ABSTRACT
In the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V; 1993), certain lifestyle modifications were recommended as definitive or adjunctive therapy of hypertension. These included weight reduction, moderation of alcohol and sodium intake, and increased physical activity. Although their effectiveness has not been conclusively determined, such interventions, the JNC-V Committee concluded, can improve the cardiovascular risk profile and can offer multiple benefits at little cost. Also mentioned as beneficial adjunctive interventions are tobacco avoidance, decreased dietary fats, and adequate potassium intake. Although the report states that stress can raise blood pressure acutely and contribute to the cause of hypertension, it also concluded that the available literature does not support the use of relaxation therapies for definitive therapy of hypertension. This conservative position seems at odds with the wealth of literature on behavioral interventions. There are dozens of studies and extensive reviews, including four major meta-analyses of behavioral interventions (variously labeled nondrug treatments, arousal reduction treatments, and relaxation therapy; Andrews, MacMahon, Austin, & Byrne, 1984; Jacob, Chesney, Williams, Ding, & Shapiro, 1991; Kaufmann et al., 1988; Ward, Swan, & Chesney, 1987).
