Intervenciones psicológicas para el manejo y reducción de estrés en pacientes hipertensos: una revisión sobre su efectividad

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Abstract

Resumen La hipertensión está considerada como una de las principales problemáticas de salud pública, pues es una enfermedad crónica asintomática caracterizada por una elevación de presión arterial, en la que inciden los niveles de estrés que percibe el paciente y cuyas consecuencias pueden ser devastadoras tanto en la salud física como emocional de este grupo. Se realizó una revisión analítica enfocada a la efectividad de diversos tipos de intervención psicológica, para disminuir los niveles de presión sistólica, controlar el nivel de la presión diastólica, disminuir la percepción del estrés de los sujetos y propiciar una mayor adherencia al tratamiento. La búsqueda se realizó en la base de datos Springer, donde 50 artículos cumplieron con los criterios de exclusión y de inclusión, para el periodo 2000-2013. La revisión arrojó una mayor inclinación hacia las intervenciones de tipo conductual (38%), sin embargo, las intervenciones cognitivo-conductuales fueron las más eficaces para disminuir los niveles de estrés y generar la reducción más significativa en presión arterial, con un 100% de resultados positivos, mientras que solo el 68.4% de los estudios conductuales reportó una mejoría.

Translated abstract

Abstract Hypertension an asymptomatic chronic disease characterized by elevated blood pressure, is considered a public health problem, affected by stress levels perceived by the patient, with physical and emotional health consequences that can be devastating for this population. This study presents an analytical review focused on the effectiveness of different types of psychological intervention to reduce systolic blood pressure levels, controlling the level of diastolic pressure, decreasing stress perception of subjects and fostering greater adherence. The search was conducted by means of the Springer database, with 50 articles selected on the basis of the inclusion and exclusion criteria for the period 2000-2013. Results showed greater inclination towards behavioral type interventions (38%), while cognitive-behavioral interventions were the most effective for decreasing stress levels and producing the most significant reduction in blood pressure, 100% of the studies based on this type of intervention showed positive results, while the behavioral type only registered 68.4% of success.

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Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program.

James Carmody, Ruth Baer (2008)

Relationships were investigated between home practice of mindfulness meditation exercises and levels of mindfulness, medical and psychological symptoms, perceived stress, and psychological well-being in a sample of 174 adults in a clinical Mindfulness-Based Stress Reduction (MBSR) program. This is an 8- session group program for individuals dealing with stress-related problems, illness, anxiety, and chronic pain. Participants completed measures of mindfulness, perceived stress, symptoms, and well-being at pre- and post-MBSR, and monitored their home practice time throughout the intervention. Results showed increases in mindfulness and well-being, and decreases in stress and symptoms, from pre- to post-MBSR. Time spent engaging in home practice of formal meditation exercises (body scan, yoga, sitting meditation) was significantly related to extent of improvement in most facets of mindfulness and several measures of symptoms and well-being. Increases in mindfulness were found to mediate the relationships between formal mindfulness practice and improvements in psychological functioning, suggesting that the practice of mindfulness meditation leads to increases in mindfulness, which in turn leads to symptom reduction and improved well-being.

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The association between self-efficacy and hypertension self-care activities among African American adults.

Graham B. Seymour, Jan Warren-Findlow, Patrick R. Huber (2012)

Chronic disease management requires the individual to perform varying forms of self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy to manage hypertension and six clinically prescribed hypertension self-care behaviors. We interviewed 190 African Americans with hypertension who resided in the greater metropolitan Charlotte area about their self-efficacy and their hypertension self-care activities. Logistic regression for correlated observations was used to model the relationship between self-efficacy and adherence to hypertension self-care behaviors. Since the hypertension self-care behavior outcomes were not rare occurrences, an odds ratio correction method was used to provide a more reliable measure of the prevalence ratio (PR). Over half (59%) of participants reported having good self-efficacy to manage their hypertension. Good self-efficacy was statistically significantly associated with increased prevalence of adherence to medication (PR = 1.23, 95% CI: 1.08, 1.32), eating a low-salt diet (PR = 1.64, 95% CI: 1.07-2.20), engaging in physical activity (PR = 1.27, 95% CI: 1.08-1.39), not smoking (PR = 1.10, 95% CI: 1.01-1.15), and practicing weight management techniques (PR = 1.63, 95% CI: 1.30-1.87). Hypertension self-efficacy is strongly associated with adherence to five of six prescribed self-care activities among African Americans with hypertension. Ensuring that African Americans feel confident that hypertension is a manageable condition and that they are knowledgeable about appropriate self-care behaviors are important factors in improving hypertension self-care and blood pressure control. Health practitioners should assess individuals' self-care activities and direct them toward practical techniques to help boost their confidence in managing their blood pressure.