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Jeffrey A. Cutler, MD; Nemat O. Borhani, MD; Charles H. Hennekens, MD; Paul Whelton, MD; the TOHP Collaborative Research Group
National Institutes of Health Bethesda, Md

JAMA. 1992;268(2):198-199.

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In Reply.

—Our article on the TOHP Phase I results elicited contrasting reactions regarding the lack of an effect of stress management on blood pressure. Dr David appears not to be surprised by the outcome, and speculates that we were intervening too late in the natural history, after the effects of chronic stress become self-sustaining. Unfortunately, the mechanisms that mediate stress-related elevations of blood pressure are poorly understood, and the role of episodic, stress-related elevations of blood pressure (cardiovascular reactivity) in the development of sustained hypertension remains unresolved.¹ Also, this interpretation is somewhat at variance with results of a meta-analysis that suggested a benefit for diastolic blood pressure in already hypertensive individuals.² David's prediction about lack of an effect of the TOHP intervention on catecholamine and cortisol excretion is borne out by preliminary analyses, although whether this represents swamping of chronic effects by acute stresses is unclear.

Dr . . . [Full Text PDF of this Article]

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