Drugs such as beta-blockers and psychosocial interventions can reduce the physiologic response to some forms of stress. In patients with known coronary disease, the cardioprotective effect of beta-blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamic-induced endothelial damage and a rising of the threshold for ventricular fibrillation.

In patients at risk for cardiovascular events who are under increased psychosocial stress, a stress management program can be considered as part of an overall preventive strategy. The goals of a stress management program are to reduce the impact in the individual of stressful environmental events and to better regulate the stress response. Interventions may be considered at several levels:

• Removal or alteration of the stressor
• Change in perception of the stressful event
• Reduction in the physiologic sequelae of stress
• Use of alternative coping strategies.

Stress management techniques typically include components of muscular relaxation, a quiet environment, passive attitude and deep breathing with the repetition of a word or phrase.

The physiologic changes produced include a decrease in oxygen consumption, reduced heart rate and respiratory rate and passive attitude and muscular relaxation. Such changes are consistent with a decrease in sympathetic nervous system activity.

Other measures, such as relaxation techniques and biofeedback, can produce a small reduction in blood pressure of 5 to 10 mmHg. Behavior modification programs are also an important adjunct to smoking cessation and have been associated with a reduction in cigarette consumption. Improvements in compliance with medication regimens may be an additional benefit from stress reduction program.