Biofeedback is defined as a group of nonpharmacological therapeutic procedures that use electronic instruments to measure. process, and provide information to patients regarding their neuromuscular and autonomic nervous system activity in the form of analogue (or binary) and visual (or auditory) signals. Recent technical improvements in blood pressure monitoring and data processing make biofeedback more reliable and comfortable to apply for the treatment of hypertension. In the present study, a meta analysis was conducted to examine treatment effects of biofeedback on lowering blood pressure of essential hypertension. A total of 22 randomized controlled studies with 905 essential hypertensive patients were selected for review. When biofeedback intervention was compared with sham or non specific behavioral control intervention, the net reductions in systolic and diastolic blood pressures were 3.9 [95% confident interval, [-0.3 to 8.2] and 3.5 [-0.1, 7.0] mmHg, respectively. Compared with clinical visits or self monitoring of blood pressure (non intervention control), the degrees of reductions in systolic and diastolic blood pressures were significantly greater in the biofeedback intervention by 7.3 [2.6, 12.0] and 5.8 [2.9, 8.6] mmHg, respectively. When biofeedback intervention types were classified into the simple biofeedback group and relaxation assisted biofeedback group, only the relaxation-assisted biofeedback group showed significant decreases in both systolic and diastolic blood pressures, compared with sham or non specific behavioral control trials (p<0.05). The results suggested that biofeedback was superior to sham or non specific behavioral intervention when combined with other relaxation therapies in essential hypertension, whereas biofeedback alone was more effective in reducing blood pressure than no intervention control. At the present stage, it is still inconclusive that biofeedback itself has anti hypertensive effect beyond the placebo effect or "remembered wellness". Future studies are needed to clarify the specific psychological and physiological mechanisms of biofeedback treatment.

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Patients with psychosomatic disease exhibit an array of physical and psychological symptoms. Psychosocial symptoms such as anxiety, irritability, depression and sleep disturbance sometimes influence the course and prognosis of the psychosomatic disease. So there is a pharmacological rationale for using psychotropic drugs for those symptoms. Benzodiazepines have a rapid onset of action and good tolerability, but have disadvantages of dependence and withdrawal problems and are inappropriate for prolonged use. Since benzodiazepines are anxiolytics with no antidepressant activity, they have no effect on comorbid depression. Thus benzodiazepines are often primarily used for a short term period, in patients who do not have serious comorbid depression. Since depression occurs as a comorbid condition in psychosomatic disease, the use of antidepressants is a logical choice. Tricyclic antidepressants (TCAs), such as imipramine and amitriptyline, are widely used and are effective but they are not well tolerated. TCAs have a delayed onset of action. Moreover, TCAs exert numerous side effects, including anticholinergic effects such as dry mouth and constipation, cardiovascular toxicity and weight gain. Thus, although TCAs are used frequently, the number of disadvantages and side effects have led to the consideration of other antidepressants. SSRIs and SNRI do not have anti cholinergic effects or act on the noradrenergic systems, there is a clear pharmacological rationale for believing that SSRIs and SNRI should be as effective as TCAs in psychosomatic disease and be better tolerated. The treatment of sleep disturbance is very important clinical issues. Benzodiazepine hypnotics are widely prescribed and effective treatment strategy. Newer hypnotics such as ω_1 receptor agonist zolpiden and quazepam are licensed recently. They are effective and have no muscle relaxant effect. The more effective management strategy is to initiate drug treatment first and, if the patient fail to archive remission, use combined treatment with either psychological techniques and/or additional medication.

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