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B., Kraemer, H. C., Southam, M. A., and Schneider, J. A. (1987). Relaxation training for essential hypertension at the worksite II. The poorly controlled hypertensive. Psychosomatic Medicine, 4p, 264 273. Aivazyan, T. A., Zaitsev, V. P., Khramelashvili, V. V., Golenov, E. V., and Kich-kin, V. I. (1988). Psychophysiological interrelations and reactivity characteristics in hypertensives. Health Psychology, j, 139 144. al'Absi, M., and Wittmers, L. E. (2003). Enhanced...

Gender

As discussed in Chapter i, incidence of hypertension is influenced by gender. Basically, males exhibit higher incidence rates of essential hypertension than females until menopause. Following this stage in life, females' incidence rates increase and actually exceed incidence rates for males (Wolz et al., 2000). Naturally, this has alerted researchers to the importance of the menstrual cycle in protecting women from onset of high blood pressures until later in life (von Eiff et al., 1971). The...

Vasodilating Antihypertensive Pharmacologic Agents

In contrast to the diuretics, which act on the kidneys, and the adrener-gic-inhibiting drugs, which act on the sympathetic nervous system, other antihypertensives exert their effect by directly attacking the extent of vasoconstriction associated with high blood pressure that occurs in vascular smooth muscle cells. Although each medication in this category has a distinct mechanism of action, all result in increased vasodilation of vascular muscle cells hence, they are grouped together as...

Dietary Factors

Among all dietary factors that have been examined with respect to essential hypertension, ingestion of sodium, mainly in the form of salt, has the most consistent linkage (Law, 1997). intersalt, the largest multi-culture study conducted examining the relation between sodium excretion and blood pressure, found that a relation was evident in each of its 52 international sites (Stamler et al., 1991 Elliott et al., 1996). The association between sodium excretion and blood pressure was strongest in...

Interpersonal Behaviors

Some research investigating acute behavioral responses of hypertensive patients has focused directly on behaviors observed during interactions with other people. If hypertensive patients resort to different acute behavioral responses to stressful interpersonal encounters than normal blood pressure controls, then perhaps these behavioral differences might help to explain how stress leads to hypertension. From this perspective, life stress leads to the onset of essential hypertension, but only if...

Isolated Clinic Normotension

A few investigators have now observed a condition in which normal blood pressures in the clinic are accompanied by elevated measures during daily life, a condition termed isolated clinic normotension. A variety of other names have been associated with this condition, including isolated home hypertension (Bobrie et al., 2001), 'white coat' normotension (Prattichizzo and Galetta, 1996), reverse 'white coat' hypertension (Wing et al., 2002), or masked hypertension (Pickering et al., 2002). For our...

Baroreceptor Reinforcement Model

Using a somewhat different approach, Dworkin (1991) also focused on baroreceptor functioning in establishing the baroreceptor reinforcement model of stress and hypertension. In contrast to many of the other theoretical perspectives, Dworkin's theoretical model of hypertension was based upon animal models of instrumental learning. A quick reminder of the principles of instrumental conditioning behaviors that are followed by reinforcement are maintained for extended durations, whereas behaviors...

Suppressed Hostility Hypothesis

The belief that essential hypertension is associated with the tendency to suppress angry feelings is one of the longest-standing psychosomatic hypotheses. As first stipulated by Alexander (1939), hypertension was associated with conflict between hidden hostile urges and dependency needs that resulted in the inadequate overt expression of anger. Accordingly, individuals who experienced angry feelings but failed to express them due to fears that by doing so they might damage important...

Series Foreword

Current Perspectives in Psychology presents the latest discoveries and developments across the spectrum of the psychological and behavioral sciences. The series explores such important topics as learning, intelligence, trauma, stress, brain development and behavior, anxiety, interpersonal relationships, education, child rearing, divorce and marital discord, and child, adolescent, and adult development. Each book focuses on critical advances in research, theory, methods, and applications and is...

Job Stress and Strain and Blood Pressure

An extensive amount of research has been conducted in work settings exploring the relation between blood pressure and either job stress or job strain (see Pickering, 1997, for a review). Many of the studies ex ploring the relation between job stress and hypertension have been based upon the Job Strain Model proposed by Karasek and colleagues (Karasek, 1979 Karasek et al., 1981). According to this perspective, job strain is influenced jointly by the psychological demands of the job andthe degree...

Cultural Influences on Stress and Blood Pressure

Researchers have long been interested in the relation various cultures exert upon measures of blood pressure. It is well known, for example, that average blood pressures among inhabitants of industrialized nations are higher than those of inhabitants of cultures predominantly consisting of agricultural and hunter-gatherer societies (Waldron et al., 1982). In fact, in some empirical reports, inhabitants of nonindustrial-ized countries were shown to exhibit stable blood pressures throughout life,...

Perception of Emotion Laden Content

It is possible to examine acute cognitive responses from an information-processing perspective. From this point of view, cognitive processing involves perception of stimuli, attentional factors, coding and storage in memory, recollection of stored information, and selection of appropriate response alternatives. It is possible that persons at risk for developing hypertension exhibit differential cognitive responding at some point in the information-processing model. For example, Shapiro (1961)...

Constitutional and Lifestyle Factors

From evidence presented in Chapter 5, it appears that the intensity, duration, or patterning of the acute physiological response to stress is the most likely candidate for mediating the stress-hypertension relation. Certainly, among all other aspects of the acute stress response, physiological reactions are the most plausible mediators. If acute cognitive, behavioral, or affective responses were shown to mediate the stress-hypertension relation, we would still be left with quite a challenge of...

Dysregulation of Baroreflex Threshold and Sensitivity

It has also been postulated that another component of the blood pressure regulation system that bridges the gap between the circulatory and nervous systems, the baroreceptor, plays a role in the relation between exposure to stress and the development of essential hypertension (Fer-arrio and Takishita, 1983). It is well known that carotid baroreceptors reset to new blood pressure thresholds after being exposed to different levels of blood pressure (Pickering and Sleight, 1977). Therefore, if an...

Does Stress Cause Essential Hypertension

The evidence examined in this book shows that there is indeed an association between stress and essential hypertension. As initially depicted in Figure 4.1, exposure to environmental stressors represented the stimulus in this model, and onset of the underlying pathology associated with hypertension represented the consequence. Based upon empirical evidence presented in Chapter 4, stressful life events, engaging in high-strain jobs, and even living in stressful industrialized nations have each...

Isolated Clinic Hypertension White Coat Hypertension

Isolated clinic hypertension presents a significant problem for physicians who rely on obtaining accurate clinic measures of blood pressure to render appropriate decisions regarding diagnosis and treatment. When nurses or physicians measure and record their elevated blood pressures in the clinic, these patients are often diagnosed and treated for essential hypertension as their elevated clinic arterial pressures are presumed to be representative of their daily arterial pressures. This may or...

Social Support Interventions to Reduce Blood Pressure

Because low social support has been strongly associated with increased incidence of essential hypertension and increased cardiovascular reactivity to stress, as reported in Chapter 7 (pp. 246-248), interventions aimed at altering access to and perception of social support have been tested among hypertensive patients. Uchino et al. (1996) reviewed 14 studies that measured blood pressures among either normotensive or hypertensive individuals before and after interventions aimed at increasing...

State Anxiety

Almost everybody has experienced anxiety at some time in life, including persons with high blood pressure as well as those with normal blood pressure. Imagine the various sensations you experience if you are asked by a teacher to report to the class the basic conclusions from an article you were supposed to have read but did not. This experience of anxiety is comprised of a number of cognitive manifestations, including catastrophic thinking, anticipation of danger, and sensing doom, accompanied...

Animal Research Linking Stress to Hypertension

Ethically, experimental studies on the effect of intensive prolonged stress upon levels of blood pressure cannot be conducted on humans. Recognizing the unpleasant impact of chronic stress and potential health consequences, we simply cannot expose humans to experimental stress conditions voluntarily. As seen above, life events commonly occur that present humans with stressful situations to which they will respond, but we do not purposefully expose humans to natural stressors like tornados,...

Emotional Defensiveness Hypothesis

A final personality characteristic that has been associated with essential hypertension is emotional defensiveness. Research in this area was grounded in the observations that hypertensive patients exhibit an acute cognitive response to stress characterized by underreporting or acknowledgment of emotional or painful stimuli (see pp. 147-151). According to the Emotional Defensiveness Hypothesis, persons who are uncomfortable in emotionally arousing situations adopt strat-egies to avoid these...

Family Support and Environment

Given the solid inverse relation between social support and a wide array of health-related variables including hypertension, it is not surprising that a number of investigators have examined the types of home environments associated with an individual's family of origin and sub sequent blood pressure status. In particular, it was hypothesized that specific parenting behaviors might characterize households of hypertensive patients and set the stage for subsequent onset of hypertension. This...

Major Life Events and Blood Pressure

Studies of the first type have typically examined the relation between stress and hypertension by measuring exposure to significant life stressors and concurrent blood pressures. Presumably, if a relation exists be tween these two variables, one would expect strong positive correlations between measures of life stress and blood pressure. For example, individuals living in the community around Three Mile Island were compared with individuals living in a control region of Frederick, Maryland,...

The Mosaic Theory

Naturally, with the existence of so many theoretical perspectives, one would hope that, as empirical evidence accumulated, one theory would receive the bulk of support as support for remaining theories waned. Unfortunately, that is not the case. There is empirical evidence to support each of the mechanisms theorized to mediate the link between stress and hypertension. In an effort to make sense of this state of affairs, many investigators have returned to a systems perspective reminiscent of...

Adherence to Antihypertensive Therapy

Prescribing an optimal antihypertensive agent is of little value if the patient is not going to take the medication. As we observed with Frank- lin, blood pressure control was difficult to achieve because he discontinued taking his medication. His case is not that unusual. It has been estimated that over half of the patients being treated for essential hypertension do not take their medications as prescribed Haynes, Taylor, and Sackett, 1983 . In a survey of Medicaid recipients with essential...

Exaggerated Cardiovascular Reactivity to Stress and Hypertension

Krantz and Manuck 1984 conducted an initial review of studies examining the relation between acute psychophysiologic response to stress and risk for both cardiovascular disease and essential hypertension. From the evidence available to them at that time, they concluded that 'promising' relations were observed regarding the role of exaggerated cardiovascular responses to stress for both medical conditions. In particular, borderline essential hypertension was shown to be associated with increased...