The major goal of this project is to determine if adding a cognitive-behavioral treatment to the drug treatment of mild hypertension will allow reductions in anti-hypertensive medication levels required to maintain blood pressure at normotensive limits (< 90 mmHg diastolic BP DBP). The cognitive-behavioral treatment is compared to a control involving all study measurements only, including self-recording of BP by patients at home and ambulatory 24-hour recording. The research involves several important methodological departures from previous work: (1) patients are thoroughly evaluated prior to the study to determine if their DBP is > 95 mmHg, unmedicated; (2) a systematic drug protocol is used to establish minimal drug requirements; (3) after the intervention phase, all patients (treatment and control.) are systematically tapered off their medication to determine minimal levels to maintain control; (4) detailed evaluations of psychosocial quality of life, health habits, and short-term memory are made periodically throughout the study; (5) long-term follow-up of all patients. To date, 10 treatment and 11 control patients have completed the intervention phase. Within three months of follow-up, 5 out of the 11 controls have returned to initial medication levels, while all-treatment patients have been able to reduce their medication requirements. In the continuation, we propose to complete the initially proposed sample to 30 treatment and 30 controls, follow-up treatment group patients for 2 years, cross over control patients to the treatment condition, compare intervention successes and failures, and provide detailed evaluations of quality of life, memory, health habits, and multiple assessments of BP (clinic, ambulatory, home) as they relate to treatment-control differences and changes over various phases of the study.
| Pasic, J; Shapiro, D; Motivala, S et al. (1998) Blood pressure morning surge and hostility. Am J Hypertens 11:245-50 |
| 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 |
