This project will target a specific population, individuals with moderate to severe essential hypertension whose disease requires at least two drugs, diuretics and sympathetic blocking agents, to manage. We will determine if either of two behavioral, or non-pharmacological, treatments, abbreviated progressive relaxation or thermal biofeedback, can be substituted for the second stage, or sympatholytic, drug in the management of the hypertension in a controlled trial. Furthermore, we will compare two follow-up maintenance procedures over one year, monthly booster sessions of behavioral treatment versus standard medical care, to see if the former leads to improved maintenance vis-a-vis the latter. More specifically, l00 individuals suffering from moderate to severe essential hypertension will, after an extensive physical, biochemical, psychological and psychophysiological assessment, be randomly assigned to receive either abbreviated progressive relaxation or thermal biofeedback. Each sub-set of 50 will be further sub-divided such that half will receive behavioral treatment while on two drugs while the other half will receive the treatment after the second stage medication is discontinued. From the pre-treatment assessment battery we will develop a scheme to predict who responds positively to behavioral treatment and who does not. Extensive biochemical assessments will allow us to understand the mechanism through which the behavioral treatments work.
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