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Auer A, von Känel R, Lang I, Thomas L, Zuccarella-Hackl C, Degroote C, Gideon A, Wiest R, Wirtz PH. Do Hypertensive Men Spy With an Angry Little Eye? Anger Recognition in Men With Essential Hypertension - Cross-sectional and Prospective Findings. Ann Behav Med 2022; 56:875-889. [PMID: 35323902 DOI: 10.1093/abm/kaab108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Higher trait anger has inconsistently been associated with hypertension and hypertension development, but social context in terms of recognition of other persons' anger has been neglected in this context. PURPOSE Here, we investigated anger recognition of facial affect and trait anger in essential hypertensive and normotensive men in addition to prospective associations with blood pressure (BP) increases. METHODS Baseline assessment comprised a total of 145 participants including 57 essential hypertensive and 65 normotensive men who were otherwise healthy and medication-free. Seventy-two eligible participants additionally completed follow-up assessment 3.1 (±0.08 SEM) years later to analyze BP changes over time. We assessed emotion recognition of facial affect with a paradigm displaying mixed facial affect of two morphed basic emotions including anger, fear, sadness, and happiness. Trait anger was assessed with the Spielberger trait anger scale. RESULTS Cross-sectionally, we found that with increasing BP, hypertensive men overrated anger displayed in facial expressions of mixed emotions as compared to normotensive men (ps ≤ .019) while there were no differences in trait anger (p = .16). Prospectively, the interaction between mean anger recognition and trait anger independently predicted BP increases from baseline to follow-up (ps ≤ .043), in that overrating displayed anger predicted future BP increases only if trait anger was high. CONCLUSIONS Our findings indicate an anger recognition bias in men with essential hypertension and that overrating displayed anger in combination with higher trait anger seems to predict future BP increases. This might be of clinical relevance for the development and progression of hypertension and cardiovascular disease.
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Affiliation(s)
- Alisa Auer
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany.,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ilona Lang
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Livia Thomas
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Clinical Research, University of Bern, Bern, Switzerland.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Cathy Degroote
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Angelina Gideon
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, and University of Bern, Bern, Switzerland
| | - Petra H Wirtz
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany.,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
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2
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Mann SJ. Neurogenic hypertension: pathophysiology, diagnosis and management. Clin Auton Res 2018; 28:363-374. [DOI: 10.1007/s10286-018-0541-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
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Theorell T, De Manzano Ö, Lennartsson AK, Pedersen NL, Ullén F. Self-reported psychological demands, skill discretion and decision authority at work: A twin study. Scand J Public Health 2016; 44:354-60. [DOI: 10.1177/1403494815626610] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Objectives: To examine the contribution of genetic factors to self-reported psychological demands (PD), skill discretion (SD) and decision authority (DA) and the possible importance of such influence on the association between these work variables and depressive symptoms. Methods: 11,543 participants aged 27–54 in the Swedish Twin Registry participated in a web survey. First of all, in multiple regressions, phenotypic associations between each one of the three work environment variables and depressive symptoms were analysed. Secondly, by means of classical twin analysis, the genetic contribution to PD, SD and DA was assessed. After this, cross-twin cross-trait correlations were computed between PD, SD and DA, on the one hand, and depressive symptom score, on the other hand. Results: The genetic contribution to self-reported PD, DS and DA ranged from 18% for decision authority to 30% for skill discretion. Cross-twin cross-trait correlations were very weak ( r values < .1) and non-significant for dizygotic twins, and we lacked power to analyse the genetic architecture of the phenotypic associations using bivariate twin modelling. However, substantial genetic contribution to these associations seems unlikely. Conclusions: Genetic contributions to the self-reported work environment scores were 18–30%.
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Affiliation(s)
- Töres Theorell
- Department of Neuroscience, Karolinska Institutet, Sweden
- Stress Research Institute, Stockholm University, Sweden
| | | | | | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Fredrik Ullén
- Department of Neuroscience, Karolinska Institutet, Sweden
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Paine NJ, Watkins LL, Blumenthal JA, Kuhn CM, Sherwood A. Association of depressive and anxiety symptoms with 24-hour urinary catecholamines in individuals with untreated high blood pressure. Psychosom Med 2015; 77:136-44. [PMID: 25647750 PMCID: PMC5119914 DOI: 10.1097/psy.0000000000000144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Depression and anxiety are considered risk factors for cardiovascular disease (CVD). The explanatory mechanisms, however, are still to be characterized. One proposed pathophysiological pathway is dysregulation of the autonomic nervous system, including heightened sympathetic nervous system activity. This study examined the relationship between symptoms of depression, anxiety, and sympathetic nervous system activity in individuals with untreated high blood pressure. METHODS A total of 140 participants with untreated high blood pressure (55% white, 38.5% female, mean [standard deviation] age = 45.5 [8.55] years) collected urine over a 24-hour period on 3 separate occasions. Urine samples were assayed for mean 24-hour epinephrine (EPI24) and norepinephrine excretion. Depressive symptoms were assessed using the Beck Depression Inventory, with anxiety symptoms assessed using the Spielberger State-Trait Anxiety Inventory. RESULTS Depression and anxiety scores were intercorrelated (r = 0.76, p < .001). EPI24 was positively correlated with anxiety (r = 0.20, p = .02) but not depression (r = 0.02, p = .77), whereas 24-hour urinary norepinephrine excretion was not correlated with anxiety (r = 0.10, p = .21) or with depression (r = 0.07, p = .39). Regression models, accounting for sex, age, body mass index, race, mean systolic ambulatory blood pressure, tobacco use, alcohol use, physical activity, and sleep efficiency confirmed that anxiety was associated with EPI24 excretion (p = .023) and that depressive symptoms were not (p = .54). CONCLUSIONS Anxiety was associated with heightened sympathoadrenal activity, suggesting a biological pathway through which anxiety could increase CVD risk. Anxiety and depression may confer increased CVD risk via different mechanisms.
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Affiliation(s)
- Nicola J. Paine
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Cynthia M. Kuhn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710 USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
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5
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Ford MT. Perceived unfairness at work, social and personal resources, and resting blood pressure. Stress Health 2014; 30:12-22. [PMID: 23625544 DOI: 10.1002/smi.2491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/08/2013] [Accepted: 03/26/2013] [Indexed: 11/11/2022]
Abstract
By drawing from theoretical perspectives suggesting that unfair conditions threaten fundamental psychological needs, perceived unfairness at work was proposed and tested as a predictor of resting blood pressure. As part of the Midlife Development in the United States Biomarkers project, participants completed questionnaires measuring perceived unfairness, self-esteem and coworker support. Resting blood pressure readings were also recorded as part of a larger physical examination. Results indicate that perceived unfairness at work was associated with higher resting diastolic and systolic blood pressure. Perceived unfairness was most strongly related to diastolic and systolic blood pressure among women with low levels of coworker support. Contrary to predictions, self-esteem did not moderate the association between perceived unfairness and blood pressure. These results suggest that high blood pressure may be a mechanism linking unfairness to negative health outcomes and point to coworker support as a moderator of the perceived unfairness-blood pressure relationship among women. Further research is needed exploring the mediating mechanisms linking unfair treatment at work to blood pressure and health.
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Abstract
BACKGROUND Recent guidelines on cardiovascular disease prevention advocate the importance of psychological risk factors, as they contribute to the risk of developing cardiovascular disease. However, most previous research on psychological distress and cardiovascular factors has focused on selected populations with cardiovascular disease. AIM The primary aim was to determine the prevalence of depression, anxiety, and Type D personality in elderly primary care patients with hypertension. Secondary aim was to examine the relation between elevated systolic blood pressure and depression, anxiety, and Type D personality. DESIGN AND SETTING A cross-sectional study in primary care practices located in the south of the Netherlands. METHOD Primary care hypertension patients (N = 605), between 60 and 85 years (45 % men, mean age = 70 ± 6.6), were recruited for this study. All patients underwent a structured interview including validated self-report questionnaires to assess depression (PHQ-9), anxiety (GAD-7), and Type D personality (DS14) as well as blood pressure assessment. RESULTS AND CONCLUSION Depression was prevalent in 5 %, anxiety in 5 %, and Type D personality in 8 %. None of the distress measures were associated with elevated systolic blood pressure of >160 mmHg (all p-values >0.05). This study showed no relation between psychological distress and elevated systolic blood pressure in elderly primary care patients with hypertension.
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Roohafza H, Sadeghi M, Naghnaeian M, Shokouh P, Ahmadi A, Sarrafzadegan N. Relationship between Metabolic Syndrome and Its Components with Psychological Distress. Int J Endocrinol 2014; 2014:203463. [PMID: 24672543 PMCID: PMC3941148 DOI: 10.1155/2014/203463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 12/26/2013] [Indexed: 01/05/2023] Open
Abstract
Background. Metabolic syndrome (MetS) and psychological distress are hypothesized to have a bidirectional relationship. According to their high prevalence in most populations, appraisal of this theory would be of great clinical and research interest. Methods. Data were available as part of the Isfahan Healthy Heart Program (IHHP). A total of 9553 men and women aged ≥19 years from three counties in central Iran were selected. Measurements consisted of serologic tests, anthropometrics, and self-reported 12-item general health questionnaire. Logistic regression analysis was used to find the association between MetS, MetS components, and distress level. Results. The mean age of 9553 participants (50% male) was 38.7 ± 15.8 years. After adjusting for demographic factors, MetS (OR = 1.25, 95% CI: 1.01-1.37), central obesity (OR = 1.40, 95% CI: 1.15-1.49), and hypertension (OR = 1.55, 95% CI: 1.42-1.70) were associated with high distress level. However, after adding smoking status and low-density lipoprotein cholesterol to the adjustment factors, hypertension (OR = 1.79, 95% CI: 1.53-1.98) and central obesity (OR = 1.41, 95% CI: 1.17-1.55), but not the MetS, remained significantly associated with distress level. Conclusion. The presence of association between the MetS as well as its key components and high distress level signifies the importance of integrating psychological assessment and intervention in the standard management of MetS patients.
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Affiliation(s)
- Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8187698191, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, P.O. Box 81465-1148, Isfahan 8187698191, Iran
- *Masoumeh Sadeghi:
| | - Mina Naghnaeian
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8187698191, Iran
| | - Pedram Shokouh
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8187698191, Iran
| | - Abdollah Ahmadi
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8187698191, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8187698191, Iran
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Xu W, Yu H, Hang J, Gao W, Zhao Y, Guo L. The interaction effect of effort-reward imbalance and overcommitment on hypertension among Chinese workers: findings from SHISO study. Am J Ind Med 2013; 56:1433-41. [PMID: 24038080 DOI: 10.1002/ajim.22254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND No previous studies investigated the interaction of effort-reward imbalance (ERI) and overcommitment on blood pressure. Our aim was to investigate associations of ERI and overcommitment (and their interaction) with blood pressure and hypertension within a Chinese population. METHODS Seven hundred thirty-four participants from the Stress and Health in Shenzhen Workers study completed a demographics, job stressor and risk factor questionnaire, and their blood pressure was measured by mercury sphygmomanometers. Risk factors for blood pressure were analyzed by multiple linear regression and risk factors for hypertension by Poisson regression. RESULTS Overcommitment was associated with diastolic blood pressure after adjustment for confounders and ERI among men (β = 0.17, P < 0.05); ERI was also associated with diastolic blood pressure and systolic blood pressure after adjustment for confounders and overcommitment. High overcommitment (PR 1.91, 95% CI 1.35-2.69), and ERI (PR = 2.47, 95% CI 1.62-3.75) were each associated with risk of hypertension after adjusting for confounders. After adjusting for ERI, the association with overcommitment was no longer significant (PR = 1.24, 95% CI 0.85-1.82) However, after controlling for overcommitment, ERI remained significantly associated with hypertension risk (PR = 2.38, 95% CI 1.53-3.71). When high overcommitment and high ERI was combined, hypertension risk was highest (adjusted PR = 2.99, 95% CI 1.82-4.91, adjusted synergy index 5.85). The interaction was significant when it was tested by an interaction term in the regression (P < 0.001). CONCLUSIONS The interaction effect of overcommitment and ERI on hypertension was independent and synergistic.
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Affiliation(s)
- Weixian Xu
- Department of Cardiology; Peking University Third Hospital and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing China
| | - Haiyi Yu
- Department of Cardiology; Peking University Third Hospital and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing China
| | - Juan Hang
- Department of Cardiology; Peking University Third Hospital and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing China
- Department of Priority; Peking University Shenzhen Hospital; Shenzhen China
| | - Wei Gao
- Department of Cardiology; Peking University Third Hospital and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing China
| | - Yiming Zhao
- Research Center of Occupational Medicine; Peking University Third Hospital; Beijing China
| | - Lijun Guo
- Department of Cardiology; Peking University Third Hospital and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing China
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D'Antono B, Moskowitz DS, Nigam A. The metabolic costs of hostility in healthy adult men and women: cross-sectional and prospective analyses. J Psychosom Res 2013; 75:262-9. [PMID: 23972416 DOI: 10.1016/j.jpsychores.2013.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/24/2013] [Accepted: 05/25/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hostility is associated with altered metabolic activity but little research has examined sex and/or age differences using a global index of metabolic dysfunction or examined different aspects of hostility. METHODS The moderating effect of sex and age on the associations between three aspects of hostility (cynical attitude, angry affect, quarrelsome behavior in daily living) and metabolic burden (number of metabolic parameters in the higher quartile) were evaluated in 188 healthy men and women (M(age)=41; SD=11.34). Three years later, metabolic burden was measured again in 133 participants. RESULTS At study onset, quarrelsome behavior was associated with greater metabolic burden in men and women (Beta=.144; p<.05). After 3 yrs, cynical hostility predicted increased metabolic burden among mid-age and older individuals (b=.013 and .046 respectively; p<.001). CONCLUSION The aspect of hostility that is most closely associated with metabolic burden depends on the age of the participants and whether measures are concurrent or prospective.
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Affiliation(s)
- Bianca D'Antono
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
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Landsbergis PA, Travis A, Schnall PL. Working conditions and masked hypertension. High Blood Press Cardiovasc Prev 2013; 20:69-76. [PMID: 23702576 DOI: 10.1007/s40292-013-0015-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 02/04/2013] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Masked hypertension, i.e., normal clinic blood pressure but elevated blood pressure during normal daily activities as measured by ambulatory monitoring, is a common problem and a serious cardiovascular risk factor. Given previously reported associations between work stressors and ambulatory blood pressure, an inquiry into the relationship between work stressors and masked hypertension is warranted. OBJECTIVE To assess the relationship between working conditions and masked hypertension. DESIGN Cross-sectional study. SETTING Hospital and home care employers in New York City. STUDY PARTICIPANTS Forty-five male and 119 female hospital and home care employee volunteers wore an ambulatory blood pressure monitor during working hours. MAIN OUTCOME MEASURES Masked hypertension was defined as work systolic ambulatory blood pressure ≥135 mmHg or diastolic ambulatory blood pressure ≥85 mmHg, and casual blood pressure <140/90 mmHg with no use of antihypertensive medications. Associations between work stressors and masked hypertension were tested by multiple logistic regression. RESULTS Masked hypertension, observed in 24.0% of males and 17.6% of females with normal casual office obtained blood pressure, was associated with evening, night or rotating shiftwork (odds ratio (OR) 8.25, 95% confidence interval (CI) 2.11-40.31) and with the combination of job strain and effort-reward imbalance (OR 2.97, 95% CI 1.02-8.60) after controlling for age. Associations remained substantial, and statistically significant for shiftwork, after individual adjustment for each of 10 potential confounders. Masked hypertension was not associated with total weekly work hours. CONCLUSIONS Masked hypertension is a significant individual and public health concern. Additional research is needed to clarify the role of work-related risk factors in the development of masked hypertension, and to develop an appropriate clinical and public health strategy for diagnosis, treatment and prevention.
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Affiliation(s)
- Paul A Landsbergis
- Department of Environmental and Occupational Health Sciences, State University of New York-Downstate School of Public Health, 450 Clarkson Ave., Box 43, Brooklyn, NY 11203, USA.
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Landsbergis PA, Dobson M, Koutsouras G, Schnall P. Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am J Public Health 2013; 103:e61-71. [PMID: 23327240 DOI: 10.2105/ajph.2012.301153] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985-2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case-control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions.
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Affiliation(s)
- Paul A Landsbergis
- School of Public Health, State University of New York-Downstate, Brooklyn, NY 11203, USA.
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Rafanelli C, Offidani E, Gostoli S, Roncuzzi R. Psychological correlates in patients with different levels of hypertension. Psychiatry Res 2012; 198:154-60. [PMID: 22386218 DOI: 10.1016/j.psychres.2011.09.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 06/20/2011] [Accepted: 09/17/2011] [Indexed: 11/18/2022]
Abstract
The evidence linking essential systemic arterial hypertension (SAH) with psychological characteristics remains equivocal. The aims of this study were to assess clinical and subclinical distress, psychosocial aspects and psychological well-being in treated hypertensive patients and to evaluate the psychosocial variables associated with higher levels of blood pressure according to guidelines for hypertension management. A consecutive series of 125 hypertensive patients were evaluated using both self- and observer-rated reliable measures. Generalized anxiety disorder, minor depression, demoralization and alexithymia were the most frequent diagnoses. Cluster analysis revealed an association of three distinct symptomatological groups such as the Anxiety-Depression, the Alexithymia and the Somatization groups, with different levels of hypertension. In particular, patients with moderate to severe hypertension were more frequently in the Anxiety-Depression and the Alexithymia groups, whereas the Somatization cluster has been shown to be associated with isolated systolic hypertension. The results provide new insight into the psychosocial characteristics among patients with different levels of SAH according to recent guidelines of the management of hypertension. They also outline the need to monitor the clinical course of hypertensive patients characterized by these specific clinical and subclinical psychological conditions.
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Affiliation(s)
- Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy.
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13
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Factores psicosociales implicados en el control de la hipertensión arterial. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bajkó Z, Szekeres CC, Kovács KR, Csapó K, Molnár S, Soltész P, Nyitrai E, Magyar MT, Oláh L, Bereczki D, Csiba L. Anxiety, depression and autonomic nervous system dysfunction in hypertension. J Neurol Sci 2012; 317:112-6. [PMID: 22425019 DOI: 10.1016/j.jns.2012.02.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 02/11/2012] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study examined the relationship between autonomic nervous system dysfunction, anxiety and depression in untreated hypertension. PATIENTS AND METHODS 86 newly diagnosed hypertensive patients and 98 healthy volunteers were included in the study. The psychological parameters were assessed with Spielberger State-Trait Anxiety Inventory and Beck Depression Inventory by a skilled psychologist. Autonomic parameters were examined during tilt table examination (10min lying position, 10min passive tilt). Heart rate variability (HRV) was calculated by autoregressive methods. Baroreflex sensitivity (BRS) was calculated by non-invasive sequence method from the recorded beat to beat blood pressure values and RR intervals. RESULTS Significantly higher state (42.6±9.3 vs. 39.6±10.7 p=0.05) and trait (40.1±8.9 vs. 35.1±8.6, p<0.0001) anxiety scores were found in the hypertension group. There was no statistically significant difference in the depression level. LF-RRI (Low Frequency-RR interval) of HRV in passive tilt (377.3±430.6 vs. 494.1±547, p=0.049) and mean BRS slope (11.4±5.5 vs. 13.2±6.4, p=0.07) in lying position were lower in hypertensives. Trait anxiety score correlates significantly with sympatho/vagal balance (LF/HF-RRI) in passive tilt position (Spearman R=-0.286, p=0.01). CONCLUSIONS Anxiety could play a more important role than depression in the development of hypertension. Altered autonomic control of the heart could be one of the pathophysiological links between hypertension and psychological factors.
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Affiliation(s)
- Zoltán Bajkó
- Department of Neurology, Mureş County Clinical Emergency Hospital, Târgu-Mureş, Romania.
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Player MS, Peterson LE. Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med 2012; 41:365-77. [PMID: 22238841 DOI: 10.2190/pm.41.4.f] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension, coronary heart disease (CHD), and anxiety disorders all cause substantial morbidity to patients and costs to the healthcare system. Associations between these diseases have been hypothesized and studied for decades. In particular, psychosocial stressors associated with anxiety disorders raise autonomic arousal via the hypothalamic-pituitary axis which increases circulating catecholamines. This heightened arousal is associated with an increased risk of hypertension and a pro-inflammatory state and, consequently, development of coronary heart disease. This association holds across the spectrum of anxiety disorders (generalized anxiety, posttraumatic stress disorder, panic disorder, and obsessive compulsive disorder) and also when controlling for comorbid conditions such as depression and physical ailments. Multiple cross sectional studies reveal a positive association between anxiety and hypertension. These associations are bidirectional, with those with hypertension being more likely to have anxiety and those with anxiety being more likely to have hypertension. However, a few studies have shown no association. Longitudinal studies point to an increased risk of development of hypertension in patients who suffer from anxiety. More convincing studies show links between anxiety symptoms and disorders, including panic disorder and PTSD, and cardiovascular outcomes. Drawing broad conclusions from these studies is challenging, however, given the multiplicity of scales used to measure anxiety disorders. Anxiety, hypertension, and CHD are common conditions seen in primary care, and anxiety may be an important predictor of future CHD outcomes. Better recognition of the association of these conditions and the possible roles of each in development of the other should alert primary care providers to be vigilant in monitoring and treating anxiety, hypertension, and CHD.
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Affiliation(s)
- Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Rosenthal T, Alter A. Occupational stress and hypertension. ACTA ACUST UNITED AC 2011; 6:2-22. [PMID: 22024667 DOI: 10.1016/j.jash.2011.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/30/2011] [Accepted: 09/06/2011] [Indexed: 01/19/2023]
Abstract
Occupational stress, or job strain, resulting from a lack of balance between job demands and job control, is considered one of the frequent factors in the etiology of hypertension in modern society. Stress, with its multifactorial causes, is complex and difficult to analyze at the physiological and psychosocial levels. The possible relation between job strain and blood pressure levels has been extensively studied, but the literature is replete with conflicting results regarding the relationship between the two. Further analysis of this relationship, including the many facets of job strain, may lead to operative proposals at the individual and public health levels designed to reduce the effects on health and well-being. In this article, we review the literature on the subject, discussing the various methodologies, confounding variables, and suggested approaches for a healthier work environment.
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Affiliation(s)
- Talma Rosenthal
- Department of Physiology and Pharmacology, Hypertension Research Unit, Sackler School of Medicine, Tel Aviv University, Israel.
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Pittman CT. Getting mad but ending up sad: the mental health consequences for African Americans using anger to cope with racism. JOURNAL OF BLACK STUDIES 2011; 42:1106-1124. [PMID: 22165423 DOI: 10.1177/0021934711401737] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Anger is a common reaction to stressful life events. However, little is known about anger’s use and efficacy as a coping strategy for racism. Is anger a coping strategy for racism that improves mental health? Or does anger operate in an opposing way, deteriorating mental health? The analyses for this research focused on a probability sample of African Americans who reported experiences of acute (n = 246) or chronic (n = 120) racial discrimination in a survey interview. General linear model results revealed that using anger to cope with racial discrimination negatively affected the general well-being and psychological distress of African Americans. These findings raise concerns about the effectiveness (or lack therefore of) of anger as a common coping mechanism for racism, given the deleterious effects it may have on African Americans’ mental health.
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Pavek K, Taube A. Personality characteristics influencing determinacy of day and night blood pressure and heart rate. Blood Press 2009; 18:30-5. [DOI: 10.1080/08037050902812648] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ogedegbe G, Pickering TG, Clemow L, Chaplin W, Spruill TM, Albanese GM, Eguchi K, Burg M, Gerin W. The misdiagnosis of hypertension: the role of patient anxiety. ACTA ACUST UNITED AC 2009; 168:2459-65. [PMID: 19064830 DOI: 10.1001/archinte.168.22.2459] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The white coat effect (defined as the difference between blood pressure [BP] measurements taken at the physician's office and those taken outside the office) is an important determinant of misdiagnosis of hypertension, but little is known about the mechanisms underlying this phenomenon. We tested the hypothesis that the white coat effect may be a conditioned response as opposed to a manifestation of general anxiety. METHODS A total of 238 patients in a hypertension clinic wore ambulatory blood pressure monitors on 3 separate days 1 month apart. At each clinic visit, BP readings were manually triggered in the waiting area and the examination room (in the presence and absence of the physician) and were compared with the mercury sphygmomanometer readings taken by the physician in the examination room. Patients completed trait and state anxiety measures before and after each BP assessment. RESULTS A total of 35% of the sample was normotensive, and 9%, 37%, and 19% had white coat, sustained, and masked hypertension, respectively. The diagnostic category was associated with the state anxiety measure (F(3,237) = 6.4, P < .001) but not with the trait anxiety measure. Patients with white coat hypertension had significantly higher state anxiety scores (t = 2.67, P < .01), with the greatest difference reported during the physician measurement. The same pattern was observed for BP changes, which generally paralleled the changes in state anxiety (t = 4.86, P < .002 for systolic BP; t = 3.51, P < .002 for diastolic BP). CONCLUSIONS These findings support our hypothesis that the white coat effect is a conditioned response. The BP measurements taken by physicians appear to exacerbate the white coat effect more than other means. This problem could be addressed with uniform use of automated BP devices in office settings.
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Affiliation(s)
- Gbenga Ogedegbe
- Department of Medicine, Columbia University/New York Presbyterian Hospital, New York, New York, USA
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Eguchi K, Schwartz JE, Roman MJ, Devereux RB, Gerin W, Pickering TG. Metabolic Syndrome Less Strongly Associated With Target Organ Damage Than Syndrome Components in a Healthy, Working Population. J Clin Hypertens (Greenwich) 2007; 9:337-44. [PMID: 17485969 PMCID: PMC8109933 DOI: 10.1111/j.1524-6175.2007.06474.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors investigated the associations between target organ damage and individual components of the metabolic syndrome (MS) compared with the MS itself. Carotid intima-media thickness (IMT), carotid plaque, and left ventricular mass index (LVMI) were assessed by ultrasonography in 356 participants who were free of overt cardiovascular disease. Participants with the MS (n=33) had higher LVMI and carotid IMT than those without the MS (n=323), but the percentage of patients who had carotid plaque was similar. Individually, each component of the MS was significantly associated with the 3 measures of target organ damage. In bivariate and multivariate analyses, the association of clinic systolic blood pressure to both LVMI and carotid IMT and the negative association of high-density lipoprotein cholesterol with carotid plaque were stronger than and independent of the MS. The data suggest that physicians should evaluate blood pressure and high-density lipoprotein cholesterol as well as other cardiovascular risk factors without regard to whether a patient meets the criteria for the MS.
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Affiliation(s)
- Kazuo Eguchi
- Center for Behavioral Cardiovascular Health and Hypertension Program, Columbia University Medical Center, New York, NY 10032, USA.
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Clays E, Leynen F, De Bacquer D, Kornitzer M, Kittel F, Karasek R, De Backer G. High Job Strain and Ambulatory Blood Pressure in Middle-Aged Men and Women From the Belgian Job Stress Study. J Occup Environ Med 2007; 49:360-7. [PMID: 17426519 DOI: 10.1097/jom.0b013e31803b94e2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to assess whether job strain is associated with 24-hour ambulatory blood pressure measurements within a subsample of the Belgian Job Stress Project (BELSTRESS) population. METHODS A group of 89 middle-aged male and female workers perceiving high job strain and an equally large group of workers perceiving no high job strain wore an ambulatory blood pressure monitor for 24 hours on a regular working day. RESULTS Mean ambulatory blood pressure at work, at home, and while asleep was significantly higher in workers with job strain as compared with others. The associations between job strain and ambulatory blood pressure were independent from the covariates. CONCLUSIONS Within this study, high job strain was an important independent risk factor for higher ambulatory blood pressure at work, at home, and during sleep in a group of men and women.
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Affiliation(s)
- Els Clays
- Department of Public Health, Ghent University, University Hospital, Ghent, Belgium.
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Đukić B, Stjepanović R, Nežić L. Benzodiazepine prescribing in the family medicine doctor's practice. SCRIPTA MEDICA 2007. [DOI: 10.5937/scrimed0701039q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hozawa A, Ohkubo T, Obara T, Metoki H, Kikuya M, Asayama K, Totsune K, Hashimoto J, Hoshi H, Arai Y, Satoh H, Hosokawa T, Imai Y. Introversion associated with large differences between screening blood pressure and home blood pressure measurement: The Ohasama study. J Hypertens 2006; 24:2183-9. [PMID: 17053539 DOI: 10.1097/01.hjh.0000249695.81241.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the effect of personality on screening blood pressures measured in clinical settings and home blood pressure measurements. METHODS From 1997 to 1999, 699 participants underwent screening and home blood pressure measurements and completed the Japanese version of the short-form Eysenck personality questionnaire. An increased screening blood pressure was defined as screening blood pressure > or = 140/90 mmHg and an increased home blood pressure was defined as home blood pressure > or = 135/85 mmHg. RESULTS Participants with lower extroversion scores (i.e., introversion) showed a greater difference between screening and home systolic blood pressure. The association between introversion and differences was statistically significant, even after adjustment for other possible factors (younger age, female, wide screening pulse pressure, never smoked, and no antihypertensive medication). The adjusted means of SBP differences were 7.3 and 4.4 mmHg among the lowest and highest extroversion quartiles, respectively (P for trend = 0.02). Other personality scores (psychoticism or neuroticism) were not associated with screening and home blood pressure differences. The incorporation of an extroversion score in the basic model consisting of the above factors that affected the difference between screening and home blood pressure slightly improved the prediction of a high home blood pressure. The area under the receiver operating characteristic curve increased by 0.037 among participants with high screening blood pressure and 0.006 for those with normal screening blood pressure compared with the basic model. CONCLUSION Physicians may need to be aware of 'introverted' patients who have high blood pressure in clinic settings, because they have the potential for 'white-coat' hypertension.
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Affiliation(s)
- Atsushi Hozawa
- Department of Health Science, Shiga University of Medical Science, Shiga, Japan.
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Jhalani J, Goyal T, Clemow L, Schwartz JE, Pickering TG, Gerin W. Anxiety and outcome expectations predict the white-coat effect. Blood Press Monit 2006; 10:317-9. [PMID: 16496447 DOI: 10.1097/00126097-200512000-00006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine whether elevated clinic blood pressure compared with daytime ambulatory blood pressure, referred to as the white-coat effect, is associated with anxiety and increased blood pressure expectancy in the doctor's office. METHODS The 24-h ambulatory blood pressure measurements and physicians' blood pressure measurements were obtained in 226 normotensive and hypertensive study participants. Anxiety levels were assessed multiple times during the clinic visit using a Visual Analog Scale. Participants' expectations regarding the clinic visit were assessed using a six-item scale (Expectations of Outcomes Scale). The white-coat effect was computed as the difference between the mean clinic blood pressure and the mean daytime ambulatory blood pressure. Multiple regression analysis was performed to examine the association between anxiety, outcome expectations and the white-coat effect, adjusting for age, sex, and ambulatory blood pressure level. RESULTS As predicted, outcome expectations and anxiety during the clinic visit were significantly associated with the white-coat effect. Results of the regression analysis indicated that only expectancy had an independent effect on the systolic white-coat effect; however, both anxiety and expectancy had independent effects on the diastolic white-coat effect. CONCLUSION Our results provide empirical support to the hypothesis that anxiety and blood pressure expectancy may elevate clinic blood pressure.
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Affiliation(s)
- Juhee Jhalani
- Columbia University Medical Center, 622 West 168th Street, PH-9, New York, NY 10032, USA.
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Clark R, Benkert RA, Flack JM. Violence exposure and optimism predict task-induced changes in blood pressure and pulse rate in a normotensive sample of inner-city black youth. Psychosom Med 2006; 68:73-9. [PMID: 16449414 DOI: 10.1097/01.psy.0000195744.13608.11] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This investigation examined the association of violence exposure (home and neighborhood) and optimism to task-induced changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR). METHODS Drawn from a larger investigation, the convenience sample for this study consisted of 172 normotensive black youth (mean age = 11.5 years, standard deviation = 1.3). Violence exposure and optimism were self-reported by participants, and task-induced changes in SBP, DBP, and PR were measured with an automated monitor during two sequentially administered digit-forward and digit-backward tasks. RESULTS Hierarchical regression analyses revealed that violence exposure was inversely related to task-induced changes in SBP (p = .010) and DBP (p = .005). Optimism was not an independent predictor of blood pressure or PR changes (p-s > .32). The final step of these hierarchical analyses indicated that the effects of violence exposure and optimism interacted to predict task-induced changes in SBP (p = .013) and PR (p = .003). Follow-up regression analyses indicated that violence exposure was inversely related to task-induced changes in SBP among participants high in optimism and was positively associated with PR reactivity in participants low in optimism. CONCLUSIONS The youth in this study have intact mechanisms for buffering blood pressure responses to violence exposure, especially those who are more optimistic about their future-a person factor whose moderating effects might wane with advancing age.
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Affiliation(s)
- Rodney Clark
- Department of Psychology, Wayne State University, Biobehavioral Research Laboratory, Program for the Advancement of Youth and Urban Health, Detroit, MI 48202, USA.
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Rabineau KM, Treiber FA, Poole J, Ludwig D. Interactive effects of anger expression and ET-1 Lys198Asn polymorphism on vasoconstriction reactivity to behavioral stress. Ann Behav Med 2005; 30:85-9. [PMID: 16097909 DOI: 10.1207/s15324796abm3001_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ineffective anger expression has been associated with essential hypertension (EH) and with blood pressure (BP) reactivity to stress. The ET-1/Lys198Asn polymorphism has been associated with increased resting BP and exaggerated vasoconstrictive mediated BP reactivity. African Americans (AAs) are at particular risk for development of EH, report greater anger difficulties, and exhibit greater vasoconstrictive reactivity than their European American (EA) counterparts. PURPOSE The objective is to investigate a gene-environment model of stress reactivity in which anger expression, particularly in combination with ET-1 T allele carrier status and AA ethnicity, would be associated with the greatest vasoconstrictive reactivity in response to a behavioral stressor. METHODS One hundred ninety-one AA and 197 EA normotensive young adults (M age=18.8+/-2.5 years) participated in the study. Total peripheral resistance index (TPRI) reactivity was assessed during a 10-min video game challenge. Anger expression was measured using Spielberger's Anger Expression Scale. RESULTS A multiple regression model with TPRI reactivity as the dependent variable revealed a three-way interaction effect for anger management (i.e., AM=anger control minus anger out scores), ethnicity, and ET-1 polymorphism. Specifically, AA carriers of the ET-1 polymorphism with poor AM skills exhibited the greatest TPRI reactivity. CONCLUSIONS Individuals with a genetic predisposition for exaggerated vasoconstriction who also display low AM skills may be at particular risk for development of stress-induced EH. Such individuals may particularly benefit from anger management training.
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Affiliation(s)
- Kristen M Rabineau
- Department of Psychiatry, Medical College of Georgia, Georgia Prevention Institute, Augusta 30912, USA
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Affiliation(s)
- Ann M Borzecki
- Center for Health Quality, Outcomes, and Economic Research, Bedford Veterans Affairs Hospital, Bedford, Mass, USA
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Suka M, Yoshida K, Sugimori H. Persistent insomnia is a predictor of hypertension in Japanese male workers. J Occup Health 2004; 45:344-50. [PMID: 14676413 DOI: 10.1539/joh.45.344] [Citation(s) in RCA: 177] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Insomnia is one of the most common complaints at worksites, as well as in the general population. This study aims to assess the effect of insomnia on the development of hypertension in Japanese male workers. Using the annual health examination database of a Japanese telecommunication company, eligible middle-aged male participants in the 1994 health examination were followed up until 1998 or the development of hypertension (either initiation of antihypertensive therapy or a systolic blood pressure > or = 140 mmHg and/or a diastolic blood pressure > or = 90 mmHg). The effect of difficulty initiating sleep (DIS) was assessed with a DIS dataset (n=4,794), which included non-DIS (n=4,602) and persistent-DIS (n=192) subjects. That of difficulty maintaining sleep (DMS) was assessed with a DMS dataset (n=4,443), which included non-DMS (n=4,157) and persistent-DMS (n=286) subjects. The incidence of hypertension among persistent-DIS (40.1%; 130.7 per 1,000 person-yr) was significantly higher than that among non-DIS (30.6%; 89.9 per 1,000 person-yr). The incidence of hypertension among persistent-DMS (42.3%; 136.7 per 1,000 person-yr) was significantly higher than that among non-DMS (30.7%; 90.8 per 1,000 person-yr). After adjusting for potential confounding factors (i.e. age, body mass index, smoking, alcohol drinking, and job stress), persistent complaints of DIS and DMS were significantly associated with an increased risk of hypertension (OR=1.96; 95%CI: 1.42-2.70 and OR=1.88; 95%CI: 1.45-2.45, respectively). Persistent insomnia may be a useful predictor of hypertension in Japanese male workers.
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Affiliation(s)
- Machi Suka
- Department of Preventive Medicine, St. Marianna University School of Medicine, Sugao, Kawasaki, Kanagawa, Japan
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Schum JL, Jorgensen RS, Verhaeghen P, Sauro M, Thibodeau R. Trait anger, anger expression, and ambulatory blood pressure: a meta-analytic review. J Behav Med 2004; 26:395-415. [PMID: 14593850 DOI: 10.1023/a:1025767900757] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A meta-analysis of 15 studies was conducted to investigate the relationship between trait anger and ambulatory blood pressure. Overall, the experience of anger was significantly and positively associated with systolic blood pressure (r+ = 0.049), but not reliably associated with diastolic blood pressure (r+ = 0.028). After removing an outlier, the expression of anger was found to have a reliable inverse relationship with diastolic blood pressure (r+ = -0.072). No reliable relationship between expression of anger and systolic blood pressure (r+ = -0.041) was found. These results continue to support the modest role of self-reported trait anger and anger expression in blood pressure levels. Several suggestions for future research are discussed, including increasing the focus on the complexity and synergism of these effects.
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Affiliation(s)
- Jennifer L Schum
- Department of Psychology, Center for Health and Behavior, Syracuse University, Syracuse, New York, USA
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Hogan BE, Linden W. Anger response styles and blood pressure: At least Don’t Ruminate about it! Ann Behav Med 2004; 27:38-49. [PMID: 14979862 DOI: 10.1207/s15324796abm2701_6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Research on anger suggests a link with blood pressure (BP), but the findings are complex and highly variable; this is at least partly attributable to measurement issues. PURPOSE In this study we used a new model of anger responding that comprises 6 independent anger response styles in 2 dimensions: Aggression, Assertion, Social Support Seeking, Diffusion, Avoidance, and Rumination. Linear and interactive relations between the anger response styles and resting and ambulatory BP were tested, controlling for traditional risk factors and level of hostility. METHODS Data from 2 samples of different cardiovascular health status were examined. In Study 1, 109 healthy participants (45 men and 64 women) were recruited. Study 2 involved a sample of 159 hypertensive patients (90 men and 69 women). All participants provided demographic and health information; completed the Behavioral Anger Response Questionnaire, a hostility measure; and underwent resting BP measurement. Study 2 participants also provided 24-hr ambulatory BPs. RESULTS Examination of linear effects revealed inconsistent associations between anger response styles and BP. The moderating effect of Rumination on the relationship between the other anger response styles and BP was examined next. Rumination had a deleterious influence on the relation between Avoidance and Assertion and resting and ambulatory BP levels. The moderating influence of Rumination on Social Support Seeking varied between the genders. CONCLUSIONS Overall, the results suggest that rumination is a critical moderating variable in the relation of anger and BP.
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Merritt MM, Bennett GG, Williams RB, Sollers JJ, Thayer JF. Low educational attainment, John Henryism, and cardiovascular reactivity to and recovery from personally relevant stress. Psychosom Med 2004; 66:49-55. [PMID: 14747637 DOI: 10.1097/01.psy.0000107909.74904.3d] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The John Henryism hypothesis proposes that a high level of John Henryism (JH: high-effort coping with psychosocial demands) is predictive of hypertension at low but not high socioeconomic status (SES). The objectives of the present study were to determine whether high JH and low SES (education, income, job status, and job strain) were associated with increased cardiovascular responses to laboratory social stressors. METHODS Subjects were 58 normotensive, healthy black men age 23 to 47 years. The procedure included the completion of psychosocial questionnaires and participation in a psychophysiological reactivity protocol. The reactivity protocol involved the following experimental tasks and associated recovery periods: an active speech task and an anger recall task. Measures of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and rate pressure product (RPP) were obtained continuously using a Finapres beat-to-beat blood pressure monitor throughout the reactivity protocol. RESULTS At high JH, low (compared with high) education level was linked with higher DBP during anger recall and final recovery, higher SBP during final recovery, and higher HR and RPP during speech preparation and final recovery (p <.05). Among subjects with low education, high (vs. low) JH was associated with higher SBP, HR, and RPP during final recovery (p <.05). CONCLUSIONS John Henryism may increase the risk of cardiovascular disease among people with low education by increased cardiovascular reactivity and prolonged recovery to stress.
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Affiliation(s)
- Marcellus M Merritt
- Psychiatry and Behavioral Sciences, Behavioral Medicine Research Center, Duke University Medical Center, Durham, NC, USA.
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Grewen KM, Girdler SS, Hinderliter A, Light KC. Depressive symptoms are related to higher ambulatory blood pressure in people with a family history of hypertension. Psychosom Med 2004; 66:9-16. [PMID: 14747632 DOI: 10.1097/01.psy.0000106881.60228.16] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated whether parental history of hypertension (FH+) enhances the impact of depressed mood, indexed by Beck Depression Inventory (BDI), on ambulatory blood pressure (ABP). METHODS Twenty-four-hour ABP, urinary norepinephrine (NE), and cortisol were obtained in 314 unmedicated normotensive and hypertensive men and women (age 18-64 years) who also completed the BDI. RESULTS Subjects with a positive family history of hypertension (N = 177) exhibited significantly greater mean body mass index (BMI) and ABP compared with subjects without (N = 137). Importantly, when covarying for age, BMI, gender, and race, linear regressions revealed significant FH by BDI interactions. Higher BDI scores were significantly associated with higher 24-hour ABP in FH+ subjects, but not in FH- participants. Relationships were significantly stronger in those with two hypertensive parents vs. those with one vs. those with no hypertensive parents. Increases in BDI scores were significantly related to greater heart rate (HR) and 24-hour urinary NE in both FH+ and FH- groups, although no evidence of a mediational role for NE in the effect of BDI score on blood pressure (BP) or HR was seen. CONCLUSIONS These findings suggest that depressed mood may be reliably associated with higher BP only among those with an underlying susceptibility to HTN.
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Affiliation(s)
- Karen M Grewen
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7175, USA.
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Mezulis AH, Abramson LY, Hyde JS, Hankin BL. Is There a Universal Positivity Bias in Attributions? A Meta-Analytic Review of Individual, Developmental, and Cultural Differences in the Self-Serving Attributional Bias. Psychol Bull 2004; 130:711-47. [PMID: 15367078 DOI: 10.1037/0033-2909.130.5.711] [Citation(s) in RCA: 507] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers have suggested the presence of a self-serving attributional bias, with people making more internal, stable, and global attributions for positive events than for negative events. This study examined the magnitude, ubiquity, and adaptiveness of this bias. The authors conducted a meta-analysis of 266 studies, yielding 503 independent effect sizes. The average d was 0.96, indicating a large bias. The bias was present in nearly all samples. There were significant age differences, with children and older adults displaying the largest biases. Asian samples displayed significantly smaller biases (d = 0.30) than U.S. (d = 1.05) or Western (d = 0.70) samples. Psychopathology was associated with a significantly attenuated bias (d = 0.48) compared with samples without psychopathology (d = 1.28) and community samples (d = 1.08). The bias was smallest for samples with depression (0.21), anxiety (0.46), and attention-deficit/hyperactivity disorder (0.55). Findings confirm that the self-serving attributional bias is pervasive in the general population but demonstrates significant variability across age, culture, and psychopathology.
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Affiliation(s)
- Amy H Mezulis
- Department of Psychology, University of Wisconsin, Madison, WI 53706, USA.
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Bishop GD, Enkelmann HC, Tong EMW, Why YP, Diong SM, Ang J, Khader M. Job demands, decisional control, and cardiovascular responses. J Occup Health Psychol 2003; 8:146-56. [PMID: 12703880 DOI: 10.1037/1076-8998.8.2.146] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The demand-control model for coronary heart disease was tested using ambulatory blood pressure monitoring. Male patrol officers (N = 118) wore ambulatory blood pressure monitors during 1 of their day shifts with readings taken every 30 min. Following each reading, officers completed a questionnaire using a handheld computer. Significant interactions were obtained between job demands and decisional control for heart rate and pressure rate product such that both variables were highest under conditions of high demand and low control. Main effects were obtained for control such that diastolic blood pressure and mean arterial pressure were significantly higher under conditions of low control. These results support the demand-control model and emphasize the importance of psychological control in cardiovascular responses.
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Affiliation(s)
- George D Bishop
- Department of Social Work and Psychology, National University of Singapore.
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Abstract
Notion of consumers-producers co-operation allows better understanding of the basic mechanisms of homeostasis. This concept refers to the biological variables (BV) that are produced by tissues and organs (producers) and used for provision of functional activity of other organs and tissues (consumers). The rate of BV consumption is a major BV down-regulation factor, which participates in two kinds of imbalance: feedback and feedforward. When consumers are activates prior to producers, BV decrease and up-regulation forces are activated to counteract the decrease (feedback imbalance). Feedforward imbalance appears when producers are activated and BV consumption is postponed or suppressed. Prolonged feedforward imbalance is supposed to lead to chronic metabolic disturbances and diseases (obesitas, atherosclerosis, hypertension, NIDDM, Syndrome X, etc.).
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Affiliation(s)
- G M Sarov
- Department of Pathophysiology, Trakian University, Stara Zagora, Bulgaria.
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