A controlled study of a standardized behavioral stepped treatment for hypertension

A standardized behavioral stepped care (SC) treatment for hypertension (blood pressure monitoring followed by self-administered systolic blood pressure biofeedback and relaxation, in sequence, as needed) was administered to 51 patients whose blood pressures were medically controlled to within normal limits. The effects of treatment upon blood pressure, medication requirements, and cost of care were compared with those of 51 referred care (RC) control patients who continued their usual care for hypertension. SC and RC patients were matched in groups on the basis of medication requirements (Group I, diuretics; Group II, beta-blockers alone or with a diuretic; and Group III, vasodilators alone or with a drug from Group I or II). The duration of the SC procedure was 1, 4, or 7 months--as necessary--and the follow-up period was 12 months. The RC protocol lasted 19 months. Medication requirements for SC patients declined to levels significantly (p less than 0.05) lower than those of RC patients from the biofeedback phase throughout follow-up for all drug groups combined. However, when the drug groups were analyzed separately, this was true for Groups I and II only. Similarly, the cost of care for all drug groups combined was lower for SC patients from the biofeedback phase through 9 months of follow-up, also reflecting changes seen in Drug Groups I and II only. Blood pressure levels remained controlled, in all groups, throughout the investigation. Clinical possibilities for combined behavioral and pharmacological treatment of hypertension are discussed relative to the pathophysiology of hypertension, and questions for future research are suggested.