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Behavioral vs β-blocker therapy in patients with primary hypertension: Effects on blood pressure, left ventricular function and mass, and the pressor surge of social stress anger

American Heart Journal
Publication Date
DOI: 10.1016/0002-8703(88)90563-7
  • Part Iii: Quality Of Life Issues And Behavorial Considerations In Hypertension
  • Medicine


Abstract We compared the relative effects of relaxation therapy, conventional hygienic techniques, and a β-receptor blocker, atenolol, on control of arterial pressure, left ventricular mass, and diastolic function in patients with mild primary hypertension. Furthermore, we related these effects to baseline neural tone and its changes and assessed the efficacy of relaxation or the pressor surge of “soclal stress” anger. In group I left ventricular mass index was related to both systolic and diastolic blood pressure ( r = 0.46; p < 0.05). Plasma norepinephrine was related to age ( r = 0.33; p < 0.01). Slope was inversoly related to both plasma norepinephrine ( r = −0.29; p < 0.05) and age ( r = −0.31; p < 0.05). Relaxation therapy reduced both supine systolic and diastolic blood pressures, 4.5% and 7.6%, respectively, but did not affect plasma norepinephrine. Hyglenic informational therapy reduced plasma norepinephrine by 18%; ( p < 0.05) and did not change blood pressure. Blood pressure responders to nondrug therapy (i.e., diastolic blood pressure reduction of 7% or more) had a 7% reduction of left ventricular mass index ( p < 0.02). On the other hand, atenolol reduced systolic and diastolic blood pressure by 10% and 15%, respectively, ( p < 0.01) and improved left ventricular function by 17% ( p < 0.05) without a significant change in left ventricular mass index. Finally, relaxation therapy but not hyglenic therapy reduced systolic blood pressures 4% and 6%, respectively ( p < 0.01), both before and during social stress anger. Changes in vascular stiffness caused by noradrenergic hyperactivity may lead to a reduction in left ventricular compliance and dlastolic dysfunction, separate from and in addition to the effects of left ventricular hypertrophy. Thus both the elevated blood pressure and the sequelae of arterial hypertension may be managed more effectively by therapy that neutralizes sympathetic tone, whether it be relaxation therapy techniques of β-receptor blockade.

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