To the Editor.
—The article on the effect of nonpharmacologic interventions on blood pressure of persons with high normal levels was interesting.1 I would just like to comment about the lack of an observed effect from stress management. First, as the authors pointed out, although the patients were compliant, there was no evidence of effective stress management training on the Hassles questionnaire. So, it doesn't appear that the perception of one's stresses was affected by the stress management.The authors are quite correct in stating that what is even more important than the "hassles" one perceives is one's reaction to them.2 The authors did state that they collected data on cardiovascular reactivity and urinary excretion of catecholamines and cortisol. However, the difficulty with these 24-hour urinary studies is they will not only measure baseline secretion, but also acute secretion of those hormones in response to the events that
David DS. Distress Over the Noneffect of Stress. JAMA. 1992;268(2):198. doi:10.1001/jama.1992.03490020042020