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.     

Blood pressure variability and stress management training for essential hypertension

The purpose of this study was to determine whether stress management training reduces blood pressure (BP) variability in hypertensive patients. Previous literature suggests that cardiovascular risk is not only a function of BP levels, but also of BP variability, and this partially depends on changes induced by the stress of everyday life. The authors reanalyzed data from a previous study of 43 male patients with essential hypertension who were randomly assigned to 2 groups (stress management training and waiting list). Patients in the stress management group lowered their self-measured BP variability significantly from pretreatment to the 4-month follow-up examination, showing a mean reduction of 2.6/1.5 mm Hg in the standard deviation of systolic/diastolic BP (SBP/DBP), and a mean decrease of 1.84/1.59% in the coefficient of variation of SBP/DBP. For SBP, these reductions were significantly greater than those showed by the control group. These results suggest that stress management training is effective in reducing day-to-day BP variability, providing an additional reduction in cardiovascular risk for hypertensive patients.     

Predicting treatment outcome to progressive relaxation training in essential hypertensive patients

Nineteen borderline essential hypertensive patients participated in (a) a pretreatment assessment of sympathetic nervous system activity (SNS), (b) a progressive muscle relaxation training program, and (c) a posttreatment assessment of SNS functioning. During both pre- and posttreatment assessments, each subject participated in a laboratory session during which cardiovascular responses to two behavioral challenges were measured, a 24-hr urine collection for catecholamine analysis and the completion of relevant self-report questionnaires. Results revealed that subjects who improved the most with relaxation training (showed the greatest reduction in blood pressure) were individuals who, at pretreatment, (a) were less reactive to laboratory challenges, (b) possessed lower levels of resting epinephrine, and (c) scored lower on measures of trait anger and higher on assertiveness. Posttreatment assessment results showed that relaxation training did not affect cardiovascular reactivity to laboratory tasks or self-report of anger and assertion.Funding for this study was made available through a West Virginia University Senate Research Grant (87-824).     

Home relaxation techniques for essential hypertension

A 10-week relaxation treatment focused on home practice and self-monitoring of blood pressure for the purpose of lowering blood pressure in patients with essential hypertension. Comparisons were made among relaxation (n = 13), relaxation in combination with electromyographic biofeedback (n = 14), and a control condition in which patients simply monitored their blood pressure (n = 14). These three groups of patients, all of which received antihypertensive medication, were compared with a fourth group that practiced relaxation without drug therapy (n = 17). Relaxation and relaxation/biofeedback were equally effective in reducing blood pressure recorded at home in the morning and evening and produced greater decreases than in the control group. Relaxation without drugs, although somewhat more effective than self-monitoring, did not reduce blood pressure as much as the two conditions in which medication was combined with relaxation. Although reductions over the course of treatment were noted in blood pressure recorded in the laboratory, the four treatment conditions did not differ significantly from one another.     

Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension

BACKGROUND. Endothelium regulates vascular tone by influencing the contractile activity of vascular smooth muscle. This regulatory effect of the endothelium on blood vessels has been shown to be impaired in atherosclerotic arteries in humans and animals and in animal models of hypertension. METHODS. To determine whether patients with essential hypertension have an endothelium-dependent abnormality in vascular relaxation, we studied the response of the forearm vasculature to acetylcholine (an endothelium-dependent vasodilator) and sodium nitroprusside (a direct dilator of smooth muscle) in 18 hypertensive patients (mean age [+/- SD], 50.7 +/- 10 years; 10 men and 8 women) two weeks after the withdrawal of antihypertensive medications and in 18 normal controls (mean age, 49.9 +/- 9; 9 men and 9 women). The drugs were infused at increasing concentrations into the brachial artery, and the response in forearm blood flow was measured by strain-gauge plethysmography. RESULTS. The basal forearm blood flow was similar in the patients and controls (mean +/- SD, 3.4 +/- 1.3 and 3.7 +/- 0.8 ml per minute per 100 ml of forearm tissue, respectively; P not significant). The responses of blood flow and vascular resistance to acetylcholine were significantly reduced in the hypertensive patients (P less than 0.0001); maximal forearm flow was 9.1 +/- 5 ml per minute per 100 ml in the patients and 20.0 +/- 8 ml per minute per 100 ml in the controls (P less than 0.0002). However, there were no significant differences between groups in the responses of blood flow and vascular resistance to sodium nitroprusside. Because the vasodilator effect of acetylcholine might also be due to presynaptic inhibition of the release of norepinephrine by adrenergic nerve terminals, the effect of acetylcholine was assessed during phentolamine-induced alpha-adrenergic blockade. Under these conditions, it was also evident that the responses to acetylcholine were significantly blunted in the hypertensive patients (P less than 0.03). CONCLUSIONS. Endothelium-mediated vasodilation is impaired in patients with essential hypertension. This defect may play an important part in the functional abnormalities of resistance vessels that are observed in hypertensive patients.     

Meditation training and essential hypertension: A methodological study

Meditation training appears to be a promising psychological approach to the control of hypertension. However, most studies to date have had serious deficiencies. This study attempted to correct many of these deficiencies. Forty-one unmedicated hypertensives referred by general practitioners were randomly allocated to three groups. The treatment group (SRELAX) underwent training procedures based on Transcendental Meditation; a placebo control group (NSRELAX) underwent identical training but without a mantra. Both procedures were compared with a no-treatment control group. The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups, compared with the no-treatment controls, with diastolic percentage reductions reaching significance (p<0.05). There was considerable subject variation in response, with overall a mean decline in diastolic blood pressure of 8–10% on 3-month follow-up. Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed.This research was funded by a grant from the Auckland Medical Research Foundation.     

Biobehavioral approaches to the treatment of essential hypertension

Despite recent advances in the medical management of hypertension, chronically elevated blood pressure remains a major health problem in the United States, affecting almost 50 million Americans. It is widely recognized that lifestyle factors contribute to the development and maintenance of elevated blood pressure. This article critically reviews current approaches to the nonpharmacological treatment of high blood pressure and highlights outcome studies of exercise, weight loss and dietary modification, and stress management and relaxation therapies. Methodological issues in the assessment and treatment of hypertension are discussed, along with possible mechanisms by which lifestyle modification may reduce elevated blood pressure.     

Stress reactivity of intraocular pressure after relaxation training in open-angle glaucoma patients

The present study was based on the hypothesis that stress may contribute to increased intraocular pressure (IOP) in open-angle glaucoma patients. It is investigated whether IOP reactivity to a mental stressor test (MST) can be influenced by relaxation training. Twenty three patients with open-angle glaucoma were randomly assigned either to a training group (TG) or to a waiting-list control group (CG). Prior to as well as after the completion of the training all patients were exposed to the MST. IOP and heart rate as well as self-ratings of psychological strain were assessed three times: (1) at baseline, (2) after exposition to the stressor, and (3) after a 10-min relaxation phase. Results provide evidence that the MST is a valid procedure to induce psychophysiological activation and that elevated IOP levels in open-angle glaucoma patients might be provoked by stressing situations. However, participation in the relaxation training did not influence IOP stress reactivity.     

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.     

The effects of relaxation/imagery training on recurrent aphthous stomatitis: a preliminary study

Recurrent aphthous stomatitis (RAS) is one of the most common diseases of the oral mucosa. Although etiology remains unknown, immunological and emotional disturbances have been implicated in the pathogenesis of RAS. No consistently effective therapeutic regimen has been found. The present study investigates the voluntary modulation of RAS employing hypnosis-like relaxation/imagery training procedures. A multiple baseline design was used to evaluate change in frequency of ulcer recurrence. The role of psychological distress, ratings of perceived pain, and hypnotizability in the treatment of RAS were also examined. Results suggest that the relaxation/imagery treatment program was associated with a significant decrease in the frequency of ulcer recurrence for all subjects. Psychological distress was examined for relationship to ulcer recurrence and symptomatic changes with treatment, but no pattern was found. Finally, little support was found for the role of high hypnotic ability in the treatment of RAS.     

The effectiveness of activity scheduling and relaxation training in the treatment of spasmodic dysmenorrhea

The first purpose of this study was to examine the effectiveness of activity scheduling as a treatment for spasmodic dysmenorrhea, compared to relaxation training (a treatment of demonstrated effectiveness) and to a waitinglist control condition. The second purpose was to examine the differential effectiveness of these treatments on different measures. Forty women suffering from spasmodic dysmenorrhea completed six individualized treatment sessions or remained on the waiting list. Results showed that both activity scheduling and relaxation training were effective treatments for spasmodic dysmenorrhea, with both treatments producing improvements on general measures of dysmenorrhea, a symptom severity measure, and an activity measure.     

在社区中应用分筋理筋手法治疗落枕的临床疗效分析

目的：探讨分筋理筋膜手法治疗落枕的临床效果,分析分筋理筋手法在社区的应用价值和优势,从而更好为社区居民服务,更好地发掘利用和推广分筋理筋技术。方法：选取2014年1月至2015年1月,新二和一社区健康服务中心诊治的120例落枕患者为研究对象,按照随机数表法将其分为观察组与对照组,其中对照组采用拔罐治疗,观察组采用分筋理筋手法治疗,评估两组患者的治疗效果以及治疗1次和3次后的VA S疼痛评分、VA S强直评分。结果：采用分筋理筋手法治疗的观察组其总有效率为98.3%,明显高于采用拔罐治疗的对照组88.3%,差异显著有统计学意义(P<0.05)。治疗1次后,观察组与对照组的VAS疼痛评分分别为(2.78±0.89)、(4.41±1.67)分,观察组的VAS疼痛评分显著低于对照组,二者比较有统计学差异(P<0.05);治疗3次后,观察组的VAS疼痛评分仍低于对照组(P<0.05)。治疗1次及治疗3次后,观察组的VAS强直评分均显著低于对照组,二者比较有统计学差异(P<0.05)。结论：采用分筋理筋手法治疗落枕具有较佳的疗效,方法简便,医疗风险较低,适宜在社区卫生中心推广应用。     

A combination of methyldopa, hydrochlorothiazide and amiloride in the treatment of essential hypertension

41 patients (35 males and 6 females) with moderate hypertension were treated with a combination of methyldopa/hydrochlorothiazide/amiloride (M/HCT/A). In a double blind study the blood-pressure-lowering effect of this combination was compared with the effect of M or HCT/A alone. After 8 weeks of treatment, the combination of M/HCT/A lowered the elevated blood pressure more efficiently than the two monotherapies . M counteracted the potassium-loosing effect of HCT/A, but did not prevent the elevation of serum urea, creatinine and uric acid which is observed under treatment with HCT/A.