The proposed research is a controlled evaluation of a multimodality biobehavioral group treatment for essential hypertension (EH) which has demonstrated clinical effectiveness in a single group outcome study, and (in individual treatment format) in a controlled comparison with relaxation training and with a medically-followed control. This non-drug treatment includes biofeedback-assisted training techniques aimed at teaching the patient self-regulation of vasodilation in the hands and feet, an index of the alpha-adrenergically mediated defense pattern. In a previous group outcome study of 77 patients with EH, significant reductions in both systolic and diastolic blood pressure (BP) and in medication level were observed, with 65% of the 54 medicated patients able to eliminate antihypertensive medication while at the same time reducing BP 15/10 mm Hg. An additional 24% of the medicated patients were able to cut their medications approximately in half while reducing BP by 17/12 mm Hg. The remaining 11% of the medicated patients showed no improvement in either BP or medication requirement. Follow-up data available on 61 of these patients over an average of 33.25 months indicated no significant regression in these results. This controlled study uses a time-lagged multiple baseline time series design. In a group of medicated EH patients all initially taking a diuretic plus a sympatholytic agent, after stepped medication withdrawal of all patients comparison will be made between the effects of the biobehavioral treatment, a medically-followed control condition, and supportive group therapy, an attention-placebo control condition. It is hypothesized that BP measures taken (a) blindly in the clinic, (b) during reactivity testing in the lab, (c) during 24-hour ambulatory monitoring in the world at large, and (d) during self-regulatory practice by the patient at home will all show greater reductions with the biobehavioral treatment than with the medically-followed control condition or with the attention-placebo control condition. Patients who must be re-medicated before completing training due to medical practice considerations will be studied separately to determine the effectiveness of biobehavioral treatment with this more seriously ill group.
| Fahrion, S L (1991) Hypertension and biofeedback. Prim Care 18:663-82 |
| Fahrion, S; Norris, P; Green, A et al. (1986) Biobehavioral treatment of essential hypertension: a group outcome study. Biofeedback Self Regul 11:257-77 |
