Efficacy of relaxation techniques in hypertensive patients.

We examined 117 outpatients (20- to 45-year-old men) with mild essential hypertension before treatment, after the main treatment course (6 weeks), and at 12-month follow-up. The patients were randomized into two major groups: (a) a treatment group that received autogenic training (23 patients), biofeedback (24 patients), or breathing-relaxation training (23 patients) and (b) a control group that consisted of 24 patients who did not receive any intervention and 23 patients who were treated with a "psychological placebo." Clinical, psychological, and psychophysiological data from all patients who were offered relaxation therapy were analyzed. By the end of follow-up, and compared to the control group, the treatment group demonstrated a significant reduction in systolic and diastolic blood pressures, peripheral vascular resistance, and hypertensive response to emotional stress, and an improvement in psychological adaptation, quality of life, and capacity for work. Comparative analysis of the efficacy of different relaxation methods revealed that biofeedback and breathing-relaxation training resulted in the greatest reduction in blood pressure. The antihypertensive effect of relaxation therapy correlated positively with pretreatment blood pressure levels and negatively with the duration of illness and certain psychological features.

Primary hypertension: left ventricular mass and function, sympathetic nervous system activity, and therapy.

Left ventricular (LV) mass is a predictor of morbidity in patients with hypertension. To elucidate the mechanisms of left ventricular hypertrophy (LVH) in primary hypertension, we examined the relationships of LV mass, arterial blood pressure, and plasma norepinephrine--as a marker of sympathetic nervous system tone--in three populations of patients with mild or moderate hypertension. We found linking of neural tone with (a) arterial blood pressure in mild and moderate hypertension, (b) LV mass in moderate hypertension, and (c) diastolic function in mild hypertension, suggesting that neural tone is a factor in both the pathogenesis and the sequelae of hypertension. Additionally, elevated norepinephrine level may reflect subtle loss of diastolic function before hypertrophy is manifest. Both nondrug and drug therapy may regress LV mass after blood pressure reduction with disparate effects on neural tone.

The USA-USSR collaborative cross-cultural comparison of autogenic training and thermal biofeedback in the treatment of mild hypertension.

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 protocols were carried out in both settings (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.

[Psychological nondrug treatment of hypertension and the criteria of its effectiveness]. / Psikhologicheskoe nemedikamentoznoe lechenie gipertonicheskoi bolezni i kriterii ego éffektivnosti.

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 questionnaire for examination of a personality and the interpersonal relationships test) and psychophysiological investigation. The patients were allocated to 3 groups by random 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.

[The effectiveness of psychorelaxation therapy in patients with hypertension]. / Effektivnost' psikhorelaksatsionnoi terapii u bol'nykh gipertonicheskoi bolezn'iu.

A study of 117 patients with labile essential hypertension before as well as 6 weeks and 12 months after psychorelaxation treatment (PRT), making use of autogenous training, biological feedback or respiratory relaxation training techniques (the main group), and the control patients, exposed to no psychological effects and those on the so-called psychological placebo, demonstrated a significantly greater fall of systolic and diastolic arterial blood pressure, total peripheral resistance and hypertensive response to emotional stress, as well as better psychological adaptation, quality of life and working capacity in the main-group patients, as compared to the controls, by the end of the study.

[Changes in the levels of adrenergic and serotoninergic indices in patients with depressive states]. / Nekotorye osobennosti izmeneniia urovnia adrenergicheskikh i serotoninergicheskikh pokazatelei u bol'nykh s depressivnymi sostoianiiami.

The blood and urine levels of biogenic amines and their metabolites were examined in 37 males with depressions chiefly of schizophrenic nature. The content of almost all catecholamines in the urine, as well as the level of serotonin in the blood were found to be lowered, however, the excretion of 5-hydroxyindolacetic acid with the urine remained unchanged. A rise of the noradrenaline blood level and of the homovanillic acid: dopamine ratio were noted. In patients with agitated depression, the noradrenaline content in the urine was higher than in patients with melancholic depression. A positive therapeutic effect and, even to a greater extent, egress from the depression were accompanied with a rise of the urine levels of almost all the agents examined.

[The comparative effectiveness of different psychological methods for treating patients with a labile course of hypertension (based on international research data)]. / Sravnitel'naia éffektivnost' razlichnykh psikhologicheskikh metodov lecheniia bol'nykh s labil'nym techeniem gipertonicheskoi bolezni (po dannym mezhdunarodnogo issledovaniia).

Examination of 110 patients with essential hypertension (EH) carried out in the USSR and GDR revealed, by the end of the observation period (one year), a significant lowering and normalization of arterial pressure at rest and a certain reduction of the intensity of the hypertensive response to psychoemotional stress influences in the presence of psychological relaxation therapy (PRT). The survey made it possible to try the designed methods for PRT in both countries and demonstrated that the intensity of the hypotensive action of the methods appeared comparable in different populations of patients suffering from essential hypertension. The intensity of the hypotensive action of PRT correlated with the level of arterial pressure before treatment, with the age of EH patients, and with their psychological characteristics.

The effects of thermal biofeedback and autogenic training of cardiovascular reactivity: the joint USSR-USA Behavioral Hypertension Treatment Project.

Cardiovascular reactivity (heart rate, systolic, and diastolic BP) to mental arithmetic and cold pressor were measured before and after treatment as part of the cross-cultural (USSR and USA) evaluation of thermal biofeedback and autogenic training (in comparison with self-relaxation) as treatments for mild hypertension in unmedicated males. There were no statistically reliable decreases in cardiovascular reactivity from before to after treatment. However, downward shifts in basal levels of systolic and diastolic BP at post-treatment led treated patients to have lower stress-induced levels of BP.