A behavioral treatment program as a therapy in the control of primary hypertension. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. Relaxation therapy for hypertension: setting‐specific effects. Attention and Autonomic Self‐Regulation Behavioral treatment of essential hypertension: a comparison between cognitive therapy and biofeedback of heart rate. Thermal biofeedback as an effective substitute for sympatholytic medication in moderate hypertension: A failure to replicate The USA-USSR collaborative cross-cultural comparison of autogenic training and thermal biofeedback in the treatment of mild hypertension. Relaxation training for essential hypertension at the worksite: I. The untreated mild hypertensive. Stress management for essential hypertension: comparison with a minimally effective treatment, predictors of response to treatment, and effects on reactivity. Blood pressure biofeedback exerts intermediate-term effects on blood pressure and pressure reactivity in individuals with mild hypertension: a randomized controlled study. Evaluating the response of mild hypertensives to biofeedback-assisted relaxation using a mental stress test. Effects of group relaxation training and thermal biofeedback on blood pressure and related physiological and psychological variables in essential hypertension Placebo-controlled biofeedback blood pressure effect in hypertensive humans. Combined behavioral and pharmacological treatment of essential hypertension Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees. Effects of Feedback and Reinforcement on the Control of Human Systolic Blood Pressure RANDOMISED CONTROLLED TRIAL OF YOGA AND BIO-FEEDBACK IN MANAGEMENT OF HYPERTENSION Hypertension self-control with a portable feedback unit or meditation-relaxation Treatment of Hypertension with Biofeedback and Relaxation Techniques [Psychological nondrug treatment of hypertension and the criteria of its effectiveness]. Psychological treatment of essential hypertension: A controlled comparison of meditation and meditation plus biofeedback Preliminary results from a controlled evaluation of thermal biofeedback as a treatment for essential hypertension Can general practitioners use training in relaxation and management of stress to reduce mild hypertension? Comparison of Biofeedback Pulse Wave Velocity and Progressive Relaxation in Essential Hypertensives Controlled evaluation of thermal biofeedback in treatment of elevated blood pressure in unmedicated mild hypertension Controlled trial of biofeedback-aided behavioural methods in reducing mild hypertension. Clinical Effects of Blood Pressure Biofeedback Treatment on Hypertension by Auto-shaping Relaxation behavior therapy as sole treatment for mild hypertension.
In order to assess the effects of a Behavioral Treatment Program in the control of primary hypertension , twenty one unmedicated hypertensives were r and omly allocated to three groups : first , a treatment group ( BHG ) receiving a Behavioral Treatment which included : deep muscle relaxation , peripheral temperature Biofeedback and anxiety management training ; second , the placebo attention control group ( PHG ) and third , a control group of hypertensives too ( CHG ) . Additionally , were compared with seven normotensives subjects ( CNG ) . The post-treatment measures showed a significant reduction ( p < 0.001 ) in systolic and diastolic values only in the ( BHG ) . In a six months follow-up the ( BHG ) group still showed a significant reduction in the systolic and diastolic BP ( p < 0.02 ; p < 0.01 ) . Moreover individual variations in response to treatment were observed in this group , ( BHG ) CONTEXT The long-term risk for developing hypertension is best described by the lifetime risk statistic . The lifetime risk for hypertension and trends in this risk over time are unknown . OBJECTIVES To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk . DESIGN , SETTING , AND PARTICIPANTS  Community-based prospect i ve cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline ( 1976 - 1998 ) . MAIN OUTCOME MEASURES Residual lifetime risk ( lifetime cumulative incidence not adjusted for competing causes of mortality ) for hypertension , defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications . RESULTS The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher ( greater-than-or-equal to 140/90 mm Hg regardless of treatment ) were 90 % in both 55- and 65-year-old participants . The lifetime probability of receiving antihypertensive medication was 60 % . The risk for hypertension remained unchanged for women , but it was approximately 60 % higher for men in the contemporary 1976 - 1998 period compared with an earlier 1952 - 1975 period . In contrast , the residual lifetime risk for stage 2 high blood pressure or higher ( greater-than-or-equal to 160/100 mm Hg regardless of treatment ) was considerably lower in both sexes in the recent period ( 35%-57 % in 1952 - 1975 vs 35%-44 % in 1976 - 1998 ) , likely due to a marked increase in treatment of individuals with substantially elevated blood pressure . CONCLUSION The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90 % , indicating a huge public health burden . Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement , efforts should be directed at the primary prevention of hypertension & NA ; We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication . The effect was assessed in multiple setting s , including the relaxation therapist 's office , the Hypertension Clinic , and the patient 's natural environment , the latter using 24‐hour automated ambulatory blood pressure measures . Nineteen patients were r and omized  either to temperature biofeedback‐assisted relaxation or to an attention control , “ stress education . ” Antihypertensive medication was kept constant . In the behavioral therapist 's office , blood pressure decreased in equivalent amounts with both treatments . Hypertension Clinic nurse blood pressure remained stable or increased with both treatments , but again there was no difference between treatments . Ambulatory blood pressure increased with relaxation therapy and decreased with stress education , the effect being significant for diastolic pressure . The effects on ambulatory blood pressure were limited to the waking hours . The only variable that showed superior effects for relaxation therapy was physician‐determined blood pressure . These results call into question the generalizability of the effects of relaxation therapy from one setting to another & NA ; To examine how various aspects of attentional functioning are affected by autonomic self‐regulation procedures , this study compared the effect of two treatment programs ( EMG and thermal biofeedback used in conjunction with various somatic and cognitive relaxation/self‐regulation strategies , and Benson 's Relaxation Response procedure ) and a Waiting List control group for essential hypertensive adults on three , perhaps overlapping , attentional dimensions : the capacity to disembed figure from ground ( Embedded Figures Test , Block Design , and Picture Completion WAIS subtests ) ; the capacity to voluntarily deploy attention ( Digit Span subtest of the WAIS ) , and capacity to sustain attention or become absorbed ( as measured by the Tellegen Absorption Scale ) . Thirty essential hypertensive men and women were r and omly placed in one of the three groups . Attentional dimensions were assessed before and after the 10‐week treatment program ( or waiting period ) and the relationship between blood pressure and attentional changes were assessed . The only group to evidence significant blood pressure reduction , the “ Biofeedback Group , ” became significantly more Field Independent as measured by the EFT ( p less than 0.001 ) and the Block Design measure ( p less than 0.01 ) and evidence d a strong trend in the same direction on the Picture Completion measure ( p less than 0.052 , NS ) . No other significant pre‐post attentional changes were found . A Pearson product correlation revealed that changes in diastolic blood pressure were significantly correlated with changes in EFT ( r = 0.54 , p less than 0.0001 ) and the Picture Completion measure ( r = 0.32 , p less than 0.05 ) . The cognitive effect of autonomic self‐regulation is discussed . In addition , the possible role of attention in autonomic self‐regulation is examined & NA ; The efficacy and the mechanisms of action of two behavioral treatments for essential hypertension were compared : cognitive group therapy for anger control and biofeedback for heart rate control . The cognitive therapy aim ed at lowering the “ general anger ” level and helping overt expression of “ anger out ; ” heart rate biofeedback aim ed at slowing heart rate in stress situations . Ninety‐seven essential hypertensive patients were r and omly assigned to three groups ; after 20 dropouts , 77 patients fully participated in the study : cognitive treatment ( N = 30 ) , biofeedback ( N = 27 ) , and control ( no treatment , N = 20 ) . The treatments were held in 17 weekly sessions ; during treatment , blood pressure was measured once a month , and during follow‐up after 1 and 6 months . The anger level and heart rate control were assessed at the beginning and the end of treatment . The main results were : 1 ) a significant decrease of blood pressure for both treatments as compared with control , 2 ) a significant decrease of blood pressure with heart rate biofeedback as compared with cognitive therapy , and 3 ) a better control in anger achieved with cognitive therapy and a lesser control in heart rate as compared with biofeedback Thirty-three moderate hypertensives were converted to a 2-drug regimen of metoprolol and diuretic and BPs stabilized at a well-controlled level . They then completed one of three conditions over an 8-week interval : ( I ) 16 sessions of TBF ( h and and foot warming ) ; ( II ) 16 sessions of frontal EMG-BF ; ( III ) regular home monitoring of BP . Attempts were then made to withdraw the patients from the sympatholytic medication . Those successfully withdrawn were followed up for one year . There were no significant advantages for TBF over the other two conditions in the short term or with long-term follow-up . Only 27 % of treated patients ( including Condition III failures who were remedicated and treated with TBF ) were successfully off of the sympatholytic at a one-year follow-up . The generally poor results on clinical outcome were confirmed by clinic BPs , home BPs by patients , and 24-hour ambulatory BPs We have conducted a cross-cultural ( USA and USSR ) comparison of thermal biofeedback ( TBF ) and autogenic training ( AT ) to a self-relaxation control condition in 59 unmedicated males with mild hypertension . Identical assessment and treatment protocol s were carried out in both setting s ( Albany , New York , and Moscow ) . Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks . Results showed comparable , significant ( p less than .05 ) , short-term decreases ( M = 8.5 mm Hg ) in diastolic blood pressure ( DBP ) for both treatments at both sites . However , the Soviet patients , starting with significantly ( p less than .01 ) higher systolic blood pressures ( SBPs ) , showed significant decreases ( M = 12.8 mm Hg ) in SBP , whereas the American patients did not change appreciably ( M = 4.6 mm Hg ) . During follow-up , the treated Soviet patients showed significantly ( p less than .05 ) better maintenance of treatment effects , from 3 months to 1 year , than did the American patients . At 1 year , 75 % of the treated Soviet patients had DBPs less than 90 mm Hg , whereas only 24 % of the American patients had comparable DBPs & NA ; This industry‐based r and omized study compared the effects of behavioral treatment ( BT ) and blood pressure monitoring ( BPM ) on blood pressure ( BP ) change in 158 unmedicated persons with mild hypertension ( diastolic blood pressure 90 to 104 mm Hg ) . Participants recruited by a three‐stage screening were r and omly assigned to BT or BPM groups and stratified by entry diastolic blood pressure ( DBP ) , age , and sex . BT participants received relaxation training , with or without the addition of biofeedback , cognitive restructuring , and health behavior change components . During the study , all participants were followed by their usual care physicians and received medical advice . At 18 weeks into the study , after the BT groups completed training , both the BT and BPM groups showed significant reductions in systolic blood pressure ( SBP ) and DBP assessed in the company medical clinic ( 7.4 and 9.0 mm Hg SBP and 4.5 and 5.9 mm Hg DBP , respectively ) . These reductions were maintained throughout the 36‐week follow‐up period . Reductions in BP assessed at the participants ' worksite were similar for BT and BPM participants throughout most of the trial , indicating little advantage to the inclusion of behavioral interventions over monitoring alone . Differences in BP changes observed among participants receiving various combinations of behavioral treatment components indicated that the cognitive restructuring component reduced SBP in the worksite by an additional 5.4 mm Hg ( p less than 0.05 ) . Possible explanations for the BP changes observed in the BPM group and implication s of the results for the treatment of unmedicated mild hypertensives are discussed Few studies of psychological interventions for essential hypertension have incorporated comprehensive coping skills treatment programs , evaluated the efficacy of such programs against credible , minimally effective controls , examined the effects of these interventions on pressor responses , or clarified the nature of person by treatment interactions . The present study examined the relative effectiveness of multimodal stress management training and a minimally effective treatment control ( i.e. GSR biofeedback training ) in the treatment of essential hypertensives ' blood pressure at rest and in response to simulated stressful interpersonal situations . At the conclusion of an 8 week training period , stress management participants exhibited reliably lower resting diastolic blood pressure and tended to exhibit lower systolic pressure than controls . The former condition maintained their lower pressures through a 6-month follow-up period , but decreases in controls over follow-up rendered the conditions equivalent in blood pressure . No differences between conditions emerged in analyses on pressor responses .  Stress management training was somewhat more effective for individuals scoring low rather than high on measures of trait anxiety and irritability OBJECTIVE This r and omized controlled study examined whether a 4-week blood pressure ( BP ) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension . METHODS Participants in the active biofeedback group ( n=20 ) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals , whereas participants in the sham biofeedback group ( n=18 ) were told to manipulate their BP without feedback signals . BP , skin temperature , skin conductance , BP reactivity to stress , body weight , and state anxiety were assessed before training and repeated at the eighth week after the training . RESULTS The decreases in systolic ( 12.6 + /- 8.8 versus 4.1 + /- 5.7 ) and mean BP ( 8.2 + /- 6.9 versus 3.3 + /- 4.9 ) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group ( p=0.001 and 0.017 , respectively ) . Results from analysis of covariance with the follow-up systolic blood pressure ( SBP ) ( or mean arterial pressure [ MAP ] ) as the dependent variable , baseline SBP ( or MAP ) as the covariate , and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP ( p=0.013 and 0.026 , respectively ) . The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group ( p=0.005 and 0.01 , respectively ) , but not for the control group . For the sample as a whole and for the biofeedback group , the state anxiety score and body weight remained unchanged . CONCLUSIONS BP biofeedback exerts a specific treatment effect in reducing BP  in individuals with mild hypertension , possibly through reducing pressor reactivity to stress The objective of this study was to evaluate the long term effect of a program of biofeedback-assisted relaxation on hypertensive patients by mental stress test reactivity . Twenty mild hypertensive patients were subjected to a mental arithmetic stress test before and six months after completing biofeedback-assisted relaxation therapy . The therapy consisted of 10 sessions of biofeedback-assisted relaxation instruction and continuous home practise . The study group was compared to a control group . The biofeedback-assisted relaxation treatment produced a mild improvement in blood pressure control and decreased the dose of drugs used as well as a decrease in state-anxiety ( p < 0.05 ) . The stress-induced increases in systolic blood pressure , diastolic blood pressure , heart rate , galvanic skin response and skin temperature were all significantly attenuated six months after completion of biofeedback-assisted relaxation treatment One hundred and one patients , 70 experimental and 31 controls , with a diagnosis of essential hypertension , were examined for the effects of group relaxation training and thermal biofeedback on blood pressure and on other psychophysiologic measures : heart rate , forehead muscle tension , finger temperature , depression , anxiety , plasma aldosterone , plasma renin activity , and plasma and urinary cortisol .  Eighty percent of the participants were medicated . Treatment yielded a short-term success rate , defined as a decrease in mean arterial pressure of 5 mm Hg , of 49 % in the experimental group . Other significant short-term changes included a reduction of forehead muscle tension , state anxiety , plasma aldosterone , and increased finger temperature . Follow-up measurements were made approximately 10 months after treatment in 36 patients , 51 % of the treatment completers . Twenty of the 36 were short-term treatment failures , while 16 were treatment succeeders . Thirty-seven percent of the short-term succeeders continued to meet blood pressure criterion at follow-up . In short-term succeeders , continued practice of relaxation may influence long-term maintenance of decreased blood pressure . It is suggested that group relaxation training can be beneficial for short-term and long-term adjunctive treatment of essential hypertension  in selected individuals The role of biofeedback in blood pressure control remains ill-defined because of nonspecific ( placebo ) effects , small study numbers , and the technical limitations of continuous pressure feedback . Clarification of its potential is awaited by those seeking a nonpharmacological approach to blood pressure control . This study examines the capability for systolic pressure lowering of 5 mm Hg or more using continuous pressure feedback in a statistical sample of untreated , well-characterized , mildly hypertensive individuals . Subjects were r and omized in a double-blind study to active or placebo biofeedback . Placebo consisted of a modified contingency approach , using a partial disguise based on a digital high pass filter with 15 elements . Blood pressure-lowering capability was assessed during two laboratory sessions . Continuous visual feedback result ed in 11 of 28 subjects on active treatment and 12 of 28 on placebo treatment lowering their systolic pressure by 5 mm Hg or more ( 11 + /- 5.6 and 12 + /- 8.4 mm Hg , respectively ; P = NS ) . Pre study pressure was well-matched ( 153 + /- 9/97 + /- 4 and 154 + /- 8/98 + /- 4 mm Hg , respectively ) . An initial small difference in diurnal profile did not change . These findings indicate that among mildly hypertensive individuals , almost half can lower systolic pressure at will for short periods . This capability is independent of the real or placebo nature of the feedback signal . We conclude that there is no specific short-term biofeedback pressure-lowering capability in hypertensive individuals . Further exploration is needed to determine whether specific components of the placebo effect can be delineated , whether personality characteristics influence the response , and whether further biofeedback training can alter the outcome Fifty-two pharmacologically treated hypertensive patients were r and omized to one of four treatment groups : ( 1 ) diastolic blood pressure biofeedback , ( 2 ) progressive deep muscle relaxation training , ( 3 ) self-directed relaxation training , or ( 4 ) medication alone . Data collection occurred during baseline , treatment , and 1-year follow-up phases in a laboratory , a medical clinic , and the patient 's own home . Patients from all four groups combined showed mean blood pressure reductions of −10.2/−5.5 mm Hg on clinic recordings and −2.4/−.7 mm Hg on home recordings , which were maintained throughout the follow-up period . There were no significant differences among the four groups in terms of blood pressure reduction . Patients given adjunctive behavioral treatment showed significantly larger reductions in medication usage compared to patients treated with medication alone , but there were no significant differences among the three behaviorally treated groups . Patients who showed medication reductions did not show subsequent blood pressure elevation . The results suggest that combined behavioral and pharmacological therapy may be superior to pharmacological therapy alone in the treatment of essential hypertension OBJECTIVES This study examined the impact of a workplace-based stress management program on blood pressure ( BP ) , emotional health , and workplace-related measures in hypertensive employees of a global information technology company . DESIGN Thirty-eight ( 38 ) employees with hypertension were r and omly assigned to a treatment group that received the stress-reduction intervention or a waiting control group that received no intervention during the study period . The treatment group participated in a 16-hour program , which included instruction in positive emotion refocusing and emotional restructuring techniques intended to reduce sympathetic nervous system arousal , stress , and negative affect , increase positive affect , and improve performance . Learning and practice of the techniques was enhanced by heart rate variability feedback , which helped participants learn to self-generate physiological coherence , a beneficial physiologic mode associated with increased heart rhythm coherence , physiologic entrainment , parasympathetic activity , and vascular resonance . BP , emotional health , and workplace-related measures were assessed before and 3 months after the program . RESULTS Three months post-intervention , the treatment group exhibited a mean adjusted reduction of 10.6 mm Hg in systolic BP and of 6.3 mm Hg in diastolic BP . The reduction in systolic BP was significant in relation to the control group . The treatment group also demonstrated improvements in emotional health , including significant reductions in stress symptoms , depression , and global psychological distress and significant increases in peacefulness and positive outlook . Reduced systolic BP was correlated with reduced stress symptoms . Furthermore , the trained employees demonstrated significant increases in the work-related scales of workplace satisfaction and value of contribution . CONCLUSIONS Results suggest that a brief workplace stress management intervention can produce clinical ly significant reductions in BP and improve emotional health among hypertensive employees . Implication s are that such interventions may produce a healthier and more productive workforce , enhancing performance and reducing losses to the organization result ing from cognitive decline , illness , and premature mortality An automatic procedure providing information about human systolic blood pressure at each successive heartbeat under routine laboratory conditions is described . Twenty normal male subjects were given feedback of their own systolic pressure , half operantly reinforced for increasing and half reinforced for decreasing their pressure . Significant differences in pressure were obtained in a single session . The apparatus and results suggest a possible approach to the treatment of essential hypertension 34 hypertensive patients were assigned at r and om either to six weeks ' treatment by yoga relaxation methods with bio-feedback or to placebo therapy ( general relaxation ) . Both groups showed a reduction in blood-pressure ( from 168/100 to 141/84 mm . Hg in the treated group and from 169/101 to 160/96 mm Hg in the control group ) . The difference was highly significant . The control group was then trained in yoga relaxation , and their blood-pressure fell to that of the other group ( now used as controls ) Thirty borderline essential hypertensives were r and omly assigned to a portable constant-cuff blood pressure feedback technique or meditation-relaxation . Each technique was taught in the laboratory , then practice d twice daily at home for four weeks . Subjects mailed daily records of their progress . Seven feedback and ten meditation-relaxation subjects completed the program . Both techniques produced significant systolic and diastolic reductions within practice sessions and diastolic reductions over weeks of training . Neither technique improved reductions nor reduced initial systolic pressure levels over the four weeks . Differences between biofeedback and meditation-relaxation in within-session pressure reductions were not significant & NA ; The present study describes a 16‐week trial of the use of a combination of biofeedback and relaxation techniques for the treatment of hypertension . Twenty‐two hypertensive patients were r and omly allocated to one of three groups : ( 1 ) diastolic blood pressure feedback , electromyographic feedback , and verbal relaxation ; ( 2 ) sham blood pressure feedback ; and ( 3 ) no treatment . For the 14 patients completing active treatment during an initial or crossover period , the average changes in blood pressure as measured outside the laboratory were minimal ( 0/−1 and + 1/0 mm Hg , supine and st and ing , respectively ) . Average blood pressure reduction in the laboratory was no greater with active than with sham blood pressure feedback ( −3/−2 vs. −5/−2 mm Hg ) . One subject , however , after showing no change in blood pressure during sham feedback , achieved pronounced and prolonged improvement following active treatment . Overall results do not support the usefulness of these techniques as primary therapy in most hypertensives Eighty patients with essential hypertension , stages IIA-IIB , were examined three times : on admission to hospital , and 1 and 12 months later . All patients were subjected to clinical , psychological ( brief multifactorial question naire for examination of a personality and the interpersonal relationships test ) and psychophysiological investigation . The patients were allocated to 3 groups by r and om selection :  30 patients practicing autogenic training ( group 1 ) , 30 patients on relaxation therapy making use of biological feedback ( BFB ) ( group 2 ) , and 20 patients exposed to no psychological influences ( group 3 , or the controls ) . In the presence of psychological treatment , the BP decline , the increase in stress tolerance and the improvement of the psychological status were significantly more marked in the former two groups , as compared to the controls . Comparative assessment of the efficiency of autogenic training and BFB showed no basic differences between the two treatment methods . In cases where treatment proved inefficient , the patients exhibited a negative attitude to treatment and markedly demonstrative character Twenty-one patients with essential hypertension were r and omly allocated to eight 1-hour sessions of meditation training , meditation plus biofeedback-aided relaxation , or a no-treatment control group . Statistically significant falls in systolic and diastolic blood pressure occurred after both training programs , although overall reductions in blood pressure were not significantly greater in either program than in the control group . Meditation plus biofeedback-aided relaxation produced falls in diastolic blood pressure earlier in the training program than did meditation alone . All patients practice d meditation regularly between training sessions : The amount of practice did not correlate with the amount of blood pressure reduction after training . On question naire measures of psychological symptoms and personality , sex differences emerged , with females showing significant abnormalities in hostility scores and males showing significantly raised levels of somatopsychic symptoms . In females , outward-directed hostility fell significantly and assertiveness increased after training , but in males , somatopsychic symptoms were unchanged In a controlled trial , thermal biofeedback ( n=20 ) and abbreviated progressive relaxation ( n=22 ) were compared in the treatment of mild to moderate hypertensive patients whose blood pressures ( BP ) were initially controlled on two medications . For the clinical end point of maintaining control of BP on a single drug after treatment , biofeedback was superior to relaxation training ( at 3 months , 47 % success for biofeedback versus 23 % for relaxation ) . This same result tended to be true for patient-measured home BPs . BPs from laboratory psychophysiological testing showed no consistent advantage for one treatment over the other To see whether general practitioners could effectively carry out training in relaxation and management of stress to reduce mild hypertension a study was carried out with a sub sample of phase 2 of the Medical Research Council 's treatment of mild hypertension trial.1 In the main mild hypertension trial patients had been receiving either an active drug or placebo for six years . In phase 2 a sub sample of these patients were r and omly allocated either to continue or to stop receiving the active drug or placebo . In a further sub sample patients were again r and omised to receive or not to receive relaxation therapy . This factorial design presented an additional opportunity to assess whether patients controlled with active drugs might have their blood pressure maintained by this behavioural therapy once drug treatment was stopped and to assess whether blood pressure might be further reduced by this therapy in patients who had been under regular medical supervision for as long as six years and who had already received non-pharmacological advice . The therapy was conducted by general practitioners in group sessions once a week for eight weeks . The training in relaxation was accompanied by galvanic skin resistance biofeedback . At one year follow up blood pressure in the relaxation subgroups was either maintained ( in the group who had stopped receiving drugs ) or reduced further ( in the group who had continued receiving drugs and in both placebo groups ) , while in the control group it had increased in all the subgroups , but particularly in those who had stopped receiving drugs . Differences in changes in blood pressure between the relaxation and control groups were significant . There were five new cardiovascular events , including evidence of myocardial ischaemia in blindly coded electrocardiograms in the control group , compared with one in the treatment group . General practitioners , if motivated , can successfully apply this technique of training those with mild hypertension in relaxation and management of stress In a study undertaken to evaluate the clinical effectiveness of two behavioral treatments for essential hypertension ( biofeedback on arterial pulse-wave velocity and progressive relaxation )  24 hypertensive subjects were r and omly assigned to either a relaxation or biofeedback treatment group for 5 weekly sessions . In a second stage of the study 16 of the original subjects received both biofeedback and relaxation treatments during 5 additional weekly sessions . Results indicated that biofeedback and relaxation were equally effective in initial lowering of blood pressure in hypertensives . Although biofeedback training led to superior reductions at the 3-mo . follow-up point , after 1 yr . the blood pressures of both groups were not only equal but well below those presented at the beginning of the study In the first of two studies , 42 unmedicated mild hypertensives completed either 16 sessions of thermal biofeedback ( TBF ) training for h and ( 7 sessions ) and foot ( 9 sessions ) warming or 8 weeks of monitoring BPs at home . There was a trend ( p<.10 ) for more of those treated ( 57.1 % ) to have DBPs lower than 90 mm Hg than for those only monitoring BPs at home ( 33 % ) . Analyses of clinic BP values from r and om zero sphygmomanometer measurements , from 24-hour ambulatory BP monitoring , and from home  BP measurements made by the patient showed no advantage for treatment versus BP monitoring . Sixteen of the 21 patients in BP monitoring were later treated . Analyses of treatment effects across all treated subjects by gender revealed a significant ( p=.02 ) decrease in DBP for treated female subjects ( n=13 ) but not for males ( n=24 ) . In the second study the 22 initial treatment successes , that is , those whose DBP was below 90 mm Hg at posttreatment ( 59.4 % of those who completed treatment ) , were r and omized to an intensive follow-up ( monthly visits for 6 months , then visits every two months ) emphasizing regular home practice with an electronic TBF device or regular follow-up ( visits every 3 months ) . Twelve of the 22 were still normotensive at 12 months . There were no differences at any point during the follow-up between the two conditions in success rate or BPs despite a numerical advantage in reported frequency of home practice by those in the intensive follow-up condition Employees of a large industry were screened for the presence of coronary risk factors . A total of 204 employees , aged 35 - 64 years , with two or more such factors ( serum cholesterol concentration greater than or equal to 6.3 mmol/l ( 243.6 mg/100 ml ) , blood pressure greater than or equal to 140/90 mm Hg , and current cigarette consumption greater than or equal to 10 cigarettes a day ) were r and omly allocated to a biofeedback group receiving training in relaxation and management of stress or a control group . Both groups received simple health education literature . After eight weeks of training , and again eight months later , the biofeedback group showed a significantly greater fall in systolic and diastolic blood pressures than the control group ( p less than 0.001 ) . Plasma renin activity and plasma aldosterone concentration were measured in a sub sample at entry to the study and again at eight weeks and eight months ; both showed a greater reduction in the biofeedback compared with the control group at eight weeks ' follow-up . The greater reduction in blood pressure in the subjects in the biofeedback group compared with the control group ( 11.0 mm Hg systolic and 8.8 mm Hg diastolic ) , persisting eight months after the training , suggests that relaxation-based behavioural methods might be offered as a first-time treatment to patients with mild hypertension Objective Although biofeedback has been reported to be efficacious in the treatment of hypertension , the degree of response has varied . This study investigated the mechanisms of blood pressure reduction by biofeedback . Method : Thirty out patients with essential hypertension ( 10 men and 20 women ) aged 38 to 65 years were studied . Subjects were r and omly assigned to group A or B. Subjects in group A underwent biofeedback treatment once a week for a total of four sessions . Those in group B self-monitored their blood pressure during the sessions as the control period and later underwent the same biofeedback treatment . Results : Blood pressure measured by doctor was reduced by 17 + /- 18/8 + /- 7 ( p < .01 ) and elevation of pressure induced by mental stress testing was suppressed by 8 + /- 9 ( p < .05)/4 + /- 8 during the treatment period in group A ( mm Hg ) . In group B , both blood pressure measured by doctor and elevation of pressure by mental stress testing remained unchanged during the control period and they were later suppressed by 20 + /- 15/9 + /- 7 ( p < .01 ) and 11 + /- 10 ( p < .05)/5 + /- 9 by the biofeedback treatment . Self-monitored pressure in both groups tended to decrease by the biofeedback treatment . Systolic and diastolic pressures as well as pulse rate decreased , skin temperature increased , and alpha-wave amplitude on electroencephalography increased during the therapy ( p < .05 ) . Conclusion : This treatment was effective in suppressing the pressor response to stress . Patients whose  blood pressure  increases with stress may be suited for biofeedback intervention & NA ; This study tested the efficacy of relaxation therapy as sole treatment for mild hypertension in 110 men and women recruited from a five‐stage worksite blood pressure screening program . Participants were r and omized to 12‐weeks of relaxation therapy or support therapy .  Outcome blood pressure assessment s made by assessors who were unaware of group allocation revealed similar decreases in both treatment groups at post‐treatment and 6‐month follow‐up . While body weight did not change , alcohol consumption decreased similarly in both groups , and alcohol consumption was positively correlated with both absolute diastolic blood pressure and change in diastolic blood pressure at outcome . In conclusion , a superior blood pressure effect was not associated with relaxation therapy ;  however , alcohol consumption decreased in both treatment groups , suggesting that both interventions facilitated changes in health risk behaviors and indirectly on blood pressure level
OBJECTIVES To assess the evidence for the long-term effectiveness of biofeedback for the treatment of essential hypertension in adults and to model any clinical benefits .