Behavioral approaches to the treatment of hypertension

This chapter discusses behavioral approaches to the treatment of hypertension. The non-pharmacological approaches have been considered under five major methodological headings. These are biofeedback techniques, relaxation techniques, psychotherapy,suggestion and placebo effects, and environmental modification. For each of the five methods, material and data reported are examined using the clinical pharmacological format developed for the study of other therapeutic agents in human. The results of this analysis indicate that most of the studies have been of the phase I type—that is, demonstration of effects in small numbers of subjects in acute (short term) treatment situations. Phase II studies—that is, controlled clinical trials, with comparison with known effective agents are sparse. Phase III studies—that is, the data derived when large scale clinical use of the new therapy, without controls, are undertaken, may be beginning, although phase II efficacy and safety have not been established. The information currently available from these phase I studies indicates the effects on blood pressure that are small (e.g., 5-25 mm Hg MBP) with minimal data about the duration of such effects. From current data, these methods are adjunctive and not alternative, particularly in patients with moderate to severe hypertension. The problem of compliance with therapy would seem to be similar with the non-pharmacological as with the pharmacological modalities.