The effect of biofeedback-assisted relaxation training on blood pressure and selected biochemical parameters in patients with essential hypertension

The effect of EMG biofeedback-assisted relaxation on blood pressure and selected biochemical parameters was evaluated in 38 patients with essential hypertension. Training consisted of 8 weeks of biofeedback and home practice of relaxation exercises. Mean blood pressure decreased in the experimental group from 144/90 to 133/84 mm Hg while the control group remained unchanged. Statistically significant decreases in the experimental group also occurred in muscle tension levels, in plasma aldosterone, and in urinary cortisol. Both aldosterone and cortisol are secreted by the adrenal cortex. It was concluded that the technique taught to the experimental group produced a reduction in skeletal muscle tension and a decrease in stress responding mediated by the adrenal cortex.     

Sustained effects of biofeedback-assisted relaxation therapy in essential hypertension

The usefulness of biofeedback-assisted relaxation as an adjunct or substitute for pharmacotherapy in essential hypertension can be enhanced if the effects are shown to persist after formal treatment has ended. Patients with essential hypertension successfully treated with biofeedback-assisted relaxation were recalled for follow-up yearly after the termination of treatment. Twenty-six of 40 patients met the BP criterion for success. At one-, two-, and three-year follow-up, 31%, 38%, and 27% of the successful completers continued to meet the criterion for success. The pretreatment-posttreatment decreases in BP were accompanied by decreases in forehead muscle tension and urinary cortisol. Forehead muscle tension, urinary cortisol, and anxiety levels were significantly lower than pretreatment one year after the end of treatment. Self-report data were used to assess continued relaxation practice. No relationship was found between practice and any other dependent measure. It appears that some patients trained in biofeedback-assisted relaxation can maintain lowered blood pressure, muscle tension, anxiety, and cortisol levels over the long term; however, the role of relaxation practice in maintaining these lowered levels remains unclear.     

Sustained effects of biofeedback-assisted relaxation therapy in essential hypertension.

The usefulness of biofeedback-assisted relaxation as an adjunct or substitute for pharmacotherapy in essential hypertension can be enhanced if the effects are shown to persist after formal treatment has ended. Patients with essential hypertension successfully treated with biofeedback-assisted relaxation were recalled for follow-up yearly after the termination of treatment. Twenty-six of 40 patients met the BP criterion for success. At one-, two-, and three-year follow-up, 31%, 38%, and 27% of the successful completers continued to meet the criterion for success. The pretreatment-posttreatment decreases in BP were accompanied by decreases in forehead muscle tension and urinary cortisol. Forehead muscle tension, urinary cortisol, and anxiety levels were significantly lower than pretreatment one year after the end of treatment. Self-report data were used to assess continued relaxation practice. No relationship was found between practice and any other dependent measure. It appears that some patients trained in biofeedback-assisted relaxation can maintain lowered blood pressure, muscle tension, anxiety, and cortisol levels over the long term; however, the role of relaxation practice in maintaining these lowered levels remains unclear.     

Interaction of biofeedback-assisted relaxation and diuretic in treatment of essential hypertension

Thirty patients with essential hypertension participated in a study designed to compare two treatments: diuretic medication alone (n=10) and biofeedback assisted relaxation combined with diuretic (n=20). One of 10 patients lowered BP with diuretic alone and 11 of 20 patients lowered BP with diuretic combined with biofeedback-assisted relaxation. The addition of the behavioral intervention to the diuretic therapy produced a decrease in blood pressure beyond that associated with the diuretic alone. The decreases in BP mediated by diuretic were related to high entry levels of BP, low anxiety, forehead muscle tension, anger expression and plasma renin activity. The BP decrease mediated by combined diuretic and biofeedback-assisted relaxation was associated with high pretreatment BP, anger controlled, low finger temperature and high/normal plasma renin activity.This work supported by the Northwestern Ohio Heart Association under grant No. 93132 to Dr. McGrady.     

Interaction of biofeedback-assisted relaxation and diuretic in treatment of essential hypertension.

Thirty patients with essential hypertension participated in a study designed to compare two treatments: diuretic medication alone (n = 10) and biofeedback assisted relaxation combined with diuretic (n = 20). One of 10 patients lowered BP with diuretic alone and 11 of 20 patients lowered BP with diuretic combined with biofeedback-assisted relaxation. The addition of the behavioral intervention to the diuretic therapy produced a decrease in blood pressure beyond that associated with the diuretic alone. The decrease in BP mediated by diuretic were related to high entry levels of BP, low anxiety, forehead muscle tension, anger expression and plasma renin activity. The BP decrease mediated by combined diuretic and biofeedback-assisted relaxation was associated with high pretreatment BP, anger controlled, low finger temperature and high/normal plasma renin activity.     

高血压患者心电图左心室高电压和左心室肥厚与血压的关系

目的:探讨原发性高血压患者常规心电图检测左心室高电压和左心室肥厚与血压的关系.方法:回顾分析我科2009年1月～2009年12月门诊及住院就医的各期原发性高血压患者92例临床资料,并与同期76例健康体检者对比.结果:高血压组心电图对左心室肥厚的检出率为15.22%,明显高于对照组,有统计学差异(x2=19.07,P<0.01);高血压组心电图对左心室高电压的检出率为20.65%,明显高于对照组,有统计学差异(x2=4.23,P<0.05).高血压组左心室肥厚率随着病情的加重逐渐加重,各级之间相比差异有统计学意义(P<0.01).左心室高电压情况各级之间相比差异亦有统计学意义(P<0.01),但与病情无明显的相关性.结论:心电图监测左心室肥厚和左心室高电压,简便易行,高血压患者应定期复查心电图,发现异常,积极降压等治疗.     

Effects of group relaxation training and thermal biofeedback on blood pressure and related physiological and psychological variables in essential hypertension

One hundred and one patients, 70 experimental and 31 controls, with a diagnosis of essential hypertension, were examined for the effects of group relaxation training and thermal biofeedback on blood pressure and on other psychophysiologic measures: heart rate, forehead muscle tension, finger temperature, depression, anxiety, plasma aldosterone, plasma renin activity, and plasma and urinary cortisol. Eighty percent of the participants were medicated. Treatment yielded a short-term success rate, defined as a decrease in mean arterial pressure of 5 mm Hg, of 49% in the experimental group. Other significant short-term changes included a reduction of forehead muscle tension, state anxiety, plasma aldosterone, and increased finger temperature. Follow-up measurements were made approximately 10 months after treatment in 36 patients, 51% of the treatment completers. Twenty of the 36 were short-term treatment failures, while 16 were treatment succeeders. Thirty-seven percent of the short-term succeeders continued to meet blood pressure criterion at follow-up. In short-term succeeders, continued practice of relaxation may influence long-term maintenance of decreased blood pressure. It is suggested that group relaxation training can be beneficial for short-term and long-term adjunctive treatment of essential hypertension in selected individuals.I greatly appreciate the assistance of Minda Sogocio, Judy Stewart, and Kay Gerstenmaier from the Toledo Health Department, and Ilona Jurek, Carrie Wakai, and Robert Spain from the Medical College of Ohio at Toledo. This research was supported by a grant to A. McGrady through the Hypertension Control Program of the City of Toledo Health Department, from the Ohio Department of Health.     

Intracellular electrolytes and selected biochemical parameters in patients with borderline arterial hypertension and positive family history of hypertension

The studies involved 22 patients with borderline hypertension and familial history of the arterial blood hypertension (mean age 24.6 years) and 9 patients without familial history of hypertension (mean age 22.2 years). Control group included 10 healthy volunteers (mean age 27.5 years). Erythrocyte Na+ and K+ levels, daily secretion of noradrenaline (NA), adrenaline (A) and dopamine (DA), prostacyclin metabolite 6-keto-PGF1 alpha, beta-thromboglobulin levels (beta-TG), triglyceride cholesterol, and HDL-cholesterol were determined in all examined subjects. Friedewald's equation was used to calculate LDL-cholesterol. Moreover, LCAT activity was measured. An increase in erythrocyte Na+, increased sympathetic activity, excessive platelet activity and decreased 6-keto-PGF1 alpha levels were found in the group of hypertensive patients with familial history of the arterial blood hypertension. HDL-cholesterol was significantly lower in these patients than in the control group. Atherogenic index (cholesterol/HDL-cholesterol ratio) was the highest in the hypertensive patients with familial history of the arterial blood hypertension. The difference was insignificant, however. Patients with the borderline hypertension and familial predisposition to this disease differ from the hypertensive patients without familial history of the arterial hypertension in humoral profile suggesting a contribution of the genetic factors to the development of the arterial blood hypertension.     

Effect of somatostatin on plasma renin activity and blood pressure in patients with essential hypertension

The effects of somatostatin on plasma renin activity (PRA) and blood pressure were evaluated in patients with essential hypertension (EH) and in normotensive subjects. All subjects examined were hospitalized and placed on a diet containing 7-8 g/day sodium chloride and received an intravenous infusion of somatostatin (500 microgram/20 ml of saline, for 60 min) in the basal condition. During somatostatin infusion, the mean blood pressure (MBP) remained unaffected in all patients with EH and the normotensive subjects, while the PRA decreased slightly in the EH group. When the patients with EH were classified according to their renin levels (low, normal and high), parallel significant decreases in MBP and PRA were found only in the high renin group during the somatostatin infusion. No significant change in MBP and PRA was observed in the other groups including the normotensive subjects. To assess the activity of synthetic somatostatin, the plasma levels of growth hormone (GH) and cyclic AMP were measured. These levels were lowered significantly during the infusion and the GH levels showed a rebound 15 min after cessation of the infusion. The cyclic AMP returned to the basal levels, but no rebound was observed. The above data indicate that the fall in blood pressure in the high renin group in the basal condition was probably due in part to reduced renin release by somatostatin, and the maintenance of high blood pressure especially in high renin EH.     

The effect of inhibition of prostaglandin synthesis on plasnta renin activity and blood pressure in essential hypertension

The influence of oral indomethacin treatment (75 mg daily for a week) on urinary excretion of prostaglandin (PG) F_2α, plasma renin activity (PRA), blood pressure (BP) and electrolyte excretion (Na⁺ and K⁺) was studied in 21 patients with untreated essential hypertension (9 women and 12 men, aged from 40 to 45 years). PGF_2α excretion and PRA were markedly suppressed by indomethacin in both sexes. A close correlation was found between the decreases in PGF_2α excretion and PRA. 13,14dihydro-15keto-PGF_2α (a metabolite of PGF_2α) excretion also tended to be lowered during the indomethacin treatment. BP tended to increase but urine volume and electrolyte excretion were unchanged during the indomethacin period. The results suggest that in essential hypertension inhibition of the PG synthesis causes a concomitant suppression in PRA and may slightly increase BP.     

ACE2基因多态性与高血压患者血压昼夜节律变化相关性研究

目的:研究血管紧张素转换酶2(ACE2)基因多态性与高血压患者血压昼夜节律变化的关系.方法:选择符合入选标准的高血压患者336例,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)的方法,进行ACE2基因分型.根据血压昼夜节律变化,将高血压患者分为勺型与非勺型两组.分析基因型是否为非勺型血压的危险因素.结果:男性勺型组与非勺型组ACE2基因型多态性的分布存在显著差异,勺型组以G等位基因携带者为主.结论:ACE2基因多态性与男性高血压患者血压昼夜节律相关,携带G等位基因的患者可能更易发生夜间血压升高.     

Predictors of success in hypertensives treated with biofeedback-assisted relaxation

This paper describes differences in response in seventeen patients with essential hypertension who participated in a treatment program consisting of electromyograph biofeedback assisted relaxation training. Responders were found to have higher treatment values of urinary and plasma cortisol, Trait Anxiety and forehead muscle tension compared to treatment failures. Responders also sustained greater decreases in plasma, and urinary cortisol after treatment. These data are discussed in light of the ability to predict which hypertensive patients may be most benefitted by a relaxation based treatment.     

A retrospective,follow-up study of biofeedback-assisted relaxation therapy in patients with posttraumatic headache

Although biofeedback in the treatment of migraine and tension-type headache has been widely researched, there is little research examining biofeedback therapy in posttraumatic headache (PTH). In this retrospective study, 40 subjects with PTH who had received biofeedback-assisted relaxation at our headache clinic were questioned at least 3 months following the completion of therapy. Subjects were queried about improvements in headache, increases in ability to relax and cope with pain, and overall benefits, lasting effectiveness, and continued use of biofeedback in daily life. Results indicate 53% reported at least moderate improvement in headaches; 80% reported at least moderate improvement in ability to relax and cope with pain; 93% found biofeedback helpful to some degree; 85% felt headache relief achieved through biofeedback had continued at least somewhat; and 95% stated they were continuing to use biofeedback skills in daily life. A correlation analysis revealed a negative relationship between response to biofeedback and increased chronicity of the disorder. In other words, the more chronic the disorder, the poorer the response to treatment. A stepwise regression analysis found that chronicity of the disorder and number of treatment sessions significantly affected response to treatment. Data suggest that biofeedback-assisted relaxation should at least be considered when planning treatment strategies for posttraumatic headache.We wish to express our appreciation to Sandra Tomlinson Becky Kinloch, and C. M. Bundrick for their assistance in this project.     

Predictors of success in hypertensives treated with biofeedback-assisted relaxation

This paper describes differences in response in seventeen patients with essential hypertension who participated in a treatment program consisting of electromyograph biofeedback assisted relaxation training. Responders were found to have higher treatment values of urinary and plasma cortisol, Trait Anxiety and forehead muscle tension compared to treatment failures. Responders also sustained greater decreases in plasma, and urinary cortisol after treatment. These data are discussed in light of the ability to predict which hypertensive patients may be most benefitted by a relaxation based treatment.We would like to thank Dr. Charles Spielberger for his permission to use the State-Trait Anxiety Inventory. We thank Michael Robinson for assistance with statistical analysis.     

The effectiveness of biofeedback-assisted relaxation in modifying sickle cell crises

Eight outpatients with sickle cell disease received six EMG and six thermal half-hour biofeedback training sessions. Statistically significant changes in the desired directions were obtained for the following variables: (a) frontalis muscle tension, (b) digital temperature, (c) frequency of headache as a crisis symptom, (d) frequency of analgesic use, (e) perceived pain intensity, (f) frequency of self-treated crises, and (g) state anxiety. Nonsignificant changes in hospital chart data were found. A 6-month posttreatment follow-up questionnaire revealed the continued effectiveness of the training received regarding headaches and mild pains.Portions of this paper were presented at the meeting of the Eastern Psychological Association, April 1984 and March 1985. The authors wish to publically thank the Ladies Auxiliary of St. Luke's-Roosevelt Hospital Center for donating tape recorders, home training relaxation tapes, and velcro thermistors to all participants. The authors are deeply grateful to Doris L. Wethers, M. D., director of the Sickle Cell Clinic at St. Luke's-Roosevelt Hospital Center for her cooperation with this study. She was especially helpful in clarifying the clinical manifestations of sickle cell disease. She was also helpful in enrolling patients and in obtaining the above-mentioned funding.