Biobehavioral approaches to the treatment of essential hypertension

Despite recent advances in the medical management of hypertension, chronically elevated blood pressure remains a major health problem in the United States, affecting almost 50 million Americans. It is widely recognized that lifestyle factors contribute to the development and maintenance of elevated blood pressure. This article critically reviews current approaches to the nonpharmacological treatment of high blood pressure and highlights outcome studies of exercise, weight loss and dietary modification, and stress management and relaxation therapies. Methodological issues in the assessment and treatment of hypertension are discussed, along with possible mechanisms by which lifestyle modification may reduce elevated blood pressure. Hypertension (HTN) affects almost 50 million people in the United States (Burt et al., 1995; Joint National Committee, 1997), placing them at increased risk of stroke, myocardial infarction, congestive heart failure, kidney failure, and peripheral vascular disease. In addition, subtle cognitive impairments, which may be reversible with treatment, also have been shown to be associated with HTN (Blumenthal, Madden, Pierce, Siegel, & Appelbaum, 1993; Waldstein, Manuck, Ryan, & Muldoon, 1991). HTN is defined as having systolic blood pressure (SBP) of 140 mm Hg or greater, having diastolic blood pressure (DBP) of 90 mm Hg or greater, or taking antihypertensive medication. Blood pressure (BP) in excess of 140/90 mm Hg is further categorized in terms of severity of HTN, defined as Stage 1 (140–159/90–99 m