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 examine this question further, Sapira et al. (1971) exposed a group of hypertensive patients and normotensive controls to videotape segments of two doctor-patient interactions, one characterized as a 'rude' doctor and the other as a 'warm' doctor. Hypertensive patients exhibited greater blood pressure and heart rate responses to the filmed segments than the normal blood pressure controls. But in contrast to the normotensives, who were able to detect differences between the rude and warm doctors, the hypertensive patients reported observing no differences between the two doctors. Sapira et al. argued that hypertensive patients perceived information differently from normoten-sives, particularly information pertaining to conflict and confrontation. Because they reported no detectable differences between rude and warm doctors, the hypertensive patients would have had no conscious reason to evaluate the rude doctor negatively, and perhaps effectively avoided potential conflict or confrontation that might have occurred if they acknowledged the patient was being treated poorly. As such, hypertensives were shown to process information differently from their normotensive counterparts.
Linden and Feuerstein (1983) examined responses of hypertensive and normotensive patients during both high-distress and low-distress role-play scenarios. Although they observed no overt behavioral differences between groups, hypertensive patients showed greater SBP reactions during the role-play scenarios than normal blood pressure controls. The fact that the physiological reactions of untreated hypertensive patients were elevated without corresponding increases in self-reported distress during the interactions lends credence to the hypothesis that hypertension is associated with a 'repressive-defensive cognitive style.' In other words, although hypertensive patients experienced more arousal during the interactions, they denied feeling any more distressed than the normotensive controls.
In yet another early study comparing cognitive reactions of hypertensive and normotensive patients, Weiner, Singer, and Reiser (1962) found that hypertensives responded to the presentation ofThe-matic Apperception Test cards with avoidance of emotional content more than normotensive volunteers or patients with peptic ulcers. Although hypertensives actively resisted efforts from the test examiner to consider the emotional content of the stimuli, when they were forced to explore the emotional content, increased blood pressure responses were observed. In a study comparing hypertensive and normotensive patients, Handkins and Munz (1978) found that self-reported ratings of stress varied directly with the level of intimacy of the personal topic being discussed among normotensives. However, no relation between ratings of stress and levels of intimacy regarding the topic were observed among hypertensives, suggesting that hypertensives 'denied' emotional content of the topic as well as concealed emotion-laden topics from the interviewer. Congruent with other studies examining how hypertensives react to stress cognitively, these findings suggest that hypertensives resist efforts to report emotion-laden material, perhaps recognizing that should they engage the emotional content, they will exhibit maladaptive increases in blood pressure.
In a study that explored the correspondence between hypertensive status and coping with the experience and expression of the emotions during an interview (Knox et al., 1988), normotensives were shown to express sorrow to others more frequently than hypertensives, and their expressions of sorrow were qualitatively better at attaining instrumental support from others. Additionally, normotensives reported experiencing joy more often than hypertensives. These findings also support the hypothesis that hypertensive patients engage in emotional content much less than normotensives.
Although studies that have explored the cognitive responses of essential hypertensive patients have used a variety of different methodologies, there is a consistent finding that high blood pressure is related to a reluctance to acknowledge the aversive or negative elements of a social interaction or the experience of an emotional state. As such, hypertensives, in contrast to normotensives, appear to screen out emotion-laden experiences. Conceptually, this protective cognitive style may serve the function of preventing exaggerated physiological re sponses to stress that would be sure to occur if the situation was appraised as threatening. Because no prospective studies have examined this tendency, however, no definitive conclusions can be drawn regarding the causality of this association. It is entirely possible, and quite likely, that these cognitive response differences between hypertensive and normotensive patients are a consequence of hypertension rather than being involved etiologically.
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