REDUCTION IN DRUG REQUIREMENTS FOR HYPERTENSION BY MEANS OF A COGNITIVE-BEHAVIORAL INTERVENTION

The purpose of the present study was to test the effectiveness of a co gnitive-behavioral intervention as an adjunctive treatment of hyperten sion. To qualify for the study, subjects had to have an unmedicated cl inic diastolic blood pressure greater than or equal to 95 mm Hg. After qualification, minimal drug requirements were established using a diu retic and a beta-blocker to control blood pressure at less than or equ al to 90 mm Hg. Subjects were then randomized into a 6-week cognitive- behavioral intervention or a measurements-only control group. After th e treatment phase, medication levels were reduced in all subjects by m eans of a systematic stepdown procedure. Subjects were followed for 1 year after the stepdown was completed. Addition of the cognitive-behav ioral intervention was twice as effective as the control procedure in reducing drug requirements. At 12-months follow-up, 73% of the treatme nt group were at lower levels of medication than at the time of random ization, compared to 35% in the control group. Moreover, 55% of the tr eatment group remained completely free of medication, compared to 30% of the control group, at the 12-month follow-up. The reductions in med ication were associated with maintained controlled levels of clinic, a mbulatory, and home blood pressure. The addition of a standardized and inexpensive group-administered cognitive-behavioral intervention to t he drug treatment of hypertension is beneficial as an adjunctive treat ment in reducing drug requirements for patients with hypertension, the reby reducing the costs and potential side effects of antihypertensive medications. (C) 1997 American Journal of Hypertension, Ltd.