Abstract

This industry-based randomized study compared the effects of behavioral treatment (BT) and blood pressure monitoring (BPM) on blood pressure (BP) change in 158 unmedicated persons with mild hypertension (diastolic blood pressure 90 to 104 mm Hg). Participants recruited by a three-stage screening were randomly assigned to BT or BPM groups and stratified by entry diastolic blood pressure (DBP), age, and sex. BT participants received relaxation training, with or without the addition of biofeedback, cognitive restructuring, and health behavior change components. During the study, all participants were followed by their usual care physicians and received medical advice. At 18 weeks into the study, after the BT groups completed training, both the BT and BPM groups showed significant reductions in systolic blood pressure (SBP) and DBP assessed in the company medical clinic (7.4 and 9.0 mm Hg SBP and 4.5 and 5.9 mm Hg DBP, respectively). These reductions were maintained throughout the 36-week follow-up period. Reductions in BP assessed at the participants' worksite were similar for BT and BPM participants throughout most of the trial, indicating little advantage to the inclusion of behavioral interventions over monitoring alone. Differences in BP changes observed among participants receiving various combinations of behavioral treatment components indicated that the cognitive restructuring component reduced SBP in the worksite by an additional 5.4 mm Hg (p less than 0.05). Possible explanations for the BP changes observed in the BPM group and implications of the results for the treatment of unmedicated mild hypertensives are discussed.