Stress and Essential Hypertension

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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 for the relation between stress and hypertension, the model of stress depicted in Figure 3.3 can be applied specifically to the condition of essential hypertension. An application of this model to essential hypertension, shown in Figure 4.1, serves as the foundation for research presented in this chapter and the three

Figure4.1. The comprehensive model of stress as it applies to essential hyperten sion.

Figure4.1. The comprehensive model of stress as it applies to essential hyperten sion.

chapters that follow. In this chapter, we will consider research supporting a link between environmental stressors and essential hypertension. In Chapter 5, we will examine research supporting various elements of the acute stress response that may mediate the relation between environmental stressors and essential hypertension, most importantly the physiological responses of heart rate and blood pressure reactivity to stress. Then, in Chapters 6 and 7, we will examine individual difference variables that influence the magnitude and patterning of the acute stress response that presumably leads to the development of essential hypertension.

The model linking stress with essential hypertension shown in Figure 4.1 is quite similar to several existing models (for example, see Beilin, 1997, Jorgensen et al., 1996, and Pickering, 1997), in that all recognize that the relation between stress and essential hypertension is not simple or direct. There are multiple intervening variables that need to be measured and tested regarding their roles in the stress-hypertension relation. Because of the numerous organ systems involved in blood pressure regulation, it is quite likely that multiple etiologic pathways exist that lead to the onset of essential hypertension, and the search for the single cause of the medical condition is misguided. The present model recognizes the potential multiple pathways to essential hypertension as well as the variety of intervening variables that influence disease onset. Additionally, this model, as well as previous models, recognizes the bidirectional relation among many intervening variables. For example, in the model presented in Figure 4.1, both the acute stress response and physiological changes that maintain elevated blood pressure result from stress in addition to contributing to the level of stress an individual experiences. Jorgensen et al. (1996) proposed a more complicated syner-gistic model suggesting that individual difference personality variables were linked bidirectionally to all other components of the model, including stressors, acute stress responses, and the physiological changes that maintain elevated blood pressure. Although these synergistic relations may indeed exist, the model presented in Figure 4.1 provides a useful structure for organizing the results from empirical research presented in the next several chapters. Regardless of the exact directionality of the proposed linkages in these various models, all models highlight the importance of individual difference variables in determining who will or who will not develop essential hypertension. Before we consider the research examining the role of various intervening variables in explaining the onset of hypertension, however, it is important to examine evidence for the fundamental stress-hypertension relation.

Research Linking Stress and Essential Hypertension

Since the 1900s, a variety of studies have been conducted to examine the relation between stress and essential hypertension. Although it is beyond the scope of this book to review each of these in detail, representative studies that have explored this association will be presented. These can be categorized into several different types: studies of major life event stressors, studies of job stress and strain, studies contrasting prevalence of hypertension in cultural regions characterized by differential levels of stress, and animal research linking stress and hypertension.

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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