OBJECTIVE: To test the efficacy of individualized stress management for primary hypertension in a randomized clinical trial with the use of ambulatory blood pressure (BP) measures. METHODS: Men and women aged 28 to 75 years with mean ambulatory BP greater than 140/90 mmHg received 10 hours of individualized stress management by means of semistandardized treatment components. They were randomly assigned to immediate treatment (n = 27) or a wait list control group (n = 33). Participants on the wait list were subsequently offered treatment. Six-month follow-up data were available from 36 of the 45 participants who completed treatment. Measures were 24-hour ambulatory BP, lipid levels, weight, and psychological measures. RESULTS: Blood pressure was significantly reduced in the immediate treatment group and did not change in control subjects (-6.1 versus +0.9 mmHg for systolic and -4.3 versus +0.0 mmHg for diastolic pressure). When the wait list control group was later treated, BP was similarly reduced by -7.8 and -5.2 mmHg, and for the combined sample, total change at follow-up was -10.8 and -8.5 mmHg. Level of BP at the beginning of treatment was correlated with BP change (r = 0.45 (p < 0.001) and 0.51 (p < 0.001), respectively), and amount of systolic BP change was positively correlated with reduction in psychological stress (r = 0.34) and change in anger coping styles (r = 0.35 to 0.41). CONCLUSIONS: Individualized stress management is associated with ambulatory BP reduction. The effects were replicated and further improved by follow-up. Reductions in psychological stress and improved anger coping appear to mediate the reductions in BP change.

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