Theodore Weiss

Behavioral versus pharmacological treatments for essential hypertension--a needed comparison.

&NA; Comparison of mild‐to‐moderate essential hypertension patients treated for 6 weeks by antihypertensive medication versus metronome‐conditioned relaxation versus biofeedback versus a mild exercise control procedure showed that those on medication achieved the greatest decrease in blood pressure. The relaxation and biofeedback groups decreased more than the mild exercise group, as predicted, but not significantly more. The differences in benefits of the groups were not a function of group differences in initial blood pressure levels nor in compliance. Nor did the groups differ in the side effects that are usually associated with medications. A second phase of 6 weeks with another treatment or combination of treatments did not add significantly. Some characteristics of patients moderately predicted treatment benefits, for example, high scores on the Jenkins Activity Survey Scales (1) [Type A, S or H], for the relaxation and biofeedback treated patients predicted which patients received greater benefits.

Effects of beta-adrenergic stimulation and blockade on cardiovascular reactivity, affect, and type A behavior.

&NA; The present study examined the acute effects of drugs that stimulate or block sympathetic nervous system activity on components of Type A behavior, affect, and cardiovascular responses to mental stressors. Either propranolol (a beta‐adrenergic blocker), isoproterenol (a beta‐agonist), or placebo was infused intravenously at different times in 12 healthy males. In two sessions, placebo (saline) was administered first, followed by a structured interview, challenging mental arithmetic test, and completion of affect scales. The procedure was then repeated with one of the active drugs, presented in counterbalanced order. Results indicated reliable drug effects on both heart rate (HR) and systolic blood pressure (SBP) reactivity to the tasks, with change scores to the tasks markedly increased by isoproterenol. Anxiety and hostility ratings paralleled results for HR and BP, with much of this effect being due to higher affect ratings for isoproterenol. The effect of the drugs on Type A behavior was unexpected, with global Type A and several components lowered by isoproterenol and unaffected by propranolol. These data are discussed in terms of the interfering effects of anxiety on Type A speech components. The influence of isoproterenol on affect and reactivity might reflect the physiologic action of a beta 2‐adrenergic positive feedback loop which increases release of endogenous norepinephrine, and/or potentiating effects of emotion on reactivity to stress.

Effects of repeated ambulatory ECG monitoring and relaxation practice on premature ventricular contractions.

&NA; Ten patients with premature ventricular contractions (PVCs) were studied to assess the effects of adaptation and relaxation practice on arrhythmia frequency. They had 48 hr of ambulatory ECG monitoring on three occasions: 1) at entry into the study; 2) 4 wk later, after no intervention; and 3) after 4 wk of practicing the relaxation response. Results showed a significant decrease in PVC frequency from the first to the second monitoring, i.e., before relaxation practice. Of eight patients who completed the third monitoring, only three showed a decline in PVC frequency below baseline levels. The group as a whole showed an increase in PVC frequency with relaxation practice, although this was not statistically significant. These findings suggest that there is an important adaptational effect to repeated ambulatory ECG monitoring in PVC patients—namely, a decrease in arrhythmia frequency. Relaxation practice did not produce any clear effect for the overall group.