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Cognitive behavioral techniques for hypertension: are they effective?

D M Eisenberg¹, T L Delbanco, C S Berkey

¹Division of General Medicine and Primary Care, Beth Israel Hospital, Boston, MA 02215.

Annals of Internal Medicine

|June 15, 1993

Summary

Cognitive behavioral therapies for essential hypertension show no significant benefit over sham treatments or self-monitoring. While better than no therapy, these interventions lack clinical significance due to methodological limitations.

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Area of Science:

Cardiology
Behavioral Medicine
Clinical Psychology

Background:

Essential hypertension is a widespread cardiovascular condition.
Cognitive behavioral therapies (CBTs) are increasingly explored for managing hypertension.
Existing research has yielded mixed results regarding CBT efficacy.

Purpose of the Study:

To systematically evaluate the effectiveness of cognitive behavioral therapies for essential hypertension.
To synthesize findings from published randomized controlled trials (RCTs).

Main Methods:

A comprehensive literature search was conducted on MEDLINE and reference lists for RCTs published between 1970 and 1991.
Studies included interventions like biofeedback, relaxation, and meditation, compared against no therapy, waiting lists, or placebo controls.
Meta-analyses were performed on data from 1264 patients across 26 eligible trials.

Main Results:

Meta-analyses revealed that CBTs were superior to no therapy but not to credible sham techniques or self-monitoring.
In comparisons with placebo interventions, systolic blood pressure decreased by 2.8 mm Hg and diastolic by 1.3 mm Hg, neither statistically nor clinically significant.
Methodological limitations, including small sample sizes and confounding factors, were identified across the studies.

Conclusions:

Cognitive behavioral therapies do not demonstrate superior efficacy compared to placebo or self-monitoring for essential hypertension.
The current body of literature is limited by significant methodological inadequacies.
No specific cognitive behavioral technique showed greater effectiveness than others.