Psychological interventions in hypertension: rationale and efficiency

The paper reviews the main tasks of the psychological intervention in patients with arterial hypertension (HTN) and prehypertension. It presents an analysis of the studies, involving the assessment of psychological intervention efficiency in HTN prevention, lowering blood pressure (BP) and promoting adherence to treatment in HTN patients as well as prevention and correction of psychopathological complications of HTN. According to the results of well-planned studies, the psychological methods, used in the HTN prevention and treatment, do not achieve a satisfactory level of evidence-based efficiency. The findings in favor of the psychological intervention for HTN prevention are the weakest. At the same time, there is evidence of the efficiency of some psychological methods in reducing BP and promoting adherence to treatment. The efficiency of psychological intervention in preventing and slowing progression of vascular cognitive dysfunction is well documented, although the BP is not taken into account in most relevant studies. The authors suggest possible explanations of the limited efficiency of psychological interventions in HTN prevention and treatment according to up-to-date meta-analytic studies and outline future directions of research.

1. Lang GF. Selected works. M.: Meditsina, 1975. 232 p. In Russian

2. Alexander F. Psychosomatic medicine. New York: W. W. Norton and Co, 1950. 288 p.

3. Dunbar HF. Mind and body: psychosomatic medicine, new enlarged edition; New York: Random House, 1955. 263 p.

4. Binger CA. Critique of psychotherapy in arterial hypertension. Bull N Y Acad Med. 1945;21(11):610–615.

5. Kitaev-Smyk LA. Psychology of stress. Psychological anthropology of stress. M.: Academicheskiy Project, 2009. 943 p. In Russian.

6. Wasserman LI, Ababkov VA, Trifonova EA. Coping with stress: theory and psychodiagnostics. SPb: Rech, 2010. 192 p. In Russian.

7. Sparrenberger F, Cichelero FT, Ascoli AM, Fonseca FP, Weiss G, Berwanger O et al. Does psychosocial stress cause hypertension? A systematic review of observational studies. J Hum Hypertens. 2009;23(1):12–9. doi:10.1038/jhh.2008.74

8. Babu GR, Jotheeswaran A, Mahapatra T, Mahapatra S, Kumar A Sr, Detels R et al. Is hypertension associated with job strain? A meta-analysis of observational studies. Occup Environ Med. 2014;71(3):220–7.

9. Pogosova GV. Psychological stress and acknowledgement of its value as a first order cardiovascular risk factor. Kardiologiia. 2007;47(2):65–72. In Russian.

10. Cuffee Y, Ogedegbe C, Williams NJ, Ogedegbe G, Schoenthaler A. Psychosocial risk factors for hypertension: an update of the literature. Curr Hypertens Rep. 2014;16(10):483. doi:10.1007/s11906–014–0483–3

11. Pan Y, Cai W, Cheng Q, Dong W, An T, Yan J. Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies. Neuropsychiatr Dis Treat. 2015;11:1121–30. doi:10.2147/NDT.S77710

12. Ayvazian TA. Psycho-relaxation in the treatment of hypertension. Kardiologiia. 1991;31(2): 95–98. In Russian.

13. Dickinson HO, Campbell F, Beyer FR, Nicolson DJ, Cook JV, Ford GA et al. Relaxation therapies for the management of primary hypertension in adults. Cochrane Database Syst Rev. 2008; (1):CD004935. doi:10.1002/14651858.CD004935.pub2

14. Wang J, Xiong X, Liu W. Yoga for essential hypertension: a systematic review. Gonzalez GE, ed. PLoS ONE. 2013;8(10):e76357. doi:10.1371/journal.pone.0076357

15. Tyagi A, Cohen M. Yoga and hypertension: a systematic review. Altern Ther Health Med. 2014;20(2):32–59.

16. Kim I-H, Kim C, Seong K, Hur M-H, Lim HM, Lee MS. Essential oil inhalation on blood pressure and salivary cortisol levels in prehypertensive and hypertensive subjects. Evidence-based Complementary and Alternative Medicine: eCAM. 2012; 2012:984203. doi:10.1155/2012/984203

17. Kühlmann AYR, Etnel JRG, Roos-Hesselink JW, Jeekel J, Bogers AJJC, Takkenberg JJM. Systematic review and meta-analysis of music interventions in hypertension treatment: a quest for answers. BMC Cardiovasc Disord. 2016;16:69. doi:10.1186/ s12872-016-0244-0

18. Rainforth MV, Schneider RH, Nidich SI, Gaylord-King C, Salerno JW, Anderson JW. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep. 2007;9(6):520–8.

19. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisogna-no JD, Elliott WJ et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension. 2013;61(6):1360–83. doi:10.1161/HYP.0b013e318293645f

20. 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;26 (1):37–46.

21. Linden W, Moseley JV. The efficacy of behavioral treatments for hypertension. Appl Psychophysiol Biofeedback. 2006;31(1):51–63.

22. Nolan RP, Floras JS, Harvey PJ, Kamath MV, Picton PE, Chessex C et al. Behavioral neurocardiac training in hypertension: a randomized, controlled trial. Hypertension. 2010;55(4):1033–9.

23. Greenhalgh J, Dickson R, DundarY. Biofeedback for hypertension: a systematic review. J Hypertens. 2010;28(4):644–52. doi:10.1097/HJH.0b013e3283370e20

24. Blom K, Baker B, How M, Dai M, Irvine J, Abbey S et al. Hypertension analysis of stress reduction using mindfulness meditation and yoga: results from the HARMONY randomized controlled trial. Am J Hypertens. 2014;27(1):122–9.

25. Linden W. Psychologic treatment for hypertension can be efficacious. Prev Cardiol. 2003;6(1):48–53.

26. Bloomfield DA, Park A. Decoding white coat hypertension. World J Clin Cases. 2017;5(3):82–92.

27. Ebrahim S, Smith GD. Lowering blood pressure: a systematic review of sustained effects of non-pharmacological interventions. J Public Health Med. 1998;20(4):441–8.

28. Batey DM, Kaufmann PG, Raczynski JM, Hollis JF, Murphy JK, Rosner B et al. Stress management intervention for primary prevention of hypertension: detailed results from Phase I of Trials of Hypertension Prevention (TOHP-I). Ann Epidemiol. 2000;10(1):45–58.

29. Wang SZ, Li S, Xu XY, Lin GP, Shao L, Zhao Y et al. Effect of slow abdominal breathing combined with biofeedback on blood pressure and heart rate variability in prehypertension. J Altern Complement Med. 2010;16(10):1039–45. doi:10.1089/ acm.2009.0577

30. Lin G, Xiang Q, Fu X, Wang S, Wang S, Chen S et al. Heart rate variability biofeedback decreases blood pressure in prehypertensive subjects by improving autonomic function and baroreflex. J Altern Complement Med. 2012;18(2):143–52. doi:10.1089/acm. 2010.0607

31. Xu XY, Gao J, Ling D, Wang TH. Biofeedback treatment of prehypertension: analyses of efficacy, heart rate variability and EEG approximate entropy. J Hum Hypertens. 2007;21(12):973–5. doi:10.1038/sj.jhh.1002237

32. Hughes JW, Fresco DM, Myerscough R, van Dulmen MH, Carlson LE, Josephson R. Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosom Med. 2013;75(8):721–8. doi:10.1097/PSY.0b013e3182a3e4e5

33. Clifford PA, Tan SY, Gorsuch RL. Efficacy of a self-directed behavioral health change program: weight, body composition, cardiovascular fitness, blood pressure, health risk, and psychosocial mediating variables. J Behav Med. 1991;14(3):303–323.

34. Vásquez E, Strizich G, Gallo L, Marshall SJ, Merchant GC, Murillo R et al. The role of stress in understanding differences in sedentary behavior in Hispanic/Latino adults: results from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Journal of Physical Activity & Health. 2016;13 (3): 310–317. doi:10.1123/jpah.2014–0608

35. Yau YH, Potenza MN. Stress and eating behaviors. Minerva Endocrinol. 2013;38(3):255–67.

36. Siegrist J, Rödel A. Work stress and health risk behavior. Scand J Work Environ Health. 2006;32(6):473–81.

37. Schroeder K, Fahey T, Ebrahim S. Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database Syst Rev. 2004;(2): CD004804.

38. Gwadry-Sridhar FH, Manias E, Lal L, Salas M, Hughes DA, Ratzki-Leewing A et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. Value Health. 2013;16(5):863–71. doi:10.1016/j.jval.2013.03.1631

39. Matthes J, Albus C. Improving Adherence with medication: a selective literature review based on the example of hypertension treatment. Deutsches Ärzteblatt International. 2014;111(4):41–47. doi:10.3238/arztebl.2014.0041

40. Li VV, Kausova GK, Svitich TN, Karashanova LK. The results of educational activity of the health school for patients with arterial hypertension — a 10-year experience. Science and Healthcare. 2014;1:31–34. In Russian.

41. Balkarov IM, Kozlova VG, Shonichev DG, Novikova MS, Solov’eva OL, Shakhnova EA. Some approaches to the increasing of the quality of treatment of patients with arterial hypertension (the experience of a “School for patients with arterial hypertension”). Ter Arkh. 2000;72(1):47–51. In Russian.

42. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304–14. doi:10.4065/mcp.2010.0575

43. Stavropoulou C. Non-adherence to medication and doctor-patient relationship: evidence from a European survey. Patient Educ Couns. 2011;83(1):7–13. doi:10.1016/j.pec.2010.04.039

44. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34.

45. Račić MN, KusmukSH, Mašić SR, Ivković NM, Joksimović VR, Matović JM. Impact of the physician-patient relationship on the treatment outcomes of arterial hypertension. Opshtamedicina. 2017;23(1–2):1–8.

46. Elias MF, Goodell AL, Dore GA. Hypertension and cognitive functioning: a perspective in historical context. Hypertension. 2012;60(2):260–268.

47. Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB et al. Impact of hypertension on cognitive function: a scientific statement from the American Heart Association. Hypertension (Dallas, Tex: 1979). 2016;68(6): e67-e94. doi:10.1161/ HYP.0000000000000053

48. Obisesan TO. Hypertension and cognitive function. Clin Geriatr Med. 2009;25 (2):259–288.

49. Gąsecki D, Kwarciany M, Nyka W, Narkiewicz K. Hypertension, brain damage and cognitive decline. Curr Hypertens Rep. 2013;15(6):547–58. doi:10.1007/s11906–013–0398–4

50. Li BY, Wang Y, Tang HD, Chen SD. The role of cognitive activity in cognition protection: from Bedside to Bench. Transl Neurodegener. 2017;6:7. doi:10.1186/s40035–017–0078–4

51. Cheng ST. Cognitive reserve and the prevention of dementia: the role of physical and cognitive activities. Curr Psychiatry Rep. 2016;18(9):85. doi:10.1007/s11920–016–0721–2

52. Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW et al. ACTIVE Study Group. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc. 2014;62(1):16–24. doi:10.1111/jgs.12607

53. Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia. Cochrane Database Syst Rev. 2013;(6): CD003260. doi:10.1002/14651858.CD003260.pub2

54. Singh-Manoux A, Marmot M. High blood pressure was associated with cognitive function in middle-age in the Whitehall II study. J Clin Epidemiol. 2005;58(12):1308–15.

55. Gupta R, Solanki RK, Pathak V. Blood pressure is associated with cognitive impairment in young hypertensives. World J Biol Psychiatry. 2008;9(1):43–50.

56. Knecht S, Wersching H, Lohmann H, Bruchmann M, Duning T, Dziewas R et al. High-normal blood pressure is associated with poor cognitive performance. Hypertension. 2008;51(3):663–8. doi:10.1161/HYPERTENSIONAHA.107.105577

57. McCubbin JA, Peach H, Moore DD, Pilcher JJ. Decreased Cognitive/CNS function in young adults at risk for hypertension: effects of sleep deprivation. Int J Hypertens. 2012;2012:989345. doi:10.1155/2012/989345