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 cognitive-behavioral intervention as an adjunctive treatment of hypertension. To qualify for the study, subjects had to have an unmedicated clinic diastolic blood pressure > or = 95 mm Hg. After qualification, minimal drug requirements were established using a diuretic and a beta-blocker to control blood pressure at < or = 90 mm Hg. Subjects were then randomized into a 6-week cognitive-behavioral intervention or a measurements-only control group. After the treatment phase, medication levels were reduced in all subjects by means of a systematic stepdown procedure. Subjects were followed for 1 year after the stepdown was completed. Addition of the cognitive-behavioral intervention was twice as effective as the control procedure in reducing drug requirements. At 12-months follow-up, 73% of the treatment group were at lower levels of medication than at the time of randomization, compared to 35% in the control group. Moreover, 55% of the treatment group remained completely free of medication, compared to 30% of the control group, at the 12-month follow-up. The reductions in medication were associated with maintained controlled levels of clinic, ambulatory, and home blood pressure. The addition of a standardized and inexpensive group-administered cognitive-behavioral intervention to the drug treatment of hypertension is beneficial as an adjunctive treatment in reducing drug requirements for patients with hypertension, thereby reducing the costs and potential side effects of antihypertensive medications.