Stress management, blood pressure and quality of life.

This paper addresses three questions. First, we examine the effectiveness of relaxation and stress management in reducing hypertension and its complications by reviewing published studies including our own. Secondly, we report quality of life under such treatment, and thirdly, we discuss possible mechanisms. There is considerable evidence to show the effectiveness of a variety of non-pharmacological measures. In a randomized, controlled trial we showed that relaxation and stress-management training was associated with a reduction in blood pressure (BP) maintained over 4 years of observation. There were signs of a possible reduction in coronary heart disease (CHD) risk while maintaining or even enhancing the quality of life. Significantly more subjects in the relaxation group reported improved relationships at work, general health, enjoyment of life, and personal and family relationships than those in the control group at a 4-year follow-up. A similar but statistically insignificant trend was shown for the general level of physical energy, sexual life, concentration at work, mental well-being and social life. The relaxation group also displayed a belief in greater control over their health. There was no consistent relationship between the degree of reduction in BP and improvement in the above aspects of life, but those who practised relaxation regularly, who integrated relaxation in everyday activities and who used cognitive reappraisal as part of their stress-management strategies, showed greater reduction in BP than those who did not. Other studies have shown that this therapy can contribute significantly to the better control of BP with smaller doses of antihypertensive drugs, thus reducing the chances of side effects.