Eisenberg D M, Delbanco T L, Berkey C S, Kaptchuk T J, Kupelnick B, Kuhl J, Chalmers T C
Division of General Medicine and Primary Care, Beth Israel Hospital, Boston, MA 02215.
Ann Intern Med. 1993 Jun 15;118(12):964-72. doi: 10.7326/0003-4819-118-12-199306150-00009.
To assess by analysis of published controlled trials the efficacy of cognitive behavioral therapies (such as biofeedback, relaxation, meditation) for essential hypertension.
Randomized controlled trials published in the English language between 1970 and 1991 identified from the MEDLINE database and bibliographic references from these articles.
Limited to studies involving randomized assignment to a treatment group consisting of one or more cognitive behavioral interventions or a concurrent control group consisting of no therapy, a waiting list, regular monitoring, or placebo intervention.
Although we identified more than 800 published works, only 26 met entry criteria. We identified a number of methodologic short-comings, including small sample size, inconsistencies regarding baseline blood pressure determinations and types of control groups, and the possibility of confounding by multiple noncognitive cointerventions (diet, exercise) and expectancy (the placebo effect). In meta-analyses involving 1264 patients, differences in mean blood pressure reduction varied according to the duration of baseline blood pressure measurements and type of control groups studied. In 16 comparisons involving baseline periods of more than 1 day, with patients (n = 368) assigned to either a cognitive therapy or a placebo intervention (sham biofeedback, "pseudo-meditation"), systolic and diastolic blood pressures decreased by 2.8 mm Hg (95% CI, -0.8 to 6.4) and 1.3 mm Hg (CI, -1.3 to 3.8), respectively. These changes were neither statistically nor clinically significant.
Cognitive interventions for essential hypertension are superior to no therapy but not superior to credible sham techniques or to self-monitoring alone. The literature on this subject is limited by a variety of methodologic inadequacies. No single cognitive behavioral technique appears to be more effective than any other.
通过分析已发表的对照试验，评估认知行为疗法（如生物反馈、放松、冥想）对原发性高血压的疗效。
从MEDLINE数据库中识别出1970年至1991年间以英文发表的随机对照试验以及这些文章的参考文献。
仅限于涉及随机分配到由一种或多种认知行为干预组成的治疗组或由无治疗、等待名单、定期监测或安慰剂干预组成的同期对照组的研究。
尽管我们识别出800多篇已发表的著作，但只有26篇符合纳入标准。我们发现了一些方法学上的缺陷，包括样本量小、基线血压测定和对照组类型不一致，以及可能因多种非认知联合干预（饮食、运动）和期望（安慰剂效应）而产生混淆。在涉及1264名患者的荟萃分析中，平均血压降低的差异根据基线血压测量的持续时间和所研究的对照组类型而有所不同。在16项涉及基线期超过1天的比较中，将患者（n = 368）分配到认知疗法组或安慰剂干预组（假生物反馈、“伪冥想”），收缩压和舒张压分别降低2.8 mmHg（95% CI，-0.8至6.4）和1.3 mmHg（CI，-1.3至3.8）。这些变化在统计学和临床上均无显著意义。
对原发性高血压的认知干预优于无治疗，但并不优于可信的假技术或单独的自我监测。关于这一主题的数据受多种方法学不足的限制。没有一种单一的认知行为技术似乎比其他技术更有效。
