Novel psychophysiological therapy for the treatment of hypertension: analysis of a 16-year case study

In recent years a number of clinical investigators have questioned the efficacy of a variety of nonp-harmacological modalities in the treatment of essential hypertension, most prominently the use of biofeedback approaches.' Their skepticism enjoys significant empirical support, which is best summarized in a recent meta-analytical study of cognitive-behavioral techniques for the treatment of hypertension.' Although these investigators do not question whether the biofeedback approaches can produce transient changes in blood pressure (BP), all question the utility of the current literature. Some have concluded that the effects of these biofeedback treatments are little more than 'epiphenomena of little clinical significance,'' whereas others have urged the study of therapeutic variables interacting with biofeedback (such as the nature of therapeutic communication) that might influence the efficacy of therapy.'

Pickering, Shapiro, and a NIH task force' have collectively observed 2 critical problems in the research on nonpharmacological treatment approaches with hypertensive patients. First, the current research fails to show any 'meaningful' short-term efficacy including significant reductions in BP or other measures of treatment efficacy outside the treatment environment (hence the term ('/^/'phenomena). Secondly, there is a failure to document long-term reductions in BP as well as other cardiovascular outcome measures of clinical significance in hypertensive populations (e.g., long-term survival, development of coronary heart disease, and reductions in medication usage).

In this clinical case study, changes in cardiovascular functioning in a hypertensive woman (from age 64 to 81 years) with a remarkable family history of cardiovascular disease (CVD) are documented for a 16-year period while she participated in a therapy that combined aspects of biofeedback and traditionally supportive therapy, which is called interpersonal psychophysiological therapy (IPT). This therapy focuses on titrating and developing patient control over BP reactivity during provocative human dialogue.

For this 16-year period, the patient's medications were not changed. Nearly 26000 individual measures of BP and heart rate (HR) were recorded during therapy. Clinically significant reductions in BP, HR, and double product (DP)a measure of the workload on the heartwere observed in the first 16 months of therapy, with continued improvement over the next 16 years. Contrary to typical aging patterns, at age 81 this patient's DP measure was more than 30% lower than it was at age 64. Variability in cardiovascular measures during therapy remained relatively constant and unassociated with decreasing mean levels of BP, I IR, and DP.