Psychologic Treatment for Hypertension Can Be Efficacious

The traditional view of psychologic treatments and their efficacy for treating primary hypertension is that they may be of some benefit for borderline hypertension and that they can be potentially useful adjuncts to medical treatment. This review challenges such cautious conclusions by critically analyzing previous reviews and by also considering innovative, newer clinical trials. One reason for cautious conclusions has been selective reviewing and a lack of well-designed trials. Measurement and study protocol differences as well as differences in treatment modality have all been shown to have major effects on observed outcomes. Studies that promise better results have the following characteristics: 1) use of 24-hour ambulatory monitoring as an end point to rule out white coat hypertension that does not need treatment in the first place; 2) inclusion of patients with truly elevated blood pressure at pretreatment; and 3) multicomponent treatments that are tailored to individual patient needs.