Behavioral treatment of borderline hypertension: an overview of results

The evidence for blood pressure reduction by behavioral interventions based on relaxation, biofeedback, and related approaches is reviewed. The majority of controlled investigations indicate that behavioral treatments results in greater reductions in blood pressure than no-treatment control conditions, particularly for higher levels of blood pressure. Behavioral interventions are also effective as an adjunct to pharmacotherapy when blood pressure remains elevated despite antihypertensive medication. Results with borderline and mild hypertensives are mixed. Nonspecific factors, such as positive expectancy and habituation to repeated blood pressure monitoring, play a significant role in blood pressure change and have important clinical implications. A stepped approach for the treatment of borderline hypertensives is advanced, entailing systematic monitoring with positive expectancy followed by behavioral treatments for individuals whose blood pressure remains elevated. Next comes combined behavioral and pharmacological interventions in those still not showing adequate blood pressure decreases. Recommendations for future research on behavioral interventions are presented.