of Essential Hypertension
This chapter begins with a summary of the basic physiology of blood pressure (BP) regulation. It proceeds to the classification of BP, the definition of hypertension, and finally the characteristics of hypertensive disease. The chapter reviews traditional pharmacotherapy for hypertension according to the revised stepped-care approach, and briefly discusses nonpharmacological therapies other than biofeedback and relaxation. For the most part, the chapter comprises a detailed description of a composite treatment plan for essential hypertension. This plan utilizes and references key research from several biofeedback treatment centers and psychophysiological laboratories. We develop characteristics of baseline, treatment, and follow-up; discuss patient education; and list evaluation criteria for outcome. The chapter also suggests ways of preselecting patients to enhance their chances for success in lowering BP. It ends with suggestions for further research. (Throughout the chapter, as in other chapters, italics on first use of a term in text indicate that the term is included in the glossary at the end.)
Also germane to the behavioral treatment of patients with essential hypertension are (1) the general principles of biofeedback measurement, (2) considerations in developing low physiological arousal, (3) the intake process, (4) cognitive preparation of patients, (5) adherence, and (6) generalization. In this chapter, however, we discuss only those topics that are specific to treatment of essential hypertension.
A basic understanding of the physiology of BP (Vander, Sherman, & Luciano, 2001; Ganong, 1997) is necessary before the biofeedback practitioner can implement a treatment plan to reduce high BP. Appreciation of the complexities of neural and endocrine influences is not essential. However, the practitioner must (1) understand the variables that determine BP and the elements of BP regulation, (2) have a working knowledge of common antihypertensive medications, and (3) be able to explain to patients in lay terms the potential effects of biofeedback and relaxation on BP.