The efficacy of behavioral treatments for hypertension.

Evidence is reviewed for the efficacy of behavioral treatments for hypertension. The format chosen here is a review of reviews given that numerous consensus committee reports and quantitative reviews on the topic have been published. Extensive evidence from over 100 randomized controlled trials indicates that behavioral treatments reduce blood pressure (BP) to a modest degree, and this change is greater than what is seen in wait-list or other inactive controls. Effect sizes are quite variable. The observed BP reductions are much greater when BP levels were high at pre-test, and behavioral studies tend to underestimate possible benefits because of floor effects in their protocols. Blood pressure measured in the office may be confounded with measurement habituation. Multi-component, individualized psychological treatments lead to greater BP changes than do single-component treatments. Among biofeedback treatments, thermal feedback and electrodermal activity feedback fare better than EMG or direct BP feedback, which tend to produce null effects. There continues to be a scarcity of strong protocols that properly control for floor effects and potential measurement confounds.