In the first of two studies, 42 unmedicated mild hypertensives completed either 16 sessions of thermal biofeedback (TBF) training for hand (7 sessions) and foot (9 sessions) warming or 8 weeks of monitoring BPs at home. There was a trend (p < .10) for more of those treated (57.1%) to have DBPs lower than 90 mm Hg than for those only monitoring BPs at home (33%). Analyses of clinic BP values from random zero sphygmomanometer measurements, from 24-hour ambulatory BP monitoring, and from home BP measurements made by the patient showed no advantage for treatment versus BP monitoring. Sixteen of the 21 patients in BP monitoring were later treated. Analyses of treatment effects across all treated subjects by gender revealed a significant (p = .02) decrease in DBP for treated female subjects (n = 13) but not for males (n = 24). In the second study the 22 initial treatment successes, that is, those whose DBP was below 90 mm Hg at posttreatment (59.4% of those who completed treatment), were randomized to an intensive follow-up (monthly visits for 6 months, then visits every two months) emphasizing regular home practice with an electronic TBF device or regular follow-up (visits every 3 months). Twelve of the 22 were still normotensive at 12 months. There were no differences at any point during the follow-up between the two conditions in success rate or BPs despite a numerical advantage in reported frequency of home practice by those in the intensive follow-up condition.
Compared the self-monitored activities, locations, and postural positions of 28 hypertensives while they wore an alarm watch and then while they wore a 24-hr ambulatory blood pressure monitor (ABPM) to see if wearing the ABPM led to alterations in behavior. Within the limitations of the study (no counterbalancing of order and twice as many ABPM measures as watch measures), we found significant differences in frequency of being at home or in miscellaneous settings, in standing and reclining positions, and in mental, physical and miscellaneous activities between the two occasions.
The relationship between 24-hour ambulatory blood pressures (ABP) and blood pressures (BP) obtained during laboratory stressors was examined. Thirty normotensives (equal males and females) underwent ABP monitoring on three occasions separated by a week. They also underwent a laboratory assessment which included standard stressors (i.e., mental arithmetic, cold pressor, orthostatic response, treadmill exercise). Correlational analyses found laboratory pressures to be significantly correlated with ambulatory pressures, with laboratory baseline BPs showing higher correlations to the ambulatory BPs than the BPs obtained during laboratory stressors. In addition, gender effects were examined. In the correlational analyses between ABPs and laboratory BPs, males and females did not differ significantly in the strength of the correlations. In terms of absolute values, males were found to have significantly higher SBP during ambulatory monitoring, random-zero recordings, calibration readings, and during baselines of the laboratory assessment. There were no gender effects for these measures with respect to diastolic blood pressure or heart rate. There were also no gender effects on reactivity to laboratory stressors as measured by change scores. Exploratory analyses found no significant effect of history of familial hypertension on either the ABPs or the laboratory pressures.
Thirty-three moderate hypertensives were converted to a 2-drug regimen of metoprolol and diuretic and BPs stabilized at a well-controlled level. They then completed one of three conditions over an 8-week interval: (I) 16 sessions of TBF (hand and foot warming); (II) 16 sessions of frontal EMG-BF; (III) regular home monitoring of BP. Attempts were then made to withdraw the patients from the sympatholytic medication. Those successfully withdrawn were followed up for one year. There were no significant advantages for TBF over the other two conditions in the short term or with long-term follow-up. Only 27% of treated patients (including Condition III failures who were remedicated and treated with TBF) were successfully off of the sympatholytic at a one-year follow-up. The generally poor results on clinical outcome were confirmed by clinic BPs, home BPs by patients, and 24-hour ambulatory BPs.
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