The major purpose of this study is to determine if adding a cognitive behavioral procedure to a drug treatment of mild- moderate hypertension will allow medication reductions while maintaining normotensive blood pressure (BP) limits. Previous evaluations of such combination treatments have typically relied on BP reductions as the primary dependent measure. However, a review of the literature shows that BP reductions fail to occur in populations that are well controlled by drugs, making further reductions unlikely (e.g., floor effects). Furthermore, studies that have used drug reductions as the dependent measure have utilized subjects who have been using antihypertensives for varying amounts of time so that the current minimal drug requirements were unknown. This leaves open the possibility that drug reductions may have been possible without any added treatment. A more appropriate methodology would be to use medication reductions as the principal dependent measure in a population where minimal drug requirements are determined a priori. This study will compare the effects of a cognitive-behavioral procedure to a non-behavioral treatment drug withdrawal control in a population of 60 patients with mild-moderate hypertension at the UCLA Medical Ambulatory Care Center. Important methodological departures from previous research are: (1) minimal drug requirements will be determined by placing all subjects on sequential drug protocol (Diazide and/or Atenolol) to control BP (less than 90 mmHg) and (2) subjects in all conditions will have medications systematically reduced. Furthermore, improvements in the quality of life in patients able to reduce medications requirements will be directly assessed. Quality of life improvements have been assumed but not measured in previous studies. A final purpose is to determine if pyschological variables, primarily anger and anixety identify """"""""responders"""""""" to this combination treatment.
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| Shapiro, D; Hui, K K; Oakley, M E et al. (1997) Reduction in drug requirements for hypertension by means of a cognitive-behavioral intervention. Am J Hypertens 10:9-17 |
| Pasic, J; Shapiro, D; Jamner, L D et al. (1994) Hostility and the response to diuretic in mild-to-moderate hypertension. Am J Hypertens 7:503-8 |
| Jamner, L D; Shapiro, D; Hui, K K et al. (1993) Hostility and differences between clinic, self-determined, and ambulatory blood pressure. Psychosom Med 55:203-11 |
| Shapiro, D; Jamner, L D; Goldstein, I B et al. (1990) Single versus triplicate measurements: a commentary on Fagan et al. Hypertension 16:103-6 |
| Oakley, M E; Shapiro, D (1989) Methodological issues in the evaluation of drug-behavioral interactions in the treatment of hypertension. Psychosom Med 51:269-76 |
