Behavioral Methods in the Treatment of Hypertension

Behavioral methods to lower blood pressure include biofeedback, relaxation, psychotherapy, suggestion and placebo, and environmental modification. Reported data for each method have been examined applying the clinical pharmacologic format used to study other therapeutic agents. Most studies have been Phase I type, small numbers of subjects in acute (short-term) treatment situations. Phase II studies, controlled trials with comparison with known effective agents, are sparse, and Phase III studies are not yet appropriate. These Phase I studies indicate blood pressure effects that are small, with minimal data about their duration and their relation to the use of pharmacologic agents. The methods are adjunctive and not alternative, while the compliance problem is similar to that with pharmacologic agents. The major differences between the methods are the ease with which they can be used. Widespread application of the nonpharmacologic methods cannot currently be recommended, but further basic and clinical research into mechanisms and outcomes is encouraged.