PurposeTo quantify effectiveness of lifestyle interventions for hypertension.Data sourcesElectronic bibliographic databases from 1998 onwards, existing guidelines, systematic reviews.Study selection and data abstractionWe included randomized, controlled trials with at least 8 weeks' follow-up, compa

Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials

On screening 192 men and women aged 35-64 were identified as having two or more of the following risk factors: blood pressure greater than or equal to 140/90 mm Hg, plasma cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), and current smoking habit greater than or equal to 10 cigarettes a day. They were randomly allocated to a group for modification of behaviour or to serve as controls. Both groups were given health education leaflets containing advice to stop smoking, to reduce animal fats in the diet, and on the importance of reducing blood pressure. In addition, the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises, relaxation, and meditation and about managing stress. It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group. After four years of follow up these differences in blood pressure were maintained. Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up. At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications. Incidence of ischaemic heart disease, fatal myocardial infarction, or electrocardiographic evidence of ischaemia was significantly greater in the control group. If the results of this study could be obtained in a larger study the financial and health care implications would be enormous.

https://www.bmj.com/content/bmj/290/6475/1103.full.pdf

Trial of relaxation in reducing coronary risk: four year follow up.

Healthy adults (N = 28) participated in a randomized trial of Bonny Method of Guided Imagery and Music (GIM; a depth approach to music psychotherapy) sessions on mood and cortisol. Participants in both GIM and wait-list control conditions completed the Profile of Mood States (POMS) and donated 15 cc of blood before and after the 13-week intervention period and again at a 6-week follow-up. Split-plot factorial and post hoc analyses demonstrated that after 6 biweekly sessions GIM participants reported significant decreases between pre- and postsession depression, fatigue, and total mood disturbance and had significant decreases in cortisol level by follow-up. Pretest to follow-up decrease in cortisol was significantly associated with decrease in mood disturbance. A short series of GIM sessions may positively affect mood and reduce cortisol levels in healthy adults. Such changes in hormonal regulation may have health implications for chronically stressed people.

http://psycnet.apa.org/journals/hea/16/4/390.pdf

Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults.

An opening address should ask the right questions, which we expect to answer during the coming years. A good opening address should formu late hypotheses for falsification during the conference or in the near fu ture. Mter Dr. Groen's excellent lecture yesterday, I feel better about my task, because I feel I am not alone in asking the ten questions in my ab stract. It is an honor for me to give this short paper largely based on my expe riences during 15 years as medical director of a rehabilitation center in Ba varia, as a teacher at two medical schools in Munich and Innsbruck, and as an old-fashioned holistic cardiologist. However, it also is a difficult task for me because the subject of this conference concerning biobehavioral factors in coronary heart disease is controversial, not only in the medical society, but in my own mind as well. When I organized one of the first conferences on stress and coronary heart disease in West Germany in 1976, followed by conferences in 1979 and 1980, the semantic problems between physicians and psychologists were very significant. However, communication has improved in this area during the last decade. The most encouraging event in this field was a sym posium in May 1984 in Rotenburg/Fulda on the topic "Return to Work af ter Bypass Surgery," organized by a cardiac surgeon, Dr. Walter."

Biological and Psychological Factors in Cardiovascular Disease

This article reports the results of an 18-month study of immune system and psychological changes in stage 1 breast cancer patients provided with relaxation, guided imagery, and biofeedback training. Thirteen lymph node negative patients who had recovered from a modified radical mastectomy were randomly assigned to either an immediate treatment or a delayed treatment control group. Multiple pre-post psychological measures were performed. Significant effects were found in natural killer cell (NK) activity (p<.017), mixed lymphocyte responsiveness (MLR) (p<.001), concanavalin A (Con-A) responsiveness (p<.001), and the number of peripheral blood lymphocytes (PBL) (p<.01). No significant psychological changes were detected; however, reductions were seen in psychological inventory scales measuring anxiety. The results show that behavioral interventions can be correlated with immune system measures, thereby replicating the results of an earlier pilot study from our Center. Discussion is provided on differential T-cell and B-cell responsiveness to behavioral interventions.

Immunological responses of breast cancer patients to behavioral interventions.

The effect of EMG biofeedback-assisted relaxation on blood pressure and selected biochemical parameters was evaluated in 38 patients with essential hypertension. Training consisted of 8 weeks of biofeedback and home practice of relaxation exercises. Mean blood pressure decreased in the experimental group from 144/90 to 133/84 mm Hg while the control group remained unchanged. Statistically significant decreases in the experimental group also occurred in muscle tension levels, in plasma aldosterone, and in urinary cortisol. Both aldosterone and cortisol are secreted by the adrenal cortex. It was concluded that the technique taught to the experimental group produced a reduction in skeletal muscle tension and a decrease in stress responding mediated by the adrenal cortex.

S. Y. Tan

Papers

The effect of biofeedback-assisted relaxation training on blood pressure and selected biochemical parameters in patients with essential hypertension