TBM TBM page 761 of 770 Stress management in the workplace for employees with hypertension: a randomized controlled trial Lynn P. Clemow, 1,2 Thomas G. Pickering, 1,† Karina W. Davidson, 1 Joseph E. Schwartz, 1 Virginia P. Williams, 3 Jonathan A. Shafer , 1 Redford B. Williams, 4 William Gerin 5 Abstract While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could beneft remains difcult. Workplace programs have potential as dissemination vehicles. The objective is to evalu- ate the efectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hyper- tension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduc- tion and physician referral. Intervention group participants’ systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0–152.1) to 140.0 (95% CI: 134.7–145.2), p < .001. The diferen- tial change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = −2.05; p = .04). Diastolic BP reductions were not signifcantly diferent. Scores on measures of emotional exhaustion and depressive rumination showed signifcant improvements and correlated with reductions in SBP. There was no signifcant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension. Keywords Hypertension, Stress, Psychosocial intervention, Workplace intervention, Clinical trials INTRODUCTION Hypertension affects approximately one third of adults in the USA [1] and is one of the most important modifiable cardiovascular risk factors [2]. Large epi- demiologic studies have shown that psychosocial risk factors including hostility [3, 4], chronic psychoso- cial stress [5], nonadaptive coping [6], depression [7 , 8], work stress [9, 10], and low socioeconomic status [11, 12] contribute to the development of hyperten- sion, so it seemed logical that interventions targeting these psychosocial risk factors could help improve blood pressure (BP) control [13, 14]. The poten- tial usefulness of such approaches is heightened by patient preferences for alternatives to pharmacother- apy [15]. A number of previous intervention studies have focused on modifying stress [16–20], hostility [21], and other psychosocial risk factors [22] and have found beneficial effects on BP (or the ability to reduce antihypertension medications [23]) com- pared with control conditions. Recent reviews [14, 24] suggest psychosocial interventions using multiple components of stress or anger management (cogni- tive-behavioral approaches often combined with meditative or other relaxation techniques) [21–23] are more effective in reducing BP than single-modal- ity interventions. The dissemination of behavioral and psychosocial interventions focused on stress reduction and health presents a difficult challenge. Most interventions for hypertension noted above have been developed and delivered in clinical settings. However, med- ical practices are often overburdened, often lack the resources to deliver psychosocial interventions, and can be a difficult setting for patients to attend regular sessions [25, 26]. Worksite health promotion programs offer easy access for employees during work hours. The Federal Government has empha- sized the importance of worksite wellness programs and provided incentives in the Affordable Care Act [27 , 28], making it likely that employers will be Implications Practice: A standardized 10-session stress and anger management program delivered in groups in the workplace proved to be a practical and suc- cessful approach to reducing SBP in hypertensive employees. Research: The possibility of decreases in BP being mediated by changes in emotional exhaus- tion or depressive rumination should be explored in future research and can be effective in reduc- ing BP in hypertensive employees. Policy: The workplace may be an excellent venue for dissemination of group psychosocial interventions to address chronic conditions or health behaviors, given the high rate of retention of participants in completing the intervention. 1 Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA 2 Department of Family and Community Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA 3 Williams LifeSkills, Inc., Durham, NC, USA 4 Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA 5 Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA ORIGINAL RESEARCH © Society of Behavioral Medicine 2018. All rights reserved. For permis- sions, please e-mail: journals.permis- sions@oup.com. Correspondence to: Lynn P. Clemow, clemowlp@rwjms. rutgers.edu † Deceased (May 14, 2009) Cite this as: TBM 2018;8:761–770 doi: 10.1093/tbm/iby018 Downloaded from https://academic.oup.com/tbm/article/8/5/761/4948676 by guest on 27 January 2022