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Relaxation training may improve control
of hard-to-treat systolic hypertension
Stress-management approach
could reduce need for medication, cut health care costs
BOSTON - March 27, 2008 - Adding the relaxation response,
a stress-management approach, to other lifestyle interventions may
significantly improve treatment of the type of hypertension most
common in the elderly. Among participants in a study conducted at
the Massachusetts General Hospital (MGH) Hypertension Program and
the Benson-Henry
Institute for Mind-Body Medicine at MGH, those who received
relaxation response training in addition to advice on reducing lifestyle
risk factors were more than twice as likely to successfully eliminate
at least one blood pressure medication than were those receiving
lifestyle counseling only. The study appears in the Journal of
Alternative and Complementary Medicine.
"Nearly 80 million Americans are classified as having hypertension,
and although we have many medications to lower blood pressure, only
about a third of patients achieve adequate control of their pressures,"
says Randall Zusman, MD, co-senior author of the report who leads
the Hypertension Program at the MGH
Heart Center. "If a practice that takes only 15 to 20 minutes
a day can help decrease patients' dependence on antihypertensive
medications - reducing often-unpleasant side effects and the considerable
costs of these drugs - we could not only improve their quality of
life but lower direct and indirect health costs by billions of dollars."
Among the elderly patients in whom it is most common, isolated
systolic hypertension - an increase in only the peak arterial pressure
- is more closely correlated with adverse events like heart attack,
stroke or renal failure than is elevated diastolic pressure. Treating
systolic hypertension is particularly challenging since older patients
who take many medications are at greater risk for drug interactions
and may be more vulnerable to other side effects.
The relaxation response is a physiologic state of deep rest - involving
both physical and emotional responses to stress - that can be elicited
by practices such as meditation, deep breathing and prayer. Herbert
Benson, MD, director emeritus of the Benson-Henry Institute and
co-senior author of the current report, first described the relaxation
response almost 35 years ago, and he and his colleagues have pioneered
its use in mind/body medicine. While several studies have shown
that the relaxation response can help alleviate hypertension involving
elevated systolic and diastolic pressures, its usefulness in treating
isolated systolic hypertension has not been investigated.
The present study enrolled more than 100 patients, aged 55 and
older, whose systolic pressure remained elevated despite their taking
two or more antihypertensive drugs. Participants were randomly assigned
to two groups. The control group received weekly counseling sessions
on cardiac risk factors, the impact of stress on hypertension, and
recommendations on dietary and fitness goals. The treatment group
attended sessions that also included instruction and practice eliciting
the relaxation response. Both groups also received audiotapes to
listen to daily - the control group with general lifestyle recommendations
and the treatment group a guided relaxation response session.
Participants' blood pressure was checked after eight weeks, and
those whose pressures had dropped into the normal range - less than
140 systolic and 90 diastolic - were eligible to start reducing
the dose of one of their medications. If blood pressures remained
normal during subsequent weeks, dosage could be further reduced
or eliminated; but participants whose hypertension returned resumed
their previous dosage level. The physician conducting weekly evaluations
did not know to which group participants belonged, and participants
were told only that the study was evaluating different "stress
management" programs.
By the end of the 20-week study period, participants in both groups
had experienced a significant drop in systolic blood pressure, allowing
two thirds of all participants to attempt medication reduction.
Among relaxation response group participants, 32 percent maintained
reduced systolic pressure after eliminating one or more medications,
an accomplishment achieved by only 14 percent of those in the lifestyle-counseling
group.
"The other nonpharmacological interventions that we know can
reduce systolic blood pressure - reducing dietary sodium, weight
loss, smoking cessation and increasing physical activity - can be
very difficult for patients to achieve," says Jeffrey Dusek,
PhD, the study's lead author. "Our control group received an
intensive amount of good-health information and reported making
fairly dramatic lifestyle changes, but only the relaxation response
group was able to significantly reduce their use of antihypertensive
medications." Formerly with the Benson-Henry Institute, Dusek
is now with the Institute
for Health and Healing at Abbott Northwestern Hospital in Minneapolis.
Zusman adds, "We are now going to look at the very large patient
population currently termed pre-hypertensives - those whose blood
pressure is elevated but does not yet meet the criteria for drug
therapy. If we can train those patients to elicit the relaxation
response, we may be able to delay or even avoid the onset of hypertension,
improving their cardiovascular health, reducing dependence on medications
and potentially reducing overall health care costs." Zusman
is an associate professor of Medicine, and Benson is the Mind/Body
Medical Institute Associate Professor of Medicine at Harvard Medical
School.
Additional co-authors of the report are Patricia Hibberd, MD, PhD,
Bei-Hung Chang, ScD, Kathryn Dusek, Jennifer Johnston, MD, and Ann
Wohlhueter of the Benson-Henry Institute, and Beverly Buczynski,
RN, MGH Cardiology. The study was supported by grants from the Centers
for Disease Control and Prevention and the National Institutes of
Health. The Benson-Henry Institute has benefited from the interest
and support of John Henry, principal owner of the Boston Red Sox.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of more than $500 million
and major research centers in AIDS, cardiovascular research, cancer,
computational and integrative biology, cutaneous biology, human
genetics, medical imaging, neurodegenerative disorders, regenerative
medicine, systems biology, transplantation biology and photomedicine.
Media Contacts: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
Information about Clinical Trials
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