Natural High Blood Pressure Treatment Ebook

Hypertension Exercise Program

Blue Heron Health News has a blood pressure program that promises to help you lower your blood pressure with just 3 easy exercises. This program doesn't involve your diet, and anyone, at any age, can use this program to experience results. It involves three easy exercises. There is very little effort. The exercises are on audio, so you just have to listen. You walk around a room or you sit down. You will start experiencing the calming effects of the exercises within minutes. Best of all, you won't need to rely on medication or implement any major dietary changes. They're safe, easy and effective. Read more here...

Hypertension Exercise Program Summary

Rating:

4.8 stars out of 76 votes

Contents: Ebook
Author: Christian Goodman
Official Website: blueheronhealthnews.com
Price: $49.00

Access Now

My Hypertension Exercise Program Review

Highly Recommended

Of all books related to the topic, I love reading this e-book because of its well-planned flow of content. Even a beginner like me can easily gain huge amount of knowledge in a short period.

Overall my first impression of this ebook is good. I think it was sincerely written and looks to be very helpful.

Chronic Hypertension High Blood Pressure Is Caused by Impaired Renal Fluid Excretion

When a person is said to have chronic hypertension (or high blood pressure), it is meant that his or her mean arterial pressure is greater than the upper range of the accepted normal measure. A mean arterial pressure greater than 110 mm Hg (normal is about 90 mm Hg) is considered to be hypertensive. (This level of mean pressure occurs when the diastolic blood pressure is greater than about 90 mm Hg and the systolic pressure is greater than about 135 mm Hg.) In severe hypertension, the mean arterial pressure can rise to 150 to 170mmHg, with diastolic pressure as high as 130 mm Hg and systolic pressure occasionally as high as 250 mm Hg. Even moderate elevation of arterial pressure leads to shortened life expectancy. At severely high pressures mean arterial pressures 50 per cent or more above normal a person can expect to live no more than a few more years unless appropriately treated. The lethal effects of hypertension are caused mainly in three ways

Theories Linking Stress and Essential Hypertension

Based upon the accumulated evidence linking stress with essential hypertension presented in this chapter, several investigators began to consider how a psychological construct like stress, which presumably involved neural activation of the brain, came to be associated with the condition of essential hypertension that occurred in the circulatory system. One place to start is to examine the shared regulatory systems and circuitry described in Chapters 1 and 3 that involve both the nervous and circulatory systems (for example, the autonomic nervous system and the neuroendocrine system). It seems likely that these mechanisms would be excellent candidates for explaining the connection between stress and hypertension. In fact, it is quite clear that several organ systems and regulatory feedback loops depicted in Figure 1.2 involve the integration of brain substrates and components of the circulatory system. Dysfunctions originating from each of these organ systems and associated feedback...

High Blood Pressure Hypertension

High blood pressure (hypertension) is dangerous. If blood pressure is high, the heart has to work harder to pump the same amount of blood, which puts a great stress on the cardiovascular system. Patients with high blood pressure are more prone to heart attacks, heart failure, kidney failure, and strokes. Fortunately, blood pressure can be controlled with appropriate medications and lifestyle modifications, greatly reducing the risk of complications. Some measures that help to control high blood pressure include stopping smoking, losing excess weight, avoiding excessive salt, and exercising at least three to four times a week.

Hypertension as an Inflammatory Disease

Based upon recent evidence linking inflammatory processes in the circulatory system to the onset of cardiovascular disease (Ridker, 1998), hypotheses that essential hypertension either may be caused by the same inflammatory process or may foster the development of the inflammatory process were considered. Indeed, hypertension has been shown to be associated with increased levels of C-reactive protein, a marker of chronic inflammation within the cardiovascular system (Saito et al., 2003 Schillaci et al., 2003). Therefore, increased arterial pressures are associated with increased levels of inflammation within the cardiovascular system. To evaluate the classic chicken-or-the-egg question, Sesso et al. (2003) conducted a seven-year prospective trial examining whether levels of C-reactive protein predicted onset of hypertension. Controlling for traditional risk factors for coronary artery disease, they found that elevated C-reactive protein markers of inflammation were significantly...

How Do Environmental Stressors Lead to Essential Hypertension

Although stress is clearly implicated in the etiology of essential hypertension, it is not easy to explain how a characteristic of a job, like degree of psychologic demand or job control, or exposure to an earthquake results in the physiologic tissue damage (like vascular hypertrophy) or altered regulatory system functioning (like baroreceptor insensitivity) observed in chronic hypertension. Just how can a characteristic of an environmental stimulus lead to these physiologic changes Several of the theoretical perspectives that were highlighted in Chapter 4 hypothesized that the intensity, pattern, and duration of the acute blood pressure response to stress are important to consider when addressing this question (Folkow, 1983 Julius and Esler, 1975 Laragh, 1983). It is not surprising, then, that the comprehensive model of the stress-hypertension relation depicted in Figure 4.1 places the acute stress response in between stress and physiological change associated with essential...

Mediators of pulmonary hypertension

Mild pulmonary arterial hypertension is frequently seen in patients with ARDS, and loss of normal control over pulmonary vasomotor tone is an important mechanism underlying refractory hypoxaemia. Hypoxic pulmonary vasoconstriction is lost in sepsis induced lung injury as inhalation of 100 oxygen before and during endotoxin challenge does not prevent pulmonary hypertension and hypoxic vasoconstriction is inhibited for several hours after endotoxin challenge.71 Studies with knockout mice have demonstrated a central role for nitric oxide (NO) in the normal modulation of pulmonary vascular tone. The mechanisms whereby this regulation is lost in lung injury are not clear, but it is known that endotoxin induces COX-2 and inducible nitric oxide synthase (iNOS) expression in the pulmonary vasculature.72 The situation is complicated, however, as endotoxin contributes to an early marked pulmonary hypertension despite the induction of iNOS and irrespective of the pulmonary artery occlusion...

Summary of Measures of State Affect as Mediators of the Stress Hypertension Relation

It is also important to consider that emotional states like anxiety and anger represent a conglomeration of cognitive, physiological, and behavioral response domains. Anxiety involves physiological arousal, certain cognitive manifestations, and typically behavioral avoidance responses. Anger also contains physiological arousal, accompanied by a different set of cognitive and behavioral responses. As noted by Lang (1978), the magnitudes of responses across these domains are only weakly correlated, suggesting that they are measuring unique attributes of the affective response. As a more recent illustration of this finding, Feldman et al. (1999) analyzed the relation between measures of negative emotional reactivity (anxiety, anger, and stress) and cardiovascular reactivity to mental stress tasks from nine different studies. Their results revealed that only 2 to 12 percent of the variance of cardiovascular reactivity was explained by measures of negative affective responding, suggesting...

Summary of Cognitive Measures as Mediators of the Stress Hypertension Relation

Given findings from studies examining hypertensive patients' cognitive appraisals of emotion-laden information and painful stimuli, it could be hypothesized that hypertension is associated with an overall tendency to minimize sensitivity to a broad range of environmental stimuli. Nykli'cek et al. (2001) tested this hypothesis by exposing a group of hypertensive patients and normotensive controls to a painful electric current stimulus as well as a variety of stressful laboratory tasks. Findings revealed that hypertensive women, in contrast to normoten-sive women, exhibited diminished pain sensitivity to the electric current in addition to lower pre-task ratings of state anxiety and less negative appraisal associated with watching a stressful film segment. Pain sensitivity measures were positively correlated with ratings of negative task appraisals, providing some support for this hypothesis. However, these findings were observed only among women, and only with appraisal ratings of the...

Acute Stress Responses Mediators of the Stress Hypertension Relation

It is clear that the relation between stress and hypertension is not a simple or direct one, and that many variables serve to mediate this relation. After reviewing the evidence pertaining to the various acute stress responses that have been shown to differentiate hypertensive from normotensive patients, it is important to consider whether the observed acute stress responses that have been identified and discussed mediate the relation between stress and hypertension. A mediating variable explains the relation between two other presumably cause-and-effect variables, typically called the predictor and the criterion variables (Baron and Kenny, 1986). In this case, environmental stress is the predictor variable and the pathophysiological changes that result in essential hypertension is the criterion variable. In this relation, a certain amount of variance of the condition of essential hypertension can be explained or predicted by environmental stress. We certainly know that hypertension...

Parental History of Hypertension

Although twin studies have been valuable in exploring the relation between the genetic contribution to both cardiovascular reactivity to stress and essential hypertension, they are difficult to conduct due to the limited number of twins in the population and limited access to sets of twin data. Based upon the knowledge that hypertension aggregates in families (Paffenbarger, Thorne, and Wing, 1968 Stamler et al., 1971), a considerable amount of research has examined the genetic foundation of cardiovascular response to stress by comparing persons of different hypertensive parentage (for a review, see Fredrikson and Matthews, 1990). In most of these studies, categorization of young normotensive participants into those with or without a family history of hypertension is conducted through brief interviews of participants' biological parents regarding their hypertensive status, although a few studies have extended this definition to include parents with coronary heart disease and others...

More on Gestational Hypertension High Blood Pressure During Pregnancy

Prior to your pregnancy, you have what's known as chronic hypertension if you first develop hypertension only after the first twenty weeks of pregnancy, you have gestational hypertension. You're more likely to develop gestational hypertension if you If you develop gestational hypertension because of hypothyroidism, it's crucial to begin thyroid hormone supplementation at a dosage that is at least 100 micrograms daily. After a month, if your TSH levels are still high, the dosage may need to be increased. Gestational hypertension usually clears up after delivery, in the absence of other causes. Women with chronic hypertension (which may be first unveiled during pregnancy) tend to have a family history of hypertension. Chronic hypertension is more common in women over thirty-five and is aggravated by smoking, obesity, or kidney problems. Whether you have chronic or gestational hypertension, high blood pressure in pregnancy could lead to preeclampsia (a serious condition discussed next),...

Treatment and Prevention of Essential Hypertension

Given the evidence that has accumulated over the past half century, it is not surprising that Franklin's physician prescribed an antihypertensive medication to treat his hypertensive condition. Among all interventions that have been tested to lower blood pressure, antihypertensive medications have clearly shown the most efficacy. However, like many patients, Franklin experienced some noticeable side effects associated with the medicine that led to periods of non-adherence and, consequently, his current state of uncontrolled blood pressure. Franklin was not taking his medication during the day in which ambulatory measures of his blood pressure were obtained (see Figure 2.1), and the profile that was observed showed that his blood pressure was not well controlled. According to the JNC-7 Report (Chobanian et al., 2003), the primary goal of treating essential hypertension is to reduce mortality associated with cardiovascular and cerebrovascular disease. Reducing blood pressure to less...

Combination Antihypertensive Agents

Although all three of the broad categories of antihypertensive medications have been shown to reduce blood pressure, several possess physiological or metabolic side effects that are associated with increased risk for other pathological conditions. Already mentioned is the potassium-depleting characteristic of thiazide and loop diuretics, which results in an increased risk for arrhythmias and other metabolic disturbances. Similarly, beta-blockers have been shown to raise triglycerides and alter one's lipid profile (Kaplan, 2002). Because multiple antihy-pertensive agents may be needed to achieve optimal blood pressure control and to counteract some of the negative side effects associated with taking a single antihypertensive agent, many combination drugs

Effect of Antihypertensive Agents on Cognitive Functioning

As stated in Chapter i, it has been well documented that essential hypertension is associated with subtle cognitive impairments that can often be detected only by means of specific neuropsychological assessment strategies (see Waldstein et al., 1991). If hypertensive patients are generally aware of these cognitive deficits, they may need to exert more effort or become more engaged with mental tasks in order to perform at an acceptable level. Their exaggerated cardiovascular response to mental stress may reflect their increased effort or engagement. If pharmacologic interventions result in improved cognitive ability, as initially hypothesized by Miller et al. (1984), the mechanism of action for antihypertensive medications may involve cognitive functioning. As such, one would expect antihypertensive agents to 'normalize' the cognitive deficits commonly observed in hypertensive patients with ongoing treatment. Let's examine the body of evidence examining the effect of antihypertensive...

Pulmonary hypertension

The changes in pulmonary artery pressure during each apnoea are reversible, but in certain situations chronic pulmonary hypertension develops. This requires the presence of hypoxia during the daytime in addition to during the OSA at night, as a result of, for instance, coexisting chronic airflow obstruction, severe ventilation- perfusion mismatching due to gross obesity, or hypoventilation due to neuromuscular or skeletal disorders. Right ventricular hypertrophy develops and the pulmonary hypertension, together with endocrine and metabolic responses to hypoxia and hypercapnia, leads to right heart failure, usually at the time that daytime hypercapnia develops. The pulmonary artery pressure may only fall slightly with CPAP treatment, at least in the short term, because persistent pulmonary hypertension causes vascular remodelling and structural changes in the pulmonary microcirculation.

The Role of Individual Differences in the Association between Stress and Hypertension

Recognizing that a relation between stress and hypertension exists and that cardiovascular reactivity to stress appears to be an important mediator of that relation, let's turn to the remaining component of the model depicted in Figure 4.1. In contrast to the variables comprising the acute stress response, individual difference factors consist of relatively stable constitutional, lifestyle, psychological, and social factors that influence risk for essential hypertension, possibly through their influence on the magnitude of the acute stress response. Many of these variables, described in detail in Chapters 6 and 7, interact with one another in complex ways to affect both the magnitude and patterning of the acute stress response and the risk for essential hypertension, including age, gender, ethnicity, parental history of hypertension, sodium consumption, hostility, and lack of social support. For example, a middle-aged African American man with hypertensive parents, like Franklin,...

Intracranial hypertension

Raised intracranial pressure causes headaches which are usually bifrontal, and may be associated with nausea and vomiting. They usually clear within 20-60 min after waking in the morning. They are associated with space-occupying intracranial lesions, severe hypertension, hypercapnia, particularly in REM sleep, causing cerebral vasodilatation, cerebral oedema following a hypoglycaemic episode, and benign intra-cranial hypertension.

Hypertension High Blood Pressure

About 10 to 20 percent of people with hypothyroidism suffer from hypertension (high blood pressure), which can lead to heart failure if severe and left untreated for long periods of time. It can also lead to a heart attack or stroke. To understand high blood pressure, it's useful to explain what blood pressure is. The blood flows from the heart into the arteries (blood vessels), pressing against the artery walls. The simplest way to explain this is to think about the streets of a small city. During the evening rush hour everybody drives home using the same major streets that head to the suburbs. Normally, all of the traffic is easily handled by the multilane streets and roads, or the arteries of the city however, as the city ages, and more people move there, roads develop potholes and areas of disrepair. This results in lane closures, and the traffic backs up as the diminished road capacity is forced to accept the same flow of cars returning home. The increased pressure, manifested by...

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 behaviorally elicited cardiovascular reactions. Etio-logically this was an important finding, in that borderline essential hypertension is often considered a pre-hypertensive state. Regarding the examination of the role of cardiovascular reactivity to stress in the stress-hypertension relation, several types of studies lend support, including animal research, retrospective studies contrasting patients with essential hypertension to normal blood pressure controls, and prospective studies 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 hypertension, only about one-third were taking their antihypertensive medication after one year of treatment, even though health care was provided free of charge (McCombs et al., 1994). As in Franklin's case, many hypertensive patients discontinue taking their prescriptive medications due to their side effects, which are often more uncomfortable than the relatively unnoticeable condition of hypertension itself. Indeed, research indicates that adherence is improved among newer angiotensin...

Experimental Volume Loading Hypertension Caused by Reduced Renal Mass Along with Simultaneous Increase in Salt Intake

Figure 19-7 shows a typical experiment demonstrating volume-loading hypertension in a group of dogs with 70 per cent of their kidney mass removed. At the first circled point on the curve, the two poles of one of the kidneys were removed, and at the second circled point, the entire opposite kidney was removed, leaving the animals with only 30 per cent of normal renal mass. Note that removal of this amount of kidney mass increased the arterial pressure an average of only 6 mmHg. Then, the dogs were given salt solution to drink instead of water. Because salt solution fails to quench the thirst, the dogs drank two to four times the normal amounts of volume, and within a few days, their average arterial pressure rose to about 40 mm Hg above normal. After 2 weeks, the dogs were given tap water again instead of salt solution the pressure returned to normal within 2 days. Finally, at the end of the experiment, the dogs were given salt solution again, and this time the pressure rose much more...

Animal Research Linking Stress to Hypertension

And the chronic stress responses that are observed, including hypertension. Much of the work on developing our current understanding of stress that was presented in Chapter 3 was learned through such animal models. In this regard, several different stressors have been employed to determine whether exposure to stress results in chronic heightened blood pressures in rats or mice, including exposure to noisy, vibrating environments (Smookler and Buckley, 1969), electric shock (Shapiro and Melhado, 1958), and a variety of operant conditioning procedures (Brady, Findley, and Harris, 1971 Forsyth, 1969 Herd et al., 1969). In general, the operant conditioning paradigms have been more successful in elevating blood pressure than the other procedures (Lawler, Cox, and Hubbard, 1986). However, the observed increases rarely persisted following the duration of the experimental manipulations and when chronic elevations in blood pressure were observed, they occurred only among some animals. Based...

Volume Load Hypertension In Artificial Kidney

Chapter 17 and earlier in this chapter. That is, after the cardiac output had risen to a high level and had initiated the hypertension, the excess blood flow through the tissues then caused progressive constriction of the local arterioles, thus returning the local blood flows in all the body tissues and also the cardiac output almost all the way back to normal, while simultaneously causing a secondary increase in total peripheral resistance. 1. Hypertension Therefore, we can divide volume-loading hypertension into two separate sequential stages The first stage results from increased fluid volume causing increased cardiac output. This increase in cardiac output causes the hypertension. The second stage in volume-loading hypertension is characterized by high blood pressure and high total peripheral resistance but return of the cardiac output so near to normal that the usual measuring techniques frequently cannot detect an abnormally elevated cardiac output. Thus, the increased total...

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 social support. Presumably, if social support was related to lower blood pressures, interventions of this type would be hypothesized to result in reductions in blood pressure. Although findings from intervention studies of normotensives were mixed, a meta-analysis of intervention studies that was done on intervention trials employing essential hypertensive patients yielded a significant effect, with family-based social support interventions resulting in blood pressure reductions. Most of these...

Primary Essential Hypertension

About 90 to 95 per cent of all people who have hypertension are said to have primary hypertension, also widely known as essential hypertension by many clinicians. These terms mean simply that the hypertension is of unknown origin, in contrast to those forms of hypertension that are secondary to known causes, such as renal artery stenosis. In some patients with primary hypertension, there is a strong hereditary tendency, the same as occurs in animal strains of genetic hypertension discussed above. In most patients, excess weight gain and sedentary lifestyle appear to play a major role in causing hypertension. The majority of patients with hypertension are overweight, and studies of different populations suggest that excess weight gain and obesity may account for as much as 65 to 70 percent of the risk for developing primary hypertension. Clinical studies have clearly shown the value of weight loss for reducing blood pressure in most patients with hypertension. In fact, new clinical...

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 may not be true. Certainly, patients with established essential hypertension sustain elevated pressures throughout daily life, suggesting strong correspondence between their clinic and non-clinic blood pressure measures. On the other hand, the correspondence between clinic and non-clinic blood pressures is quite poor for patients categorized as exhibiting isolated clinic hypertension. Unfortunately, isolated clinic hypertensive patients represent a significant proportion of adult patients...

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 been related to higher blood pressures. Findings linking stress to hypertension have also been strongly supported by animal research that has consistently shown that animals exposed to a variety of stressful environments exhibit higher blood pressures than animals in less stressful environments. Yet, despite these commonly observed associations, demonstrating a causal role for stress in the etiology of hypertension requires much more evidence than what is currently available. Because most...

Antihypertensive Drugs

Drugs that are used for treating hypertonic diseases as well as symptomatic hypertensions are called antihypertensive drugs. Hypertension is a syndrome characterized by elevated arterial blood pressure that depends on a number of factors. Some of the main factors that determine arterial blood pressure are parameters of heart rate, volume, viscosity, and electrolytic contents of circulating blood. Normal range of blood pressure varies depending on sex and age. Moreover, various medical schools themselves determine what an acceptable value is. The etiology of 90-95 of cases of this disease are unknown, and these cases are referred to as primary or essential hypertension treatment is of a palliative nature that is directed to lowering systolic and diastolic blood pressure, and in general, effectively permitting control of a patient's arterial blood pressure over a long period of time. During such treatment, antihy-pertensive agents can be directed at various sections of physiological...

Example 91 A series of trials in hypertension hypothetical

In a collection of four placebo-controlled trials in hypertension a difference of 4 mmHg in terms of mean fall in diastolic bp is to be considered of clinical importance anything less is unimportant. The results, are given in Table 9.2, where and are the mean reductions in diastolic bp in the active and placebo groups respectively.

Other Types of Hypertension Caused by Combinations of Volume Loading and Vasoconstriction

Hypertension in the Upper Part of the Body Caused by Coarctation of the Aorta. One out of every few thousand babies is born with pathological constriction or blockage of the aorta at a point beyond the aortic arterial branches to the head and arms but proximal to the renal arteries, a condition called coarctation of the aorta. When this occurs, blood flow to the lower body is carried by multiple, small collateral arteries in the body wall, with much vascular resistance between the upper aorta and the lower aorta. As a consequence, the arterial pressure in the upper part of the may be 40-50 per cent higher than that in the lower body. The mechanism of this upper-body hypertension is almost identical to that of one-kidney Goldblatt hypertension. That is, when a constrictor is placed on the aorta above the renal arteries, the blood pressure in both kidneys at first falls, renin is secreted, angiotensin and aldosterone are formed, and hypertension occurs in the upper body. The arterial...

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 vasodilators. They include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium channel blockers, and direct vasodilators. Whereas direct vasodilators exert an immediate relaxing effect upon the smooth muscle cells of the vasculature, other vasodilating agents exert their effect by altering local substances known to affect vasodilation (Kannel, 2002). For example, calcium channel blockers, as their name indicates, disrupt the flow of calcium into the smooth muscle...

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. Although there is little evidence to suggest that hypertensives respond to stress with differential affective responses (namely, anxiety or anger) than normotensives, there is consistent evidence to suggest differential behavioral, cognitive, and physiological responses to stress between hypertensives and normotensives. Hypertensives, for example, have been shown to make less assertive responses to confrontation than normotensives, particularly in the nonverbal domain of eye contact. Regarding acute...

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 responsible for blood pressure regulation, including baroreceptor functioning. Peripheral adrenergic inhibitors, including reserpine, exert their blood pressure-lowering effect on the release of norepinephrine in the peripheral nervous system. Both alpha- and beta-adrenergic blocking medications influence blood pressure regula tion by blocking neural signals that lead to vasoconstriction and heart rate activation, respectively. Unlike with diuretic antihypertensive agents, metabolic problems...

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 for a given patient Despite the standing joke that the physician's choice for an antihypertensive medication depends upon which drug representative visited the clinic most recently, several pieces of information are typically considered when selecting the optimal therapy, including demographic variables associated with differential treatment response to a particular agent, the presence of any co-morbid medical conditions like heart disease or diabetes, and potential side effects that may...

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 an increased excretion of sodium and water. Consequently, cardiac output drops and blood pressure is reduced. Although the initial reduction in blood pressure is associated with di minished cardiac output, reduced peripheral resistance follows with continued diuretic use, as the body accommodates to its new fluid volume. There are three classes of diuretic agents thiazide diuretics, loop diuretics, and potassium-sparing diuretics. Although widely and safely used, thiazide and loop diuretics can...

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 mechanisms through which these classes of antihypertensive medications exert their blood pressure-lowering effect, it is possible that they impact cardiovascular reactions to stress differently. For example, because beta-blockers lower blood pressure by blocking sympathetic nervous system activation of the heart, it would certainly be expected that heart rate reactions to stress would be tempered by beta-blockade. Conversely, treatment with diuretics might be expected to influence heart rate or...

Stress and Essential Hypertension

Now that the foundations for both essential hypertension and stress have been established, we can begin to address the primary question of the book, namely, what is the relation between a psychophysiological construct like stress and the physical manifestation of essential hypertension It has probably become apparent that many of the bodily organs, systems, and mechanisms responsible for regulating arterial pressure are the same organs, systems, and mechanisms that have served usefully in explaining how environmental stress leads to physical disease. These include the branches of the autonomic nervous system, hormone and steroid release from the neuroendocrine system, and various brain regions like the hypothalamus, brain stem, and limbic system. All in all, there is a great deal of overlap between the physiological mechanisms described in Chapter i and Chapter 3 thus there is good reason to consider that an association exists between stress and hypertension. In examining the evidence...

Hypertension

Chronic hypertension is associated with obstructive sleep apnoeas even when confounding factors such as obesity, alcohol intake, diabetes mellitus and inactivity are taken into account. It is mainly due to sustained increased sympathetic activity during the day as a result of intermittent hypoxia at night. The blood pressure usually rises by around 3-5 mmHg. Hypertension has been thought to be associated even with mild obstructive sleep apnoeas but is probably only significant when the desaturation index is greater than around 20 per hour. Hypertension is most closely associated with OSA between the ages of 30 and 50, possibly because of a greater sympathetic reaction to hypoxia in this age range, and may be drug resistant, although it is reversible with CPAP treatment.

Measurement of Blood Pressure

Diagnosis and monitoring of treatment of essential hypertension require the accurate repeated measurement of blood pressure. Although on the surface it may seem that measuring blood pressure is simple, many factors need to be considered when obtaining measures of blood pressure for purposes of diagnosing and monitoring essential hypertension. For example, arterial pressure differs depending upon the specific site of the arterial bed from which the measure is obtained the closer the location is to the heart, the higher the blood pressure. Body position greatly affects blood pressure measurement, as does ingestion of a variety of substances, including alcohol, nicotine, caffeine, and a whole range of prescription and over-the-counter medications. To complicate matters further, blood pressure is a dynamic parameter, forever changing as the organism adapts to altering environmental contexts like noise level, temperature, and presence of interpersonal confrontation therefore, a single...

Ambulatory or Home Blood Pressure

Categorization of hypertension, normotension, isolated clinic hypertension, and isolated clinic normotension from clinic and either home or ambulatory blood pressures. Adapted from Pickering et al. (1999), Task Force V White coat hypertension, Blood Pressure Monitoring, 4, 333 -341. Copyright (1999), with permission from Lippincott, Williams, and Wilkins. mal blood pressures in the clinic typically exhibit normal pressures during monitoring out of the clinic. There are, however, two categories of patients for whom this is not the case. Some patients have significantly greater blood pressures in the clinic than during daily life (see Figure 2.2). Although these patients have historically been referred to as 'white coat' hypertensive patients, based upon the premise that they were exhibiting a conditioned anxiety response to being evaluated by a medical professional wearing a white coat, a more descriptive term for this condition is isolated clinic hypertension. (Some...

Interaction Transactional Theories and Research

The defense and defeat reactions. Adapted from J. P. Henry, P. M. Stephens, and D. L. Ely (1986), Psychosocial hypertension and the defence and defeat reaction, Journal of Hypertension, 4, 687- 697. Copyright (1986), with permission from Lippincott, Williams, and Wilkins. Figure 3.2. The defense and defeat reactions. Adapted from J. P. Henry, P. M. Stephens, and D. L. Ely (1986), Psychosocial hypertension and the defence and defeat reaction, Journal of Hypertension, 4, 687- 697. Copyright (1986), with permission from Lippincott, Williams, and Wilkins.

Autonomic Dysregulation

Rather than focusing on components of kidney function or vascular changes in the circulatory system in explaining the stress-hypertension association, Julius and Esler (1975) theorized that essential hypertension is caused by a nervous system dysregulation, involving both the central nervous system and branches of the autonomic nervous system. According to their theory, enhanced nervous system activation stimulates the circulatory system, much like the fight-flight (defense) response characterized in Chapter 3, resulting in elevated arterial pressures. In support of their position, they showed that the elevated blood pressures of borderline essential hypertensive patients were related to increased autonomic nervous system activity. As stated in Chapter 1, these mild hypertensive patients who exhibited elevated blood pressures associated with autonomic dysregulation have been categorized as having 'hyperkinetic' hypertension, a profile characterized by increased cardiac output rather...

The Acute Affective Stress Response

Affective variables associated with the stress-hypertension relation include an array of acute emotional responses to environmental stressors. Although positive emotions like happiness or joy could serve as potential acute affective stress responses associated with hypertension, research in this area has typically focused on emotions that constitute negative affect, mainly anxiety and anger. In this regard, not all emotions have received equal attention. In order to examine more closely the role of acute anxiety or anger responses in connection with the stress-hypertension relation, it is more important to measure short-term affective states that occur in response to situational or environmental stressors than the more enduring anxiety and anger traits. In Spielberger, Gorsuch, and Lushene's (1970) terminology, acute stress responses are best assessed using measures of state affect (responding how anxious or angry you feel right For purposes of this chapter, we will examine only...

The Acute Cognitive Stress Response

In comparison to the literature that has examined potential affective and behavioral factors that might help explain how stress leads to hypertension, fewer studies have considered acute cognitive stress response variables. It is possible that researchers are reluctant to examine cognitive variables due to the inherent difficulty in accessing reliable measures of cognitive activity. In general, there are two methods for measuring acute cognitive responses to stress, retrospective recall of thoughts and think-aloud procedures. The former involves requesting individuals to report thought content associated with a given stressful situation after the stress has dissipated, and the latter involves training respondents to state their thoughts aloud into a recorder for later scoring during the given stressful situation. Both possess obvious problems. Retrospective reports of cognitive activity are contaminated by problems of inaccurate and selective recall. While some thoughts are going to...

The Acute Physiological Stress Response

Acute psychophysiologic reactivity to stress has long been hypothesized as a mechanism involved in explaining the stress-hypertension connection (see Krantz and Manuck, 1984). In brief, psychophysio-logic reactivity refers to the magnitude of change observed in a given psychophysiologic parameter (for example, heart rate, blood pressure, or serum norepinephrine) in response to a standardized stressor. Typically, this response magnitude, or reactivity, reflects a measurable change in physiologic functioning that cannot be predicted by knowing one's resting levels of that same parameter. As an example, the magnitude of a blood pressure response to completing a serial subtraction task is generally independent of one's resting levels of blood pressure. Acute psychophysiologic reactivity generally involves calculating the difference between measures of a given parameter during a stress presentation and an associated rest period, often referred to as a baseline. Although measurement of the...

Stability of Measures of Cardiovascular Reactivity to Stress

The demonstration of generalization of cardiovascular reactions to stress from the laboratory to real-life settings is of particular importance to the reactivity hypothesis. In this regard, if measurement of laboratory task-elicited cardiovascular reactivity had no correspondence to reactions observed to naturally occurring stressors, it would be difficult to imagine how exaggerated responses only to standardized laboratory stressors, which happen rarely if at all in one's life, would lead to the development of essential hypertension. In this regard, it is important to document that measures of cardiovascular response to laboratory stimuli are related, to some extent, to the reactions individuals typically exhibit in response to daily life stressors. Some investigators have attempted to demonstrate the association between laboratory and real-life stressors by contrasting laboratory-determined measures of cardiovascular response to mental tasks with the variability of blood pressures...

Environmental Stressors and Cardiovascular Reactivity

Evidence linking stress to essential hypertension presented in Chapter 4 consisted of studies relating high blood pressure to major life events, work stress and strain, and cultural stressors like acculturation or lifestyle incongruity. Direct evidence relating stressful living conditions to onset of elevated blood pressures was also presented using experimental animal work on rats and mice genetically predisposed to develop hypertension. Given the working model illustrated in Figure 4.1, associations between these types of stressors and acute cardiovascular responses to stress would be expected in addition to the established association between stress and hypertension. Let's examine what is known about the relation between cardiovascular reactivity to stress and these types of stressors known to be associated with increased risk for essential hypertension. From the body of evidence showing that rats genetically predisposed to developing hypertension also exhibit exaggerated...

Models of the Acute Stress Response

Among all the potential acute stress response variables examined in this chapter, cardiovascular response to stress emerges as the variable that has received the strongest support for linking stress and essential hypertension. Furthermore, it is the only factor reviewed in this chapter that possesses prospective evidence connecting it to both increased incidence of hypertension among middle-aged adults and increases in blood pressure among young adults. This is not to state that the findings pertaining to differences in certain cognitive (repressive cognitive response style) and behavioral responses to stress (inappropriate assertive skills) that have been observed between hypertensive and nor- motensive patients do not play an important role rather the evidence linking these other variables to hypertension is currently much weaker, and prospective support for such hypotheses lacking. Conceptually, cardiovascular response to stress, in contrast to the other types of acute stress...

Psychological and Social Factors

From evidence presented in Chapter 6, it is quite obvious that constitutional and lifestyle factors influence the relation between stress and hypertension. They probably did in Franklin's case. Many of these same variables were shown to also be associated with elevated cardiovascular responses to stress, a hypothesized mediator of the stress-hypertension relation. However, when we applied our knowledge of these constitutional and lifestyle variables in the case of Franklin's hypertension, it became clear that the influence of several other variables was still unknown, namely, those pertaining to Franklin's psychological state both prior to and following the traumatic incident. Additionally, the influence of Franklin's social network and the support he either received or failed to receive were unknown. In this regard, it seems important to also consider psychological and social factors that may influence the stress-hypertension relation. In the same format applied in Chapter 6, both...

Psychological Factors

Personality factors have been long hypothesized to be associated with the etiology of essential hypertension (Alexander, 1939 Diamond, 1982). As mentioned in Chapter 1, even the term 'hypertension' connotes involvement of emotional or psychological factors. Historically, three different, but related, perspectives have been identified regarding the interrelation between personality factors and risk for essential hypertension the Negative Affect Hypothesis, the Suppressed Hostility Hypothesis, and the Emotional Defensiveness Hypothesis (Jorgensen et al., 1996). Very briefly, the Negative Affect Hypothesis stems from observations of psychoanalysts who worked with hypertensive patients in the early part of the twentieth century (Ayman, 1933 Dunbar, 1943), who described hypertensives as 'neurotic' patients, characterized by frequent bouts of intense negative affect, including anxiousness, anger, and depression. Based upon these observations, it was hypothesized that persons who exhibited...

Negative Affect Hypothesis

Because broad measures of neuroticism have revealed no consistent relation with essential hypertension (Cochrane, 1973 Davis, 1970 Kohler et al., 1993 Sainsbury, 1964 Spiro et al., 1995), most investigators have explored the Negative Affect Hypothesis by administering trait measures of negative affect, most commonly anxiety, anger, and depression. Although measurement of the experience of negative affect can be conducted using behavioral coding of facial displays of emotion (Ekman and Friesen, 1978), most investigators of the relation between personality factors and hypertension have used self-report questionnaires. Behavioral coding of emotions is simply too labor-intensive to conduct during the large-scale epidemiologic investigations that are typically used to address these relations. In contrast to the acute alterations in anxiety that occur in response to exposure to a threatening stimulus, trait anxiety refers to the relatively enduring anxiousness that persons experience on a...

Cognitive Factors and Information Processing

The lack of consistent findings in support of the Negative Affect, Suppressed Hostility, and Emotional Defensiveness Hypotheses has led investigators to explore new and different avenues of research to find psychological characteristics linked to the stress-hypertension relation. In particular, there is renewed interest in hypotheses pertaining to how patients with hypertension process information differently from persons with normal blood pressures. In this regard, these hypotheses take us from a concentration on the autonomic nervous system to differences presumably embedded in central nervous system activity. As mentioned in Chapter 1, essential hypertension has been associated with numerous deficits in information processing, including reduced reaction times and lower scores on attention, memory, and abstract reasoning tasks (for review, see Waldstein et al., 1991). Although adequate comparisons between samples of hypertensive and normoten-sive middle-aged and older adults have...

Lifestyle Interventions

Given the important link between obesity and risk for essential hypertension, a number of lifestyle modification programs have focused primarily on regaining normal body weight. One only needs to peruse best-selling book lists or examine the lead stories in popular monthly magazines to know that there are dozens of strategies proposed for losing weight, ranging from use of dietary supplements to appetite suppressants, and from daily exercise programs to various forms of surgery. Regardless of the strategies proposed, body weight is basically a function of the number of calories ingested and the number of calories expended on a daily basis. Therefore, most effective weight loss programs focus on some combination of reducing caloric intake (altered diet) and increasing the number of calories expended (exercise). In the fol Weight reduction stands out as one of the foremost behavioral interventions for lowering blood pressure. It is well known that even relatively minor reductions in...

Conclusions and Future Directions

Just what should be done with a patient like Franklin Although his case may appear quite complicated, involving multiple etiologic factors including exposure to a stressful job, a genetic propensity for developing hypertension, and an array of lifestyle factors that may increase his risk, it is really a fairly typical case of essential hypertension. Most individuals with hypertension are exposed to some degree of environmental stress and exhibit a wide range of lifestyle behaviors that may be linked to increased risk for developing it. However, these characteristics are common among most normotensive individuals as well. Therefore, it is quite difficult to ascertain which etiologic factors are operative in a single case of essential hypertension. In particular, because psychological stress has been inconsistently defined and measured throughout decades of research and theorizing, answers to questions concerning the relation between stress and hypertension have been even more elusive...

Comprehensive Measurement of Blood Pressure Regulation

The complexity of blood pressure regulation was highlighted in the very first chapter. There is no doubt that a multitude of physiological factors are involved in regulating arterial pressure. These include both physiological mechanisms that are responding directly to the external environment (like sympathetic nervous system response to stress) and those that are responding to changes within the internal environment of the circulatory system (like baroreceptor activation). Blood pressure dysregula-tion can be caused by events occurring outside of the circulatory system or by a systematic counter-regulatory action within the circulatory system itself. Obviously, in order to fully understand blood pressure regulation in response to something like exposure to environmental stress, it would be crucial to measure both the initial response patterns and the consequent compensatory actions. Unfortunately, studies linking stress with hypertension often do a poor job of comprehensively...

Broader Application of Ambulatory Measurement of Blood Pressure

Given the rapid advances in ambulatory recording technology that have occurred over the past decade, much has been learned regarding the 24-hour blood pressure profiles of both hypertensive and normo-tensive patients. In particular, because ambulatory measures of blood pressure are better predictors of target organ pathology and incidence of cardiovascular and cerebrovascular disease than clinic-derived measures, their increased use in clinical settings may also be warranted. Given the surprisingly high prevalence of both isolated clinic hypertensive and isolated clinic normotensive patients seen in clinic settings, it would seem that ambulatory or home blood pressure measurement strategies should be used more regularly. The current reliance on clinic-based blood pressure determinations for assigning diagnoses and formulating treatment plans runs the risk of treating isolated clinic hypertensive patients, who may not need treatment, and failing to treat isolated clinic normotensive...

Consideration of Hemodynamic Parameters

Although much has been learned regarding blood pressure regulation over the past century, the ability to distinguish elevations in blood pressure that are the result of increased cardiac output from those that are the result of increased peripheral resistance was one of the most important technological advances. Obviously, these measurement strategies enabled Lund-Johansen (1991) to differentiate the largely cardiac-mediated high blood pressure among young hypertensives from the vascular-mediated high blood pressure among older hypertensives. Although not commonly employed in clinic settings, measurement of hemodynamic functioning appears to have some promise in selecting the optimal pharmacologic agent for treating essential hypertension. In this regard, the use of hemodynamic profiling to optimize treatment outcomes warrants additional investigation. If the development of initial treatment plans for controlling hypertension were associated with better outcomes, it is possible that...

Testing Other Models of Allostatic Overload

Depicted in Figure 3.1 are the four distinct types of allostatic overload outlined by McEwen and Stellar (1993). Applying these models to research on stress and hypertension, the bulk of the literature has focused primarily on one type, the increased frequency of stress model. Although a few studies have been conducted using the delayed recovery model (Schuler and O'Brien, 1997), additional empirical work is clearly needed to examine whether recovery from stress, failure to habituate to stress, or an inadequate stress response is associated with problems of blood pressure regulation. One could argue, for instance, that the failure to exhibit any blood pressure response at all during mental stress may be just as problematic as exhibiting an exaggerated cardiovascular response. It will remain for future research to elaborate on whether these other models of allostatic overload have any place in describing the stress-hypertension relation.

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 Lal, Ahuja, and Madhukar (1982) compared a group of hypertensive patients with age-matched controls on a measure of significant events over the lifespan. Both male and female hypertensive patients reported significantly greater frequencies of distressing life events, in particular, bereavements, injuries, illnesses, and other health-related stressors. Comparable associations between elevated blood pressure and life events have been reported among samples of borderline essential hypertensive patients (Linden and Feuerstein, 1983 Myers and Miles, 1981). More recently, Larkin et al. (2004) reported a similar increased frequency of daily stressors among hypertensive patients over a one-week prospective recording period. In contrast to normotensives, who indicated an average of...

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 hypothesis stemmed from cross-fostering studies of inbred strains of SHRs and Dahl salt-sensitive rats that demonstrated that young rats, genetically endowed to develop hypertension but raised by nor-motensive mothers, developed adult blood pressures much lower than young rats raised by their natural hypertensive mothers (Azar and Hrushesky, 1985 Blizard, 1992 Cierpial and McCarty, 1991 DiNico-lantonio et al., 1986). Although the specific nature of these maternal environmental differences is...

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 contexts, and when forced to engage emotionally salient information, they may resort to denial or underreporting of emotionality. Due to the degree of discomfort associated with emotionally salient information, defensive individuals become chronically vigilant of their environment, searching for cues of emotionality and developing appropriate preemptive avoidance responses. Over time, according to the Emotional Defensiveness Hypothesis, this heightened state of vigilance and the associated state 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 individual is exposed to an environmental stressor that results in an acute elevated blood pressure response, the baroreceptors will reset to maintain this new, elevated level. In this regard, although baroreceptor involvement in the etiology of hypertension is uncertain, baroreceptor function is clearly implicated in maintaining elevated blood pressures. In addition to baroreceptors' capability to establish new thresholds, blood pressure regulation can also be disrupted by limited baro-receptor...

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 establishing how a specific thought, behavior, or emotion could possibly lead to vascular hypertrophy or baroreceptor insensi-tivity associated with the condition of prolonged essential hypertension. At least, with regard to acute physiological stress responses, plausible explanations exist regarding how hyper-responsive circulatory systems evolve into chronic problems in blood pressure regulation. For example, the description of the hyperkinetic borderline hypertensive patients established by...

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) reported significant differences between hypertensives and normotensives who were exposed to conditions of fear, anger, and frustration. Interestingly, despite the harassment experienced by participants in this study, hypertensive patients rated the experimenter as more 'friendly' than normotensives, indicating that either hypertensive patients perceived the experimental situation as less noxious than normotensives or they were glossing over the negative interactions they had just experienced. To...

Cultural Influences on Stress and Blood Pressure

Using data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study, Vargas, Ingram, and Gillum (2000) reported an inverse relation between educational attainment and incidence of high blood pressure. In this national survey, a higher risk of hypertension was associated with low educational attainment (not completing high school or attending college), even after adjusting for other standard risk factors. Using the same data set, Waitzman and Smith (1994) found a comparable association between risk for hypertension and occupational class. Both persons from lower occupational classes and persons who were raised in higher occupational classes but ended up in lower occupational classes were shown to have a higher risk for hypertension than persons from higher occupational classes. In a ten-year follow-up study of the influence of socioeconomic factors and blood pressure status, Matthews et al. (2002) found that the risk for essential hypertension was...

Job Stress and Strain and Blood Pressure

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 to which the employee controls or makes decisions regarding work outcome. Jobs that involve considerable psychological demands on the worker accompanied by very little control are characterized as having high job strain (Karasek, 1979). Interestingly, Karasek chose to use the term 'strain' to refer to these stimulus characteristics of an individual's job. To remain true to the original usage of stress and strain in physics, Selye (1956) should have probably used the term 'strain' to discuss the physiological response components to stress and Karasek should have probably used the term 'stress' to refer to the stimulus characteristics of the job. Regardless of his choice of terms, Karasek hypothesized...

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 interpersonal relationships tended to develop essential hypertension. In contrast to the Negative Affect Hypothesis which focuses upon the intensity of the emotional experience, the Suppressed Hostility Hypothesis centers around the expression of presumably normal anger ex Evidence supporting the Suppressed Hostility Hypothesis of essential hypertension has been derived from several bodies of literature (see Diamond, 1982), including psychodynamic evaluations of personality characteristics of essential...

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 not accompanied by reinforcement extinguish and are not retained in an individual's behavioral repertoire. Extrapolating from work on instrumental conditioning, Dworkin postulated that involuntary physiological responses of an organism were subject to the same learning principles as the voluntary responses typically employed in studies of instrumental conditioning. According to his perspective, elevated blood pressure could be maintained, even if associated with distal negative effects on health,...

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 purposes, let's refer to the condition as isolated clinic normotension to be consistent with the terminology used to describe isolated clinic hypertensive patients. Prior to the advent of reliable ambulatory technologies, physicians were unaware that isolated clinic normotension existed. It was simply assumed that patients who had normal blood pressure values in the clinic also maintained these normal values during daily life. This assumption, however, turned out to be incorrect. Although the...

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 the acute stress response contains the maladaptive behavioral strategy. Although any number of interpersonal behaviors could be examined with respect to this approach, almost all studies exploring differences in interpersonal behaviors between hypertensive and normotensive persons have focused on the array of behaviors evoked in response to confrontation. Early investigations of behavioral responses to confrontation provided some support for the hypothesis that hypertensive patients exhibited...

Euroform Appleton Employment

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. al'Absi, M., and Wittmers, L. E. (2003). Enhanced adrenocortical responses to stress in hypertension-prone men and women. Annals of Behavioral Medicine, 25, 25 33. Albright, C. L., Winkleby, M. A., Ragland, D. R., Fisher, J., and Syme, S. L. (1992). Job strain and prevalence of hypertension in a biracial population of urban bus drivers. American Journal of Public Health, 82, 984 989. Alexander, F. (1939). Emotional factors in essential hypertension. Psychosomatic Medicine, 1,175 179. allhat Officers and Coordinators for the allhat Collaborative Research Group (2000). Major cardiovascular events in hypertensive patients randomized to doxazosin vs. chlorthalidone. The Journal of the American Medical Association, 283,1967 1975. allhat Officers and Coordinators...

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. Although there have been reports of hypertensive patients showing marked reductions in blood pressure with supportive or psychoanalytic therapies (Moses, Daniels, and Nickerson, 1956 Reiser Because of the perceived importance of the sympathetic nervous system in the etiology of essential hypertension, the vast majority of studies examining psychological interventions aimed at lowering blood pressure have focused on interventions that were thought to alter sympathetic nervous system functioning. These...

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 lowering blood pressure have typically used samples of hypertensives without regard to the quality of their pre-treatment stress management skills (like the inclusion of patients already equipped with a broad array of stress management skills). Presumably, for many interventions that are matched with important individual characteristics, outcomes for treatment as well as prevention programs could be enhanced. From this perspective, reductions in blood pressure might not be expected for an obese...

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 hypertension may be associated not only with exaggerated heart rate and blood pressure reactions, but also with a failure to show a steady cardiovascular recovery after the task period is over. Supporting this hypothesis, Rutledge, Linden, and Paul (2000) demonstrated that measures of both cardiovascular reactivity and recovery predicted blood pressure levels during an ambulatory recording period, and that cardiovascular recovery was actually a better predictor of blood pressure status than...

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 nor-motensives, then these behaviors may be important in understanding how environmental stressors lead to hypertension. Alternatively, other investigations have focused on specific behavioral responses of hypertensive patients during stressful interpersonal encounters (Baer et al., 1980 Morrison, Manuck, and Bellack, 1985). If individuals who employed these acute behavioral responses to interpersonal stress progressed to chronic hypertensive states, and those who chose more adaptive behavioral...

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 have employed self-report methods of assessment without obtaining concomitant measures of defensiveness. It is difficult to interpret results from these studies, knowing that some hypertensive patients have been shown to exhibit defensive response styles. Even with Franklin, the ob servation that his self-reported measure of anger and anger expression increased with anger management treatment was thought to be associated with defensiveness that was evident during the pre-treatment assessment....

Renin Dysregulation

Expressing a related theoretical perspective, Laragh (1983) hypothesized that the stress-hypertension relation can also be explained by kidney function. Although he concurred that for some hypertensive patients, sodium retention leads to increases in blood pressure through expanded blood volume, as Guyton (1977) suggested, he proposed a second route to establishing high blood pressure. Rather than a dysregulation of fluid retention and blood volume, Laragh (1983) argued that this second pathway involved a dysregulation of the renin-angiotensin-aldosterone system. According to this theoretical perspective, plasma renin activity, which normally decreases in response to elevated blood pressure, remains elevated in some hypertensive patients as a result of an overactive sympathetic nervous system. Support for the existence of this subgroup of essential hypertensive patients was confirmed by Esler et al. (1977), who found that blood pressure normalized among high-renin hypertensives when...

Vascular Hypertrophy

Although one could conclude from the positions espoused by Guyton (1977) and Laragh (1983) that two subtypes of essential hypertension exist, namely, volume dependent and high-renin subtypes, another theoretical perspective has focused directly on vascular factors (Folkow, 1983). Avoiding kidney function entirely, Folkow theorized that hypertension resulted primarily from blood vessel hypertrophy caused by repeated cardiac output responses to acute environmental stressors. In a sense, the vascular change occurred in an effort to protect the capillaries downstream by limiting the elevated arterial pressure-laden blood flow. These enlarged blood vessels infringe into the lumen of the artery interfering with normal blood flow, leading to increased blood flow resistance and arterial pressure. Furthermore, vessels exposed to chronic elevations in blood pressure have been shown to exhibit a reduction in external diameter, through a process known as vascular remodeling, leading to even...

Insulin Resistance

In recent years, essential hypertension, in conjunction with several other physiological parameters (glucose intolerance, upper-body obesity, elevated triglycerides), has been shown to be related to insulin resistance. The combination of these variables has been called the insulin resistance syndrome or Syndrome X (Reaven, 1988). Insulin resistance is commonly cited as a causal agent for Type II diabetes. In contrast to Type I diabetes, which is characterized by the body's lack of insulin production, normal or even enhanced amounts of insulin are typically available in Type II diabetes the insulin receptors, however, are insensitive to insulin. It is generally thought that insulin resistance represents an adaptive bodily response to prevent additional weight gain that accompanies unhealthy lifestyles and dietary practices. Under conditions of extreme insulin resistance, an overabundance of sugars and lipids remains in the bloodstream rather than being absorbed into body tissue....

State Anger

Anger represents another measure of negative affect that is quite different from anxiety, but could also be involved in the stress-hypertension relation. Although both anxiety and anger involve activation of the sympathetic and somatic nervous systems, the cognitive and behavioral responses typically seen to anger-evoking incidents can be easily differentiated from those observed for anxiety. Anger typically involves an appraisal of intentional threat or goal blockage from an environmental encounter or situation. Although the perceived threat could be aimed at one's physical well-being (physical altercation following a traffic mishap), it is also possible to experience anger in response to perceived threats to social status, self-esteem, and psychological well-being (being the target of a racial slur). In this regard, persons can experience comparably intense anger responses to being criticized in public and being threatened with bodily harm. Behaviorally, the expe rience of anger can...

Lifestyle Factors

Although a number of lifestyle factors are associated with risk for essential hypertension (sedentary lifestyle, excessive alcohol consumption, high-sodium diet Kaplan, 2002), in order to consider these factors in explaining how stress leads to hypertension, it is important to demonstrate that individuals who respond to environmental stress by engaging in these lifestyle factors are more likely to develop essential hypertension than individuals who respond to stress using more adaptive strategies. Unfortunately, studies of this type are not routinely reported in the literature. Although we recognize that these lifestyle factors are associated with an increased risk for essential hypertension, the available evidence suggests that this increased risk might be independent of exposure to stress. For example, many people who consume high-sodium diets, drink alcohol, and exercise infrequently may maintain these behaviors during periods of stress as well as during periods of relaxation. In...

Perception of Pain

Although one might wonder what hypertension could possibly have to do with the experience of pain, there is actually a fairly consistent body of evidence demonstrating that essential hypertensive patients or persons with elevated blood pressures, in contrast to nor-motensive controls, have significantly greater pain tolerance and lower ratings of pain (Bruehl, Carlson, and McCubbin, 1992 Sheps et al., 1992 Zamir and Shuber, 1980). These findings have been very consistent across a range of pain-inducing stimuli, including electrical stimulation of tooth pulp (Zamir and Shuber, 1980), thermal pain (Sheps et al., 1992), and finger pressure pain (Bruehl et al., 1992). Comparable associations have also been observed between pain perception and ambulatory measures of blood pressure (Guasti et al., 1995 1999).

Summary

Individuals respond to stress in a variety of ways, only some of which place them at risk for developing chronic health problems like essential hypertension. Although variability exists in the magnitude of acute affective responses to stress, there is very little evidence to link either state anxiety or state anger responses to stress to onset of essential hypertension. For the most part, persons who develop hypertension exhibit the same magnitude of state anxiety and state anger responses to stress as persons who live out their lives without developing hypertension. Furthermore, blood pressure increases that have been observed during episodes of anxiety or anger quickly return to normal levels when the emotion-laden period passes. Both lifestyle behaviors and interpersonal behaviors have been identified as potential acute behavioral stress responses that differentiate hypertensive from normotensive patients. Although lifestyle factors are related to onset of hypertension, they are...

Genetic Factors

It is well established that essential hypertension runs in families (Hunt, Williams, and Barlow, 1986), leading to considerable research examining potential genetic contributions to the onset of essential hypertension, including twin studies, adoption studies, the selective breeding of animals (SHR, Dahl salt-sensitive rats, and BHRs, as discussed in Chapter 4), and genetic engineering research (see Hamet et al., 2002). According to this body of research, from 30 to 50 percent of the variance of essential hypertension is inherited and the mode of inheritance for the maj ority of cases is polygenic in origin (Dominiczak et al., 2000). Furthermore, it appears that multiple gene combinations exist that lead to essential hypertension. Therefore, it seems that no single genetic constellation accounts for all cases of essential hypertension. This is certainly the case among the various inbred rat strains that have served as animal models. Although differing genetic constellations were...

Twin Studies

Turner and Hewitt (1992) reviewed evidence from ten studies comparing the cardiovascular responses to stress of identical or monozygotic (MZ) twins and fraternal or dizygotic (DZ) twins. Although this group of studies was limited by small sample sizes, the authors concluded that cardiovascular reactivity to stress was 'moderately heritable.' Although a range of heritability estimates have been reported among these studies, the heritability estimate of .48 by Carroll et al. (1985) represents a solid median estimate considering the range of samples and stressors employed in these studies. Furthermore, the estimated heritability for heart rate response to mental arithmetic of .50 between mid-child and mid-parent approximates this value (Ditto, France, and Miller, 1989), suggesting that it represents a good estimate of the portion of variance of cardiovascular response to stress explained by genetic factors. In sum, although far from conclusive, heritability estimates of cardiovascular...

Ethnicity

Among the various ethnic groups living in the United States, incidence of essential hypertension is highest among black Americans, with blacks exhibiting at least a two times greater risk than whites and most other ethnic groups (Kaplan, 2002). One of many studies that have supported this finding is the cardia study, a multi-site longitudinal investigation of over 5000 young adults conducted in the 1980s. Congruent with other findings, the cardia investigators reported significantly higher blood pressures among black than white young adult men and women (Liu et al., 1989). However, these authors noted that several lifestyle factors that differed between blacks and whites accounted for much of the observed blood pressure difference, including body mass index, fitness, and use of cigarettes and alcohol. Therefore, it is important to consider differences in these lifestyle variables when examining ethnic differences in blood pressure status, as they appear to interact with ethnicity to...

Smoking

Ingestion of nicotine, one of many psychoactive ingredients in tobacco, results in acute increases in blood pressure that are maintained during smoking but decrease following smoking cessation (Verdecchia et al., 1995). Research on the more enduring effects of smoking on essential hypertension, however, have yielded mixed findings. In some studies, smokers have higher ambulatory blood pressures than non-smokers (Poulsen et al., 1998) yet in other studies, smoking is associated with lower daily blood pressures (Mikkelsen et al., 1997). Although evidence for smoking as a risk factor for essential hypertension is not as strong as some other established risk factors (for example, obesity or sodium consumption), it is well known that smoking represents a major risk factor for coronary heart disease in conjunction with essential hypertension and high cholesterol.

Alcohol Consumption

It is well known that consumption of alcohol is associated with increased risk for essential hypertension, even though light drinking has been shown to be associated with reduced risk for coronary heart disease (Thun et al., 1997). In general, the most recent data suggest that the relation between alcohol consumption and blood pressure is a linear one, with increased alcohol consumption associated with increases in blood pressure (Puddey et al., 1997), although some earlier reports positing a J-shaped relation have been cited, in which slight increases in incidence of high blood pressure occur with total abstinence (Shaper, Wannamethee, and Whincup, 1988). Reductions in alcohol intake are typically associated with reductions in blood pressure within a week or two (Puddey et al., 1997). Given that alcohol consumption is associated with higher blood pressures, what is the relation between alcohol consumption and acute physiological responses to environmental stress There is evidence...

Caffeine Consumption

Although ingestion of caffeine has been shown to be associated with acute increases in blood pressure, the long-term relation between caffeine use and essential hypertension is far from established (Myers, 1988). Some studies have found chronic consumption of caffeinated beverages to be associated with increases in casual blood pressures (Jee et al., 1999 Savoca et al., 2004), while others have reported lower Although the relation between caffeine consumption and essential hypertension has yet to be established, several investigators have examined the relation between caffeine use and cardiovascular response to mental stress. In general, studies comparing acute cardiovascular responses to mental stress between participants given caffeine versus placebo have revealed that administration of caffeine results in elevated blood pressure responses to stress (France and Ditto, 1988 Lane and Williams, 1985 Pincomb et al., 1987). Even Henry and Stephens (1980) reported that administration of...

Social Support

A coping strategy employed by a significant number of individuals as they confront stressors in their lives is to rely on social support. Unlike some of the other hypothesized individual difference variables associated with the stress-hypertension relation, the lack of social support has broad evidence of importance as predictor not only for coronary heart disease and stroke (Rozanski et al., 1999), but also for other causes of mortality (see Cohen and Syme, 1985). There are two general methods for assessing an individual's social support structural and functional (Uchino et al., 1996). Structural measures typically assess size of social network, number of persons living in the household, or number of people interacting with the respondent on a daily basis. However, it is well known that the quality of these interactions varies, from warm, supportive relations with loved ones to aggravating exchanges with less desirable individuals, like a nagging spouse or a hostile boss. Functional...

Religious Support

Seeking support and comfort from one's religious beliefs is another coping strategy that has been associated with blood pressure status. A number of studies have shown that higher levels of religious involvement are associated with lower blood pressures (Graham et al., 1978 Hixson, Gruchow, and Morgan, 1998 Larson et al., 1989). In particular, religious coping has been associated with lower ambulatory blood pressures among blacks more than whites (Steffen et al., 2001). One coping element often associated with religiosity, the ability to engage in forgiveness, has also been associated with lower blood pressures as well as more rapid blood pressure recovery following recollection of an interpersonal betrayal (Lawler et al., 2003). Although studies examining the relation of religiosity to cardiovascular response to stress have yet to be conducted, emerging evidence linking forgiveness with lower cardiovascular reactions has already been reported (Lawler et al., 2003 Witvliet et al.,...

Table 7 I Continued

And Essential Response to Hypertension Stress ter. As with the constitutional and lifestyle factors, there is evidence of many significant interactions among psychological and social variables. Not only are there interactions among the variables presented in this chapter there is also evidence that psychological and social variables interact with the constitutional and lifestyle variables presented in Chapter 6. Therefore, a wide range of individual difference variables needs to be considered in predicting who will or will not develop hypertension in response to living a stress-filled life. Three different psychological hypotheses have been proposed that represent individual difference variables that influence the stresshypertension relation the Negative Affect Hypothesis, the Suppressed Hostility Hypothesis, and the Emotional Defensiveness Hypothesis. There is some evidence supporting a role for each of these. Although the specific measure of negative affect varies from study to...

Prevention Programs

In contrast to pharmacologic interventions that are used primarily with essential hypertensive patients, prevention efforts have largely focused on non-pharmacologic community-based programs. In establishing guidelines for the prevention of hypertension, the Joint World Health Organization International Society of Hypertension Meeting (1992) identified several targeted goals for preventing hypertension worldwide, including weight control, increased physical exercise and potassium intake, reduction in alcohol and sodium consumption, consumption of a prudent diet, and reduction in psychosocial stress. According to these guidelines, incidence of essential hypertension would be considerably reduced if individuals would engage in these lifestyle changes. In fact, population-based studies have shown decreased incidence of hypertension when several of these lifestyle factors are changed (National High Blood Pressure Education Program Working Group, 1993). In particular, there is compelling...

Concluding Remarks

The next decade promises to bring us closer to a more definitive understanding of the link between stress and essential hypertension. It is already certain that the relation between stress and essential hypertension is not simple or direct, and that multiple etiologic factors need to be considered when explaining how a psychological construct like stress can result in the disturbed blood pressure regulation seen in essential hypertension. Optimal assessment strategies aimed at identifying the unique predictors of increased risk for hypertension on a case-by-case basis need to be devised and tested so they may be applied in clinical settings to facilitate the accurate diagnosis of hypertension as well as effective treatment planning. The literature examined in this book suggests that at least some essential hypertensive patients develop blood pressure regulation problems based upon exposure to environmental stressors and the patterning of their associated acute stress responses....

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 what was originally termed the 'mosaic' theory of hypertension proposed by Page in 1967. According to this perspective, no individual physiological mechanism explains all cases of essential hypertension by itself, and each hypothesized physiological component represents a different piece of the mosaic of causes. In this regard, the vasculature, kidneys, sympathetic nervous system, baroreceptors, renin-angiotensin-aldosterone system, and insulin resistance interact with one another in sometimes...

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 by a full array of physiological symptoms associated with sympathetic and somatic nervous system arousal, including increased heart rate, sweating, shortness of breath, muscle tension, and disturbances of the gastrointestinal system. The discomfort associated with the experience of these cognitive and somatic symptoms of anxiety often leads to behavioral escape or avoidance responses (for example, I feel ill and need to go home). Although anxiety is a normal emotion to experience in situations...

Series Foreword

Essential hypertension is of epidemic proportions worldwide and is a key contributor to heart disease and stroke. The prevalence rates vary widely across cultures and groups (e.g., ethnic, socioeconomic strata) within a country. Stress plays a significant role in the development and exacerbation of hypertension. Both hypertension and stress are of interest in part because of their relation to a surprising array of areas of functioning including obesity, alcohol use, diabetes, physical activity and exercise, anxiety, work, and interpersonal relationships. This book provides an excellent review of the current status of research on both stress and hypertension, with excellent excursions into the other topics. Hypertension encompasses intricate pathways involving biochemistry, genes and proteins, and brain and other organ regulation. Dr. Kevin Larkin has presented these complex topics in a way that is engaging and informative. This excellent style is continued throughout as he addresses...

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 the older age groups, demonstrating perhaps the effect of chronic exposure to high salt intakes. In another line of research, sodium restriction has been shown to be reliably associated with reductions in blood pressure (Cutler, Follman, and Alexander, 1997), providing further confirmation of the strong association between sodium intake and blood pressure status. Despite the consistent findings relating sodium intake to blood pressure status, there is evidence to suggest that blood pressure...

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 relation between blood pressure and gender is clearly age-related. In general, males and females have comparable blood pressure levels in childhood and early adolescence. However, blood pressures in men begin to become higher than in women in mid-adolescence and remain that way until ages in the late 50s (National Center for Health Statistics, 1977). Furthermore, because smaller body sizes are associated with higher heart rates and males are typically larger than females, mean resting heart rates...

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 mobility and social disapproval), it is unknown whether these types of stressors place the obese patient at any greater risk for hypertension than obese patients not exposed to stressful life events. Furthermore, very little is known about the relation between obesity and cardiovascular response to stress. Putnam and Rennert (1984) compared cardiovascular responses of obese and normal-weight women to a mental arithmetic task and found that heart rate responses were significantly higher among the obese...

More Products

Blood Pressure Protocol
Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook