Relaxation training may improve control of hard-to-treat systolic hypertension

The relaxation response is a physiologic state of deep rest – involving both physical and emotional responses to stress – that can be elicited by practices such as meditation, deep breathing and prayer. Herbert Benson, MD, director emeritus of the Benson-Henry Institute and co-senior author of the current report, first described the relaxation response almost 35 years ago, and he and his colleagues have pioneered its use in mind/body medicine. While several studies have shown that the relaxation response can help alleviate hypertension involving elevated systolic and diastolic pressures, its usefulness in treating isolated systolic hypertension has not been investigated.

The present study enrolled more than 100 patients, aged 55 and older, whose systolic pressure remained elevated despite their taking two or more antihypertensive drugs. Participants were randomly assigned to two groups. The control group received weekly counseling sessions on cardiac risk factors, the impact of stress on hypertension, and recommendations on dietary and fitness goals. The treatment group attended sessions that also included instruction and practice eliciting the relaxation response. Both groups also received audiotapes to listen to daily – the control group with general lifestyle recommendations and the treatment group a guided relaxation response session.

Participants’ blood pressure was checked after eight weeks, and those whose pressures had dropped into the normal range – less than 140 systolic and 90 diastolic – were eligible to start reducing the dose of one of their medications. If blood pressures remained normal during subsequent weeks, dosage could be further reduced or eliminated; but participants whose hypertension returned resumed their previous dosage level. The physician conducting weekly evaluations did not know to which group participants belonged, and participants were told only that the study was evaluating different “stress management” programs.

By the end of the 20-week study period, participants in both groups had experienced a significant drop in systolic blood pressure, allowing two thirds of all participants to attempt medication reduction. Among relaxation response group participants, 32 percent maintained reduced systolic pressure after eliminating one or more medications, an accomplishment achieved by only 14 percent of those in the lifestyle-counseling group.