Diminished pulse pressure under mental stress characterizes normotensive adolescents with parental high blood pressure

Early Antecedents of Adult Work Stress: Social-Emotional Competence and Anger in Adolescence

We hypothesized that youth with elevated coronary heart disease (CHD) risk who exhibit diminished social-emotional competence and frequent anger in adolescence experience increased occupational stress after becoming adults. Perceived job control and support from coworkers in 57 young Black and White men and women were regressed on measures of social problem-solving skill (SPS) and anger arousal (AR) obtained 5 years earlier when participants were in high school. In models controlling for grade point average (GPA), SPS and GPA independently predicted coworker support in adulthood; anger in high school predicted diminished job control. These findings suggest that occupational stress may have identifiable social-emotional antecedents early in life.

Cardiovascular reactivity and family history of hypertension: A meta-analysis

A regression-based meta-analysis examined the degree to which the effects of a family history of hypertension on cardiovascular reactivity are moderated by the magnitude of cardiovascular responses elicited in challenge/task conditions. Mean change scores for negative family history groups were regressed on mean change scores for positive family history groups. The slopes of separate regression lines obtained for systolic and diastolic blood pressure and heart rate were significantly less than 1.0 and the y-intercepts for these regression lines were significantly greater than zero. This pattern indicates that family history differences in cardiovascular reactivity to stress are greatest in situations that elicit the smallest baseline-stressor change scores in non-family-history groups.

Agonistic Interpersonal Striving: Social-Cognitive Mechanism of Cardiovascular Risk in Youth?

The social competence model (SCM) of cardiovascular disease (CVD) risk identifies combinations of goal-oriented strivings, expressive behaviors, and social skill deficits that contribute to persisting interpersonal difficulties and chronic health-damaging stress in youth. SCM hypotheses were tested on 187 Black and White adolescents who completed the Social Competence Interview (SCI) and later underwent ambulatory blood pressure (ABP) monitoring. Cluster analyses of stress narratives assessed via SCI identified 3 predicted stress profiles: agonistic (interpersonally focused), transcendent (self-development focused), and avoidant. Group comparisons using social, hemodynamic, and ABP data supported the SCM hypothesis that youths who exhibit the agonistic striving profile display diminished social competence, negative social impact, and heightened cardiovascular responding during a stress interview, and elevated ABP during normal social interactions, thus suggesting higher risk of CVD.

Parental history of hypertension and cardiovascular responses to behavioral stress in young black women

Beta-adrenergic sympathetic nervous system (SNS) hyperresponsivity to behavioral stress may play a role in the onset of sustained high blood pressure--particularly in persons with a parental history of hypertension. Although hypertension is extremely prevalent among blacks, the association between parental history of hypertension and cardiovascular hyperresponsivity has not been explored in this group. The present study examined the influence of parental history of hypertension on cardiovascular stress reactivity in a group of young black females. Contrary to previous findings with whites, black subjects with a parental history of hypertension exhibited significantly smaller systolic blood pressure and forearm blood flow increases, and moderately smaller diastolic blood pressure increases to the task. Parental history subjects also exhibited slower heart rates throughout each experimental condition. The results suggest that blacks at risk from hypertension may not exhibit the beta-adrenergic hyperresponsivity to behavioral stress observed in whites. These results may suggest that beta-adrenergically mediated hyperresponsivity may be less involved in the development of hypertension among blacks.

Effects of psychological distress on blood pressure in adolescents

This cross-sectional survey measured relationships among blood pressure and measures of psychologic distress, family structure, and economic status in a sample of adolescents exposed to Hurricane Hugo. Spielberger's Anger Scale and Derogatis' Brief Symptom Inventory were used. Data analysis revealed 5% of the 1079 adolescents were hypertensive. Multiple regression analyses revealed the following predictors of higher diastolic blood pressure: African-American race, recipient of subsidized lunch, exposure to Hurricane Hugo, and higher anger-in scores in males. The effects of a catastrophic event such as a hurricane on blood pressure and the effects of introjected anger have implications for both health care consumers and providers.

Role of cardiovascular reactivity to mental stress in predicting future hypertension

Hypertension (HT) has been known since times immemorial to be one of the major causes of morbidity and mortality. It contributes to atherosclerotic cardiovascular disease, increasing its risk 2-3 times and is also associated with dyslipidemia, insulin resistance, glucose intolerance and obesity (1). The age of onset of hypertension is now earlier than before, making it essential that early detection of people who could be future hypertensives is done. Therefore, cardiovascular reactivity to stress in predicting future hypertension becomes important. In this fast paced age most people are exposed to mental stress which is the most common and prevalent form of stress. Increase in blood pressure (BP) in response to emotional arousal is well known, but support for this hypothesis of reactivity in predicting future hypertension is limited. We are attempting here to put forth a review of the various endeavours done so far to support this hypothesis.

An historical and critical review of the articles on blood pressure published in Psychosomatic Medicine between 1939 and 1997

Between 1939 and 1997, there have been 59 volumes of Psychosomatic Medicine. Over this period there were 200 articles dealing with blood pressure. About 90% of these were concerned with high blood pressure. This article reviews all of these papers both from an historical perspective and critically. Although there has been a significant growth in the rate of articles published since 1939, there has always been a strong interest in the nature of hypertension, particularly the roles of affects and emotions in the natural history of the disease. For example, volume 1, number 1 of the Journal includes a symposium on high blood pressure in which Franz Alexander stated his well-known hypothesis that the chronic inhibition of rage plays a causal role in the production of hypertension. In various forms, the notion that anger is an important mediator of hypertension has neither been proved nor abandoned. One major conclusion drawn from this review is that the current research on high blood pressure is drifting somewhat aimlessly. It has become preoccupied with demonstrations that various stimuli or situations (usually characterized as stresses) can acutely raise blood pressure. Despite this focus, neither the necessary nor the sufficient conditions for labeling a stimulus as stress has ever been agreed upon. Likewise, there have been many demonstrations of an iatrogenic effect on blood pressure, but neither the behavioral mechanisms underlying this effect nor the strategies for eliminating it have been explicated. Finally, this article identifies several areas where it would be useful to review and integrate current knowledge. Hopefully, such integrations could play a significant role in focusing and shaping future research and clinical practice.

Cardiovascular reactivity to a naturally occurring stressor: development and psychometric evaluation of a psychophysiological assessment procedure

Three studies were conducted to examine the feasibility, reactive effects of assessment, stability, sampling parameters, and sensitivity of an assessment procedure designed to measure cardiovascular responses to a discrete, naturally occurring, and replicatable stressor--university course examinations. Undergraduate students monitored their blood pressure and heart rate several times during one or two classroom examinations and for several class sessions preceding each examination. Classroom examinations were generally associated with significant increases in subjective measures of distress and cardiovascular measures. Reactive effects of assessment and other sources of error were minimized and responses were reasonably stable over time. These results support the potential utility, validity, and cost-efficiency of this methodology for assessing cardiovascular reactivity to naturally occurring stressors.

Effects of caffeine on pressor regulation during rest and exercise in men at risk for hypertension

Caffeine-induced blood pressure elevations are well documented in habitual consumers, occurring through both vasoconstrictive and cardiostimulatory actions. Whether caffeine hinders pressor regulation during exercise has been uncertain, particularly in those at risk for hypertension. Thus effects of caffeine versus placebo were studied during supine bicycle exercise in healthy men (ages 20 to 35). Hypertension risk was defined during screening: high risk (HRISK) = 135 to 154/85 to 94 mm Hg plus parental hypertension (n = 20); low risk (LRISK) = less than or equal to 132/84 mm Hg and no parental hypertension (n = 14). Exaggerated pressor responses (greater than or equal to 230/100 mm Hg) seen during exercise after placebo identified a subgroup of seven HRISKs indistinguishable at rest from the remaining HRISK men. This subgroup showed a larger resting diastolic response to caffeine (p less than 0.05) than LRISKs and other HRISKs. Compared with placebo, caffeine increased the number of LRISK (0% to 36%) and HRISK (35% to 50%) men reaching abnormal exercise blood pressures, and blunted normal increments in cardiac index at higher workloads among HRISK men (p = 0.05). Thus restriction of caffeine before exercise might benefit persons with either risk for hypertension or unusual sensitivity to caffeine.

Family history of hypertension, gender, and cardiovascular responsivity during stress

The relationships of family history of hypertension and gender to cardiovascular responses to stress were investigated in this research. One hundred twenty-three subjects were monitored while they rested and performed two tasks, reaction time and Ravens progressive matrices. Positive-family history males exhibited higher levels of systolic blood pressure than the negative male group and higher levels of rate pressure product than the positive-family history female group. Positive-family history males also had heart rate levels as high as the females. Female subjects did not differ from each other based on family history. In addition, subjects were grouped by gender and by high- or low-heart rate reactivity. The results suggest that heart rate reactivity has equally broad effects on cardiovascular function for males and females; for males, this reactivity during rests and tasks also tends to be associated with family history of hypertension.

Blood pressure reactivity in children

This paper reviews the relevant pediatric literature about blood pressure (BP) hyperreactivity to stress as a possible precursor of hypertension and coronary heart disease. Two prospective studies of children indicate that BP hyperreactivity predicts later development of hypertension. Several studies have identified correlates of BP reactivity. Race, obesity, Type A and family history of hypertension appear to be associated with BP reactivity in children. There appear to be both genetic and environmental influences, but relatively few psychosocial variables have been studied. There are significant methodological concerns in terms of defining the characteristics of the stressors and the stability and generalizability of responses to laboratory stressors. BP reactivity in children is a potentially important area of inquiry that has been understudied.