High Blood Pressure (Hypertension)
High blood pressure is a common risk factor for heart disease and stroke later in life, and reducing blood pressure can significantly protect you from these undesirable health events. Regular relaxation and guided imagery have been shown in research studies to lower blood pressure, especially in the pre-hypertensive, mildly and moderately hypertensive stages. Imagery can also help you stop smoking, lose weight, develop an exercise habit, and reduce stress, all of which can help with high blood pressure. You can start simply with the "Relaxing into Healing" CD to introduce you to relaxation and imagery, or, better, use our "Guided Imagery for Self-Healing" book and 4 CD set that will teach you the nine essential skills of using guided imagery to help stimulate healing from within. The book will explain the process, review the science behind it, and coach you through the common questions that people have, while the CD set guides you through the 9 essential guided imagery skills taught in the book. A quicker introduction, especially for people that don't prefer to read, is to use "Self Healing with Guided Imagery", a 2 CD set featuring Dr. Andrew Weil. The first CD explains mind/body healing and guided imagery while the second teaches you the three most fundamental self-healing skills.
RESEARCH
GUIDED IMAGERY in HYPERTENSION
November, 2005
About the problem
Hypertension (HTN) is defined as a repeated blood pressure reading of greater than 140/90 mm Hg with pressures over 120/80 now considered as pre-hypertensive and worthy of lowering, especially with non-pharmacoologic means Over 50 million Americans have HTN, and more than 31% of those who have it donít realize it (National Institute of Mental Health).
Costs
According to a publication by the U.S. Preventative Services Task Force, the total costs of hypertension in 2000 was $50.3 billion (approximately $37.2 billion in direct costs; $13.1 billion in indirect costs). Hypertension is a major contributor to coronary artery disease (740,000 deaths per year in the United States), cerebrovascular disease (150,000 deaths per year), and kidney disease -- three of the leading causes of morbidity, mortality, and medical resource utilization in this country (AHA, 2002). In 2000, there were 35 million outpatient visits for hypertension (Dawber, 1980). In 2000, 44,619 deaths were attributed directly to hypertension, with HTN playing a part in 118,000 more (NIMH).
Benefits of Control
The benefits of controlling even mild hypertension are well accepted. Long-term reductions in mortality from coronary artery and cerebrovascular disease of between have been reported in large-scale studies (CDC).6 Incidence of stroke, in particular, can be sharply reduced by controlling hypertension (AHA, 2003).
Nonpharmacologic Approaches
The effectiveness and cost-effectiveness of behavioral interventions, either in place of or in combination with drug therapy, were demonstrated in many studies done in the1980s (Agras, 1981; Crowther, 1983; "Five year findings," 1979; Patel & Marmot, 1987). Along with exercise, and weight loss, relaxation techniques are among the most effective interventions. Behavioral approaches also have the added advantage of improved quality of life ("Five year findings"), better self-care, improved patient locus of control, and improving compliance (Ginsberg, Viskoper, Prem, et al, 1990).
Mind-Body Approaches*
Guided imagery is a highly effective in reducing blood pressure using deep relaxation with positive self-suggestion (Agras 1981; Lorig, Sobel, Stewart et al. 1999). Centers for Disease Control and Prevention researchers have stated that evidence for the effectiveness of certain non-drug approaches to HNT prevention and control including guided imagery is strong (Taylor, Farquhar, Nelson & Argas, 1977). Individual studies support the effectiveness of imagery, relaxation training, biofeedback with relaxation training, hypnosis, and autogenic training (Astin, Shapiro, Eisenberg, et al, 2003; Labarthe; Herrmann, 2002; & Ayala, 2002; Setter & Kupper, 2002). Positive results were further confirmed by two 2003 reviews of the medical literature. One study found ìmoderate evidence of efficacyî for using mind body modalities (relaxation, imagery, hypnosis, CBT) for managing HTN (Labarthe), while a review of 22 studies showed that biofeedback combined with relaxation significantly decreased both systolic and diastolic blood pressures (Stetter).
One researcher reported in his 2002 study that ìrelaxation techniques (autogenic training or progressive muscular relaxation, behavioral therapy or biofeedback techniques), can lower elevated blood pressure by an average of 10 mmHg (systolic) and 5 mmHg (diastolic)" (Astin, Shapiro, Eisenberg, et al.).î
More recent studies confirm that meditation (Barnes, et al, 2004a, Barnes et al, 2004b), relaxation and stress reduction (Kurz, Potz, Dorrscheidt, Uhlir 2005), and even simply breathing techniques (Bernardi, Spicuzza, Sleight, 2005) can positively affect hypertension. Meditation also appeared to decrease blood pressure among African American women (Schneider, Alexander, Staggers, Orme-Johnson, Rainforth et al., 2005) and significantly decreased mortality in hypertensive subjects (Schneider, Alexander, Staggers, Rainforth, Salerno, et al., 2005). Authors of a meta-analysis of 22 biofeedback studies concluded that only the relaxation-assisted biofeedback significantly decreased both systolic and diastolic blood pressures, so its effect may possibly only be from the relaxation component (Nakao).
* Please note that we cite studies that include relaxation training, suggestion, hypnosis, meditation, biofeedback, and psychotherapy. All these processes and interventions utilize imagery and guided imagery as core components, and in fact, it is difficult to have any effect from any of them, except meditation, without the significant use of imagery.
References
[No authors indicated] Hypertension Detection and Follow-Up Program Cooperative Group. Five-year findings of the Hypertension Detection and Follow-Up Program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA, 1979 242:2562-2572.
Agras WS. Behavioral approaches to the treatment of essential hypertension. Int J Obes, 1981 5 suppl 1:173-81.
American Heart Association. (2003). http://www.americanheart.org/presenter.jhtml?identifier=2139 Accessed June, 2003.
American Heart Association. Heart Disease and Stroke Statistics ó 2003 Update. (2002). Dallas, Tex.: American Heart Association, pg. 40. www.americanheart.org/downloadable/heart/10461207852142003HDSStatsBook.pdf Accessed June, 2003.
Astin, JA, Shapiro, SL, Eisenberg DM, Forys, KL. Shapiro, S.L., Eisenberg, D.M., Forys, KL. (2003). Mind-body medicine: state of the science, implications for practice.J Am Board Fam Pract, 2003 Mar-Apr;16(2):131-47.
Barnes VA, Davis HC, Murzynowski JB, Treiber FA. Impact of meditation on resting and ambulatory blood pressure and heart rate in youth. Psychosom Med. 2004a Nov-Dec;66(6):909-14.
Barnes VA, Treiber FA, Johnson MH. Impact of transcendental meditation on ambulatory blood pressure in African-American adolescents. Am J Hypertens. 2004b Apr;17(4):366-9.
Bernardi L, Porta C, Spicuzza L, Sleight P. Cardiorespiratory interactions to external stimuli. Arch Ital Biol. 2005 Sep;143(3-4):215-21.
Borkovec TD, et al. The role of worrisome thinking in the suppression of cardiovascular response to phobic imagery, Behavior Research and Therapy, 1993 Mar 31(3) 321-324
Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2002 Summary. Advance data from vital and health statistics; No. 328. Hyattsville, Maryland: National Center for Health Statistics. 2002.
Crowther J. Stress management training and relaxation imagery in the treatment of essential hypertension. J Behavioral Medicine, 1983 Jun 6(2) 169-187
Dawber TF. The Framingham study: the epidemiology of atherosclerotic disease.1980. Cambridge, MA: Harvard University Press.
DiGuiseppi C., for the U.S. Preventative Services Task Force. Screening for Hypertension. The Guide to Clinical Preventive Services: Task Force, Second Edition 1996 (excerpt). Posted on: http://odphp.osophs.dhhs.gov/pubs/GUIDECPS.
Friedman M, Rosenthal R. Type A Behavior and Your Heart, Fawcett Crest, NY 1974.
Ginsberg, GM, Viskoper RJ, Prem S, Bregman L, Mishal Y, Sherf, S. Resource savings from non-pharmacological control of hypertension. J Human Hypertension, 1990 Aug; 4 (4): 375-8. Herrmann, J.M. Essential hypertension and stress. When do yoga, psychotherapy and autogenic training help? [Article in German] MMW Fortschr Med, 2002 May 9;144(19):38-41
Kurz RW, Pirker H, Potz H, Dorrscheidt W, Uhlir H. [Evaluation of costs and effectiveness of an integrated training program for hypertensive patients.] [Article in German] Wien Klin Wochenschr. 2005 Aug;117(15-16):526-33.
Labarthe D, Ayala C. Nondrug interventions in hypertension prevention and control. Cardiol Clin, 2002 May;20(2):249-63
Lorig KR, Sobel DS, Stewart AL, Brown, Jr. BW, Ritter PL, Gonzalez VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing utilization and costs: A randomized trial. Medical Care, 1999 37(1): 5ñ14.
Mandle CL, Jacobs SC, Arcari PM, Domar AD. The efficacy of relaxation response interventions with adult patients: a review of the literature [see comments]. Journal of Cardiovascular Nursing, 1996 Apr, 10(3):4-26.
Nakao, M, Yano, E, Nomura, S, Kuboki T. Blood pressure-lowering effects of biofeedback treatment in hypertension: a meta-analysis of randomized controlled trials. Hypertens Res, 2003 Jan;26(1):37-46.
Ornish D. Dr. Dean Ornish's Guide to Reversing Heart Disease, Random House, NY 1990.
Orth, JE, Stiles, WB, Scherwitz, L, Hennritus, D, and Valbona, C. Patient exposition and provider explanation in routine interviews and hypertensive patientsí blood pressure control. Health Psychology. 6 (1987): 29.
Patel C, Marmot M. Stress Management, Blood Pressure and Quality of Life. Journal of Hypertension,1987 5 (supp 1): S21-S28.
Schneider RH, Alexander CN, Staggers F, Orme-Johnson DW, Rainforth M, Salerno JW, Sheppard W, Castillo-Richmond A, Barnes VA, Nidich SI. A randomized controlled trial of stress reduction in African Americans treated for hypertension for over one year. Am J Hypertens. 2005 Jan;18(1):88-98.
Schneider RH, Alexander CN, Staggers F, Rainforth M, Salerno JW, Hartz A, Arndt S, Barnes VA, Nidich SI. Long-term effects of stress reduction on mortality in persons > or = 55 years of age with systemic hypertension. Am J Cardiol. 2005 May 1;95(9):1060-4.
Stetter F, Kupper S. Autogenic training: a meta-analysis of clinical outcome studies. Appl Psychophysiol Biofeedback, 2002 Mar;27(1):45-98. Taylor CB, Farquhar JW, Nelson E, Agras S. Relaxation therapy and high blood pressure. Archives of General Psychiatry, 1977 34: 339-42.
UlmerD. Stress management for the cardiovascular patient: a look at current treatment and trends, Progress in cardiovascular Nursing, 1996 winter 11(1) 21-29.
Yucha CB, Tsai PS, Calderon KS, Tian L. Biofeedback-assisted relaxation training for essential hypertension: who is most likely to benefit? J Cardiovasc Nurs. 2005 May-Jun;20(3):198-205.
Posted in Health Issues Specific Health Issues