Volume Dysregulation

Let's start by examining the potential role of the kidney in explaining the stress-hypertension association. According to Guyton (1977), a major proponent of this theoretical perspective, the overretention of sodium and fluid and failure to direct an appropriate release of urine by the kidneys leads to an elevation of the renal threshold. The body then becomes overperfused with fluids and cardiac output increases, resulting in an elevated blood pressure. As a result of the increase in cardiac...

Info

P., Bagiella, E., Shapiro, P. A., Kuhl, J. P., Chernikhova, D., Berg, J., et al. (2001). Hostility, gender, and cardiac autonomic control. Psychosomatic Medicine, 63, 434-440. Smith, T. W. (1992). Hostility and health Current status of a psychosomatic hypothesis. Health Psychology, ii, 139 -150. Smith, T. W., and Gallo, L. C. (1999). Hostility and cardiovascular reactivity during marital interaction. Psychosomatic Medicine, 6i, 436-445. Smith, T. W., Gallo, L. C., Goble, L., Ngu, L....

Effect of Antihypertensive Agents on Cardiovascular Reactivity to Stress

If cardiovascular reactivity to stress mediates the stress-hypertension relation, it follows that interventions aimed at lowering blood pressure might also reduce the magnitude of cardiovascular response to stress. Although there is clear evidence that use of diuretics, adrenergic inhibitors, and vasodilators leads to diminished arterial pressures, we have not yet considered whether they exert this effect by dampening cardiovascular responses to stress. Given the differential physiological...

Diuretic Antihypertensive Pharmacologic Agents

Diuretic medications were the earliest form of antihypertensive therapy that followed the discovery of reserpine. In fact, the first trials demonstrating that reduction in blood pressure was accompanied by a decreased risk for cardiovascular and cerebrovascular disease employed diuretic medications (Veterans Administration Cooperative Study Group on Antihypertensive Agents, 1967 1970). As their name implies, diuretic medications work by blocking sodium retention in the kidney, which results in...

Selection of Appropriate Antihypertensive Therapy

Although diuretics, adrenergic inhibiting agents, and vasodilators will each lower blood pressure in their own distinct way, it seems obvious that optimal blood pressure control might be achieved using a lower dose of a medication or combination of medications that directly attacks the mechanisms suspected of causing essential hypertension for a given patient. Given such a broad array of available and effective anti-hypertensive agents, what determines which medication the physician will choose...

Use of Objective Psychological Measures

From the demonstrated defensiveness of some hypertensive patients and the recognized influence that awareness of hypertensive status has upon responses to measures of psychological functioning, it appears that studies of individual difference variables as they relate to essential hypertension may be seriously questioned if they solely rely on self-report questionnaires. Unfortunately, a sizable portion of investigations examining psychological parameters among essential hypertensive patients...

The Acute Behavioral Stress Response

There are several behaviors known to be associated with essential hypertension, including eating a diet high in sodium (Law, 1997), excessive use of alcohol (Puddey, Beilin, and Rakic, 1997), sedentary lifestyle (Blair et al., 1984), using diet pills containing phenylpropanolamine (Lake et al., 1989), and even consuming significant amounts of licorice (Sigurjonsdottir et al., 2001). If hypertensive patients respond to stress with any of these or other acute behavioral responses more than...

Adrenergic Inhibiting Antihypertensive Pharmacologic Agents

A number of different types of antihypertensive agents directly target blood pressure control through altering the nervous system regulation of blood pressure, including central alpha-agonists, peripheral adren-ergic inhibitors, and both alpha- and beta-adrenergic blockers. In all cases, these pharmacologic agents decrease sympathetic nervous system activation on the circulatory system. Central alpha-agonists decrease sympathetic nervous system activity through their action on brain mechanisms...

Summary

Stress has long been associated with the condition of essential hypertension. However, the relation between stress and hypertension is probably not direct, but rather involves various intervening variables depicted in Figure 4.1. Considerable empirical work has examined the relation between environmental stress and the etiology of essential hypertension, including research on stressful life events, job stress, comparisons of blood pressure across cultures, and research using rats and mice with...

Physical Activity

Physical inactivity is associated with both obesity and diabetes, and similarly has been commonly linked to the etiology of essential hypertension (Blair et al., 1984). Among its many benefits, engaging in aerobic exercise is associated with reduced blood pressures, lower heart rate, reduced sympathetic nervous system activity, and increased parasympathetic activity (Scheuer and Tipton, 1977). In a review of the literature, Light (1989) cited two studies that contrasted subjects categorized as...

What Role Does the Acute Stress Response Play in the Association between Stress and Hypertension

Through integrating the body of literature linking stress with hypertension and theoretical and empirical work on the effects of stress on the body itself, multiple demographic, constitutional, psychological, and social factors have been associated with increased risk for essential hypertension. Central to the model presented in Figure 4.1 was consideration of the mediating role of the acute stress response, comprised of affective, behavioral, cognitive, and physiological response domains....

Cardiovascular Recovery from Mental Stress

Recall the types of allostatic load outlined in Figure 3.1 (McEwen, 1998), which indicate there are physiological patterns other than exaggerated reactivity that contribute to onset of chronic stress disorders like essential hypertension. In this regard, several investigators have examined cardiovascular recovery from stress rather than cardiovascular reactivity during stress as a potential etiologic mechanism (see Schwartz et al., 2003). If one follows this line of reasoning, essential...

Diabetes

It is well known that diabetes mellitus is associated with essential hypertension, although part of this relation may be owing to the fact that both medical conditions are associated with obesity (Kaplan, 2002). It is also known that living with a chronic medical condition like diabetes presents the patient with additional stressors in life (hospitalizations or medical complications) that may further increase risk for hypertension. In contrast to some of the other constitutional factors...

Use of Individualized Patient Assessment in Optimizing Treatment Outcome

For the most part, intervention studies examining both pharmacologic and non-pharmacologic approaches have selected patients on the basis of pre-treatment blood pressure without reference to other constitutional or psychosocial characteristics that may influence treatment outcome. For example, studies of the effect of sodium restriction programs on blood pressure reduction rarely have selected patients on the basis of their sodium sensitivity, and studies of stress management programs on...

Demographic and Historic Developmental Factors

Stress reactions have been shown to be influenced by a number of individual difference variables over which one has very little control. For example, our age, genetic constellation, developmental and medical history, and in most cases gender are variables we have no direct control over. By this time next year, we will all be one year older and still composed of the same constellation of genes that we possess today. Although we may not be able to influence these variables, many of these factors...

Lifestyle Factors

Several lifestyle variables are associated with an increased risk for essential hypertension, including physical inactivity, smoking, and consumption of alcohol, caffeine, and a high-sodium diet (Kaplan, 2002). Surprisingly, many of these variables have also been shown to affect cardiovascular reactivity to stress, suggesting that perhaps their influence on risk for hypertension is expressed via the sympathetic nervous system. Let's examine the evidence linking each of these lifestyle factors...

Psychological Approaches to Blood Pressure Reduction

Early psychological interventions aimed at lowering blood pressure were based primarily on the observations of psychoanalytic practitioners who focused on treating the unique personality conditions under which hypertension occurred (Alexander, 1939 Ayman, 1933). For example, if hypertension was associated with unconscious hostile urges and dependency needs, as hypothesized by Alexander, then psychoanalysis aimed at resolving these conflicts should result in reductions in blood pressure....

Obesity

Although the relation between obesity and hypertension has been clearly established and obesity ranks as one of the primary risk factors for the development of essential hypertension (Kaplan, 2002), there is very little empirical work examining whether obesity affects the stresshypertension relation. Although one could hypothesize that living with obesity presents the patient with an additional set of stressful life circumstances that normal-weight individuals do not confront (decreased...

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...