Rate

Two groups of subjects were pretrained in Jacobson's progressive relaxation, then instructed to lower their blood pressure while receiving contingent feedback or no feedback for two 1-hr sessions. A third group was pretrained in a control relaxation procedure, then instructed to lower blood pressure while receiving contingent feedback. All subjects returned for a Follow-up session in which they attempted to reduce blood pressure without feedback. The results indicated reliable decreases in systolic blood pressure for all three groups in the first two sessions. The group pretrained in progressive relaxation and given feedback achieved greater control than the other two groups which did not differ from each other. During the Follow-up session, blood pressure decreases were small but reliable in the two groups pretrained in progressive relaxation. Heart rate and diastolic blood pressure decreased in all groups, with the progressive relaxation groups achieving the lowest levels. It is concluded that progressive relaxation and blood pressure feedback in combination are highly compatible and that progressive relaxation allows for modest blood pressure control in the absence of feedback.     

Anger management training with mild essential hypertensive patients

Casual blood pressures and measures of cardiovascular and behavioral reactions to neutral and confrontive interactions were obtained from 13 essential hypertensive patients who received training in anger management and 9 no-treatment control patients. At pre- and posttraining, heart rate (HR) and blood pressure (BP) were measured (a) at rest and (b) during role-play interactions consisting of neutral and confrontation scenes. Behavioral responses were also coded for each interaction. For treatment subjects, a 6-week program in anger management was conducted, which included relaxation training, self-statement modification, and role-play assertiveness training. Treatment subjects exhibited significantly lower casual DBPs at posttraining (M=90.2 mm Hg) than control subjects (M=95.7 mm Hg). Posttreatment casual SBPs for treatment and control subjects were not significantly different. Treatment subjects exhibited significantly more assertive skill and lesser DBP reactivity at posttreatment than their control counterparts during the confrontive interaction but not during the neutral role-play interaction.     

Pulse Transit Time Feedback and Bidirectional Blood Pressure Change

The current study examined the effects of pulse transit time feedback on systolic and diastolic blood pressure. Three subjects were given feedback designed to increase or decrease transit times. Eleven-twelve one-hour training sessions were provided over a two-week period. The results showed that during increase training, significant increases in systolic pressure and heart rate were observed, while pulse transit time showed a significant decrease. Diastolic blood pressure increases were moderate and only inconsistently observed. During decrease training, diastolic pressure and heart rate declined significantly below baseline. Pulse transit time increases were consistent but lower in magnitude than observed for the opposite training condition. Moderate systolic blood pressure decreases were inconsistently observed.     

Biofeedback as a treatment for postural hypotension

Two patients with cervical spinal cord lesions were treated for postural hypotension using auditory and visual feedback for voluntary increases in blood pressure. Following initial measures of blood pressure, feedback was delivered for systolic increases above baseline. Within several weeks, both patients learned to increase their pressure markedly from the start of training sessions to their conclusion. The patients' legs were progressively lowered during and at the end of training sessions without significant blood pressure decreases. Long-term follow-up indicated that they were able to maintain the learned increases in blood pressure despite adverse medical conditions. It is suggested that central nervous system damage disrupts homeostatic regulation, permitting greater voluntary control through biofeedback as a new feedback loop. Motivation is also considered an important variable for success.     

Biofeedback Training of Blood Pressure: A Comparison of Three Feedback Techniques

Three biofeedback procedures were compared for their effectiveness in training subjects to modify systolic blood pressure (BP). Three groups of 6 normotensives received three training sessions using one of three types of systolic BP feedback: 1) proportional feedback at 75-sec intervals, 2) relatively continuous proportional feedback, or 3) a form of continuous binary feedback. Three subjects also completed a fourth, no-feedback, session. Each session consisted of 5 training cycles, during which the subject was first instructed to “lower” BP and then “don't lower” BP. This design permitted demonstration of subjects' ability to control BP, rather than just lowering it. Systolic and diastolic BPs were recorded, as were heart rate, respiration rate and respiration volume. The continuous binary feedback technique was most successful in producing systolic BP control, apparently due to the short feedback latency and maximal information available to subjects. Diastolic BP often increased within sessions even when systolic BP decreased. No consistent covariation between BP and other physiological responses was observed, although at times these responses varied systematically with instruction. Continued systolic BP control at diminished levels was demonstrated by subjects who completed a fourth, no-feedback, session.     

Treatment of hypertension with biofeedback and relaxation techniques.

The present study describes a 16-week trial of the use of a combination of biofeedback and relaxation techniques for the treatment of hypertension. Twenty-two hypertensive patients were randomly allocated to one of three groups: (1) diastolic blood pressure feedback, electromyographic feedback, and verbal relaxation; (2) sham blood pressure feedback; and (3) no treatment. For the 14 patients completing active treatment during an initial or crossover period, the average changes in blood pressure as measured outside the laboratory were minimal (0/-1 and +1/0 mm Hg, supine and standing, respectively). Average blood pressure reduction in the laboratory was no greater with active than with sham blood pressure feedback (-3/-2 vs. -5/-2 mm Hg). One subject, however, after showing no change in blood pressure during sham feedback, achieved pronounced and prolonged improvement following active treatment. Overall results do not support the usefulness of these techniques as primary therapy in most hypertensives.     

Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy

Cancer patients who had developed negative conditioned responses to their chemotherapy either did (relaxation training) or did not (no relaxation training) receive progressive muscle relaxation training and guided relaxation imagery instructions immediately before and during their chemotherapy treatments. Physiological (blood pressure and pulse rate) measures of arousal, frequency of vomiting, and patient-reported and nurse-reported indices of negative affect and nausea were collected during pretraining, training, and posttraining chemotherapy sessions. Results indicated that during both the training and the posttraining sessions, patients in the relaxation training condition reported feeling less emotionally distressed and nauseated, and showed less physiological arousal following the chemotherapy infusion, than patients in the no relaxation training condition. The attending nurses' observations confirmed the patients' self-reports. No differences were found in frequency of vomiting between conditions. These data clearly suggest that the use of relaxation procedures may be an effective means of reducing several of the adverse side effects of cancer chemotherapy.     

Relationship Between Essential Hypertension and Cognitive Functioning II: Effects of Biofeedback Training Generalize to Non-Laboratory Environment

Eight male essential hypertensives underwent 9 weekly 2-hr biofeedback training sessions in which feedback (i.e., lights and tones) was contingent upon decreases in systolic pressure. Three weekly control sessions (with no feedback) preceded feedback training. Outside the laboratory, patients recorded blood pressure 5 times per day both at home and at work. Patients continued monitoring their blood pressure for up to 4 months after termination of feedback training. Both prior to and following the 9 weeks of biofeedback training, patients were given the Category Test (a subtest of the Halstead-Reitan Neuropsychological Test Battery). Feedback training resulted in significant reductions in blood pressure both within and outside of the laboratory. The reduction in non-laboratory pressure readings persisted for up to 4 months after feedback training was terminated. A significant positive correlation was found between systolic pressure and number of errors on the Category Test given prior to biofeedback training, and between magnitude of decrease in systolic pressure recorded during biofeedback training and improvement in Category Test performance measured subsequent to training. After completion of the study, patients were rated (on the basis of structured interview data obtained following weekly feedback sessions) as to overall level of stress (i.e., general stressfulness of life style, accidents, illnesses, emotional problems, etc.). Patients rated high in overall stress had significantly higher blood pressure readings during the control period. However, magnitude of decrease in blood pressure recorded during feedback training was essentially the same regardless of rated stress level.     

Stress management training and relaxation imagery in the treatment of essential hypertension

The present study compared the effectiveness of three procedures in the treatment of 34 individuals with essential hypertension: (1) stress management training plus relaxation imagery, which consisted of an adaptation of existing stress management techniques in conjunction with extensive relaxation training using relaxation imagery; (2) relaxation imagery alone; and (3) weekly blood pressure checks. The relaxation imagery technique involved visualization of a relaxing image along with concentration on suggestions of relaxation, heaviness, and warmth. Treatment was individualized and lasted 8 weeks. Results indicated stress management plus relaxation imagery and relaxation imagery alone were significantly more effective than blood pressure checks in reducing systolic and diastolic blood pressures during treatment and in maintaining diastolic blood pressure reductions during follow-up. However, no significant differences were found between the two treatment procedures. Clinical implications of these findings are discussed.     

The Role of Feedback in Control of Heart Rate Variability

The effects of contingent feedback (CF), non-contingent feedback (NCF). and no feedback (NF) on heart rate (HR) variability control were studied. Nine matched trios of subjects were given (ruining in HR variability control on 3 consecutive days. CF and NCF subjects attempted HR, variability control while HR feedback was continuously presented, and NF subjects attempted HR variability control without feedback. During the training periods the CF group produced reliably-lower mean HR variance than the NF group, but the NCF group was not reliably different from either of those groups. There was no significant difference among groups in negative linear trend across training periods, and the CF group did not continue to produce decreasing HR variances over sessions. However, the CF and NCF groups showed reliable quadratic trends, indicating an initial drop in HR variance followed by a return to pretraining levels. Both CF and NCF groups showed rapid, reliable increases in respiration rate during training periods. The results pose serious problems for studies which have reported feedback-related control of HR variability.     

Acute effects of transcendental meditation on hemodynamic functioning in middle-aged adults.

OBJECTIVE: Increased peripheral vasoconstriction (ie, total peripheral resistance, or TPR) has been implicated as playing an important role in the early development of essential hypertension. Some studies have demonstrated that Transcendental Meditation (TM) reduces high blood pressure, but the hemodynamic adjustments behind these blood pressure reductions have not been elucidated. The aim of this study was to provide a preliminary investigation of the acute effects of TM on TPR. METHODS: Subjects were 32 healthy adults (16 women and 16 men; 30 white and two African American; mean age, 46.4 +/- 3.9 years). Subjects were divided into a TM group of long-term TM practitioners (eight white women, nine white men, and one African American man; mean years of twice-daily TM practice, 22.4 +/- 6.7) and a control group (eight white women, five white men, and one African American man). Hemodynamic functioning was assessed immediately before and during three conditions: 20 minutes of rest with eyes open (all subjects), 20 minutes of TM (TM group), and 20 minutes of eyes-closed relaxation (control group). RESULTS: During eyes-open rest, the TM group had decreases in systolic blood pressure (SBP) and TPR, compared with increases in the control group (SBP: -2.5 vs. +2.4 mm Hg, p < .01; TPR: -0.7 vs. +0.5 mm Hg/liter per minute, p < .004). During TM, there was a greater decrease in SBP due to a concomitantly greater decrease in TPR compared with the control group during eyes-closed relaxation (SBP: -3.0 vs. +2.1 mm Hg, p < .04; TPR: -1.0 vs. +0.3 mm Hg/liter per minute, p < .03). CONCLUSIONS: TPR decreased significantly during TM. Decreases in vasoconstrictive tone during TM may be the hemodynamic mechanism responsible for reduction of high blood pressure over time. The results of this study provide a preliminary contribution to the understanding of the underlying hemodynamic mechanisms responsible for the beneficial influence of TM on cardiovascular risk factors.     

Heart rate and finger pulse amplitude during muscular relaxation with frontalis versus forearm EMG feedback.

Twenty-nine volunteers participated in a one-session experiment consisting of 10 min rest followed by a 30 min treatment period. Brief relaxation instructions were given at the beginning of the rest period. The treatment was either frontalis EMG feedback, forearm EMG feedback, or non-contingent stimulation. The two feedback groups showed EMG decreases in their respective target muscles during the no-feedback rest period, with no further decrease during feedback training, indicating that feedback was no more effective than relaxation instructions. Heart rate decreased significantly in both feedback groups. Finger pulse amplitude decreased significantly in the forearm feedback group. It is pointed out that the latter change does not necessarily indicate peripheral vasoconstriction, but may be due to a fall in pulse pressure as a consequence of increased blood flow to the relaxing muscles. The results are unsupportive of the assumption that frontalis relaxation is particularly effective in inducing a generalized relaxation.     

Relationship between pulse-wave velocity and arterial elasticity

Pulse wave velocity (PWV) was measuredin situ in 11 isolated canine common carotid arteries. Seven arteries exhibited a linear PWV/pressure function at pressures ranging from 0 to 200 mm Hg. Four arteries yielded a linear relationship between PWV and pressure between 1 and 100 mm Hg; for these vessels the relationship was nonlinear at higher pressures. Seven arteries (five from the group which was linear up to 200 mm Hg and two from the group which was linear up to 100 mm Hg) were excised and presure/volume measurements were madein vivo. Using pressure/volume data, the Moens-Korteweg equation was evaluated as a predictor of the PWV/pressure relationship over the linear region. An expression was developed to anable prediction of the pressure/volume relationship using the coefficients at the linear PWV/pressure function; these predictions were evaluated. We found that, for this range, the Moens-Korteweg equation provides a very good basis for predicting the increase in PWV with increasing bias pressure. In addition, we found that the pressure/volume relationship of common carotid arteries is well represented by an exponential of the form V/V_o=Ke^αf(P), which was derived as the inverse solution to the Moens-Korteweg equation.     

Biofeedback and relaxation in blacks with hypertension: a preliminary study

Previous studies show that stress increases blood pressure as a response to the sympathetic nervous system and that enhancement of parasympathetic activity promotes relaxation and lowers blood pressure. This paper is based on a preliminary study of 22 black subjects with a history of hypertension who were given biofeedback and relaxation training in the Biofeedback Laboratory at Howard University College of Medicine. The guided training consisted of eight weekly sessions using five instruments. Mean blood pressure (BP) was monitored in each session using a Stoelting BP Monitor. Data based on 10 characteristics (age, number of sessions, practice score, social readjustment scale, stress symptoms, systems review, initial and last systolic and diastolic BP) are analyzed and presented in five tables. Although differences between the initial and last readings of the systolic and diastolic BPs and during the test were observed, they were not statistically significant, probably due to small sample size. Analysis was also made by grouping the patients into three groups depending on the increase, decrease, or no change in BP. All patients demonstrated that the biofeedback training was beneficial in lowering the BP. These techniques should be incorporated into daily life to have lasting benefit.     

Self Control of Stress-Induced Cardiovascular Change Using Transit Time Feedback

Forty-eight normotensive subjects underwent one of four training conditions: Transit time plus stress (TTPS), Transit time minus stress (TTMS). False feedback plus stress (KF), and a stress only Control (C). In the first session, all subjects received an arithmetic stressor but without training. In the second and third sessions, subjects received training appropriate to their conditions. The TTPS and FF groups received arithmetic stressors prior to the transit time training, whereas the TTMS group rested prior to training. Training in the TTPS and TTMS groups consisted of beat-to-beat pulse transit time feedback. During the training period the FF group received bogus feedback. In the fourth session, all subjects received the stress-or followed by instructions to lower blood pressure (increase transit time). No feedback was available. Significant transit time decreases occurred in response to the stress in all groups during the first session. However, in the fourth session, the TTPS group showed virtually no transit time decrease during the stressor, while the remaining three groups continued to show significant transit time decreases to the stressor. It was concluded that self control over the subjects' reactivity to the arithmetic stressor had occurred in the transit time plus stress group. This effect did not appear to be due solely to either repeated exposure to the stressor or to learned control via feedback training. Rather, the effect seemed to result from the combination of exposure and training.