Blood pressure estimation and beliefs among normotensives and hypertensives.

14 medicated hypertensive, 15 nonmedicated mild hypertensive, 39 normotensive, and 13 hypotensive adults participated in a 1–2 hr laboratory experiment that assessed each S's symptoms, moods, and estimates of systolic blood pressure (SBP) relative to actual SBP levels. Several self-reports and autonomic measures were collected during and after each of 22 tasks. Within-S correlations indicated that all Ss could estimate SBP at levels greater than chance. Further, 68% of the Ss evidenced at least 1 significant symptom–SBP correlation. Although medicated hypertensives believed they could estimate their BP more accurately than other groups, they were actually no more accurate than the other Ss. They also evidenced far fewer empirically derived symptom–SBP and emotion–SBP correlations than any other group. Overall, blood pressure (BP) beliefs were largely inaccurate. If these erroneous beliefs can be eliminated, Ss may be able to estimate BP fluctuations more accurately. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of different stress settings on cardiovascular parameters and their relationship to daily life blood pressure in normotensives, borderline hypertensives and hypertensives

The aim of this study was to compare a traditional stress setting, consisting of two mental arithmetic tasks and two Stroop test modifications, and a stress setting of varying task demand and decision latitude according to Karasek's job strain model, with respect to their feasibility to elicit differences in cardiovascular reactivity and recovery in 20 normotensives, 20 borderline hypertensives, and 20 non-medicated hypertensives, carefully selected by means of World Health Organization criteria. In addition, the relationship between laboratory and everyday blood pressure was investigated. All subjects were tested under both stress settings in counterbalanced order. Blood pressure was recorded both intermittently from the brachial artery (Riva-Rocci) and continuously from the finger (Finapres). Heart rate and electrodermal activity were continuously measured as well. Furthermore, daily life blood pressure recorded by means of 24 h ambulatory monitoring during a normal working day served as criterion for the re-classification of the blood pressure groups by means of discriminant analysis using physiological recordings from baseline, test phases and rest phases. The groups did not show significant differences in their reactivity to the various mental stressors including the Karasek-model oriented ones but marked differences in their behaviour occurred during the 10 min of recovery following each stress setting. Both systolic and diastolic blood pressure in hypertensives failed to recover during this period. The results also showed the superiority of the Finapres method with respect to reflecting the dynamics of physiological recovery processes. None of the stress settings showed an advantage in predicting blood pressure in daily life. In general, the results question the validity of mental laboratory stressors for the prediction of cardiovascular changes in daily life but point to a possible role of recovery processes after stress in the development of essential hypertension.     

Ambulatory systolic blood pressure patterns in elderly hypertensives

In a recent study we found that patients with isolated systolic hypertension (ISH) had two patterns of systolic blood pressure (SBP) elevations by ambulatory BP monitoring (ABPM), sustained (S) and intermittent (I), the prognostic significance of which seems to be different. In the present study we tried to determine whether such patterns of SBP elevations may be detected among other hypertensives as well. Twenty-eight elderly patients (mean age 65.5+/-5.1 years), nine with ISH, 10 with systolodiastolic hypertension (SDH), and nine with white coat hypertension (WCH), underwent ABPM. Average clinic BP in the ISH group was 184/83 mm Hg, in the SDH group 172/101 mm Hg, and in the WCH group 166/91 mm Hg, where as the ABPM averages were 169/80, 167/95 and 132/73 mm Hg, respectively, and differences held true for both daytime and night-time. Five ISH and four SDH patients had S patterns on ABPM, while the other four ISH and six SDH patients exhibited I patterns; none of the nine WCH subjects had either S or I patterns. ECG revealed left ventricular hypertropy (LVH) and/or ischaemic changes in eight patients with S patterns (ISH and SDH groups combined), as opposed to two patients with I patterns and only one patient of the WCH group. This seems to further suggest that an S pattern of SBP elevation on ABPM may have worse prognostic implications than either an I pattern or no SBP elevation.     

Cardiovascular reactivity to psychological stress in aerobically trained versus untrained mild hypertensives and normotensives.

Compared cardiovascular reactivity to video game and mental arithmetic stressors among 3 groups of men (aged 21–63 yrs): (a) 11 aerobically trained mild hypertensives, (b) 7 untrained mild hypertensives, and (c) 9 untrained normotensives. Blood pressure (BP) reactivity of normotensives during the video game was generally similar to that of trained hypertensives but smaller than that of untrained hypertensives. There were no group differences in reactivity during mental arithmetic. Results indicate that aerobic training, which has been found to reduce resting BP in mild hypertensives, may also exert a favorable impact in reducing cardiovascular reactivity of hypertensives during some stressful situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of benazepril and captopril on blood pressure, glucocorticoids and progesterone in essential hypertensives

The antihypertensive activity and the influence of adrenal cortex hormones of benazepril versus captopril were studied in 30 essential hypertensives in a double-blind, randomised, placebo-controlled trial during eight weeks of treatment. Patients started with 50 mg of captopril or 10 mg of benazepril once daily; if normotension had not been obtained after four weeks of treatment the doses were increased to 50 mg twice daily or 20 mg once daily, respectively. 11-Oxycorticosteroids and progesterone in males were measured in blood and daily urine at baseline and at the 4th and the 15th days of drug administration, as well as aldosterone in daily urine by radioimmunoassay, and compared with these data in 15 healthy subjects. Following eight weeks of treatment in 64% and 56% of patients treated with benazepril and captopril respectively, blood pressure was normalised. In the corresponding remaining 14% and 13%, diastolic blood pressure decreased by 10 mmHg and more but not below 90 mmHg. Before treatment excretion of 11-oxycorticosteroids, progesterone and aldosterone was significantly increased without changes in blood levels. After two weeks of treatment 11-oxycorticosteroids and aldosterone excretion decreased (P < 0.05) without progesterone changes, benazepril treatment being more effective in decreasing 11-oxycorticosteroids levels in blood (P < 0.05). In patients with high pretreatment levels of 11-oxycorticosteroids in urine we have noticed the highest antihypertensive effect of both drugs. The main conclusions are that both the ACE inhibitors are effective in mild to moderate essential hypertensives and might decrease glucocorticoids in urine and blood.     

Childhood predictors for high adult blood pressure. The Muscatine Study

In adult populations, elevated blood pressure is related to the development of stroke, renal disease, and occlusive atherosclerosis. The significance of blood pressure levels in childhood, unless extremely elevated, has not been related to disease outcomes. In a study carried out in Muscatine, Iowa, the risk of high blood pressure in young adult life was evaluated based on the observations of blood pressure and other factors made during the school-aged years. Subjects, 2445 in number, were first observed at ages 7 through 18 years and again between 20 and 30 years. During childhood, measurements of blood pressure, height, and weight were made on alternate years. At adult ages, the same measurements were again made and a health questionnaire was administered. Adult blood pressure was correlated with childhood blood pressure, body size, and change in ponderosity from childhood to adult life. Adult ponderosity was related to childhood ponderosity, and those who were most obese as adults showed the greatest increase in weight from their childhood years. These observations suggest that strategies to prevent the acquisition of excess ponderosity during childhood may be useful in preventing adult hypertension.     

I1-imidazoline agonist moxonidine decreases sympathetic nerve activity and blood pressure in hypertensives

Moxonidine is an I1-imidazoline receptor agonist that reduces blood pressure in hypertensives. Experimental data suggest that moxonidine inhibits central sympathetic activity. However, whether such a mechanism is involved in vivo in humans is still unclear. We investigated the effects of 0.4 mg moxonidine orally on muscle sympathetic nerve activity and heart rate in an open study in 8 healthy volunteers. Furthermore, we studied the effects of 0.4 mg moxonidine on muscle sympathetic nerve activity, heart rate, blood pressure, 24-hour blood pressure profile, and hormone plasma levels in 25 untreated hypertensives in a double-blind, placebo-controlled study. Moxonidine decreased muscle sympathetic nerve activity in both healthy volunteers (P<0.05 versus baseline) and hypertensives (P<0.02 versus placebo). Plasma norepinephrine also decreased (P<0. 01), whereas plasma epinephrine and renin levels did not change (P=NS). Furthermore, moxonidine decreased systolic (P<0.0001) and diastolic (P<0.001) blood pressure. Heart rate decreased after moxonidine in healthy subjects (P<0.05); in hypertensives, heart rate decreased during the night hours (P<0.05) but not during daytime (P=NS). Plasma levels of LDL, HDL, and total cholesterol were not influenced by the drug (P=NS). Moxonidine decreases systolic and diastolic blood pressure by inhibiting central nervous sympathetic activity. This makes this new drug suitable for the treatment of human hypertension and possibly for other cardiovascular diseases with increased sympathetic nerve activity, ie, ischemic heart disease and heart failure.     

Behavioral and cardiovascular responses to interpersonal challenges among male offspring of essential hypertensives.

Behavioral, cardiovascular, and self-report measures of cognitive and affective responses to 2 interpersonal challenges were examined among 20 men with a positive (FH+) and 20 with a negative (FH–) family history of hypertension. Heart rate (HR) and blood pressure (BP) were measured throughout the laboratory session; Ss were requested to self-report positive and negative conditions, state anger, and state anxiety that occurred during interactions with a male and female confederate. Behavioral responses to interpersonal tasks were videotaped, coded, and categorized into 4 major groupings (positive verbal, positive nonverbal, negative verbal, and negative nonverbal). FH+ individuals exhibited significantly higher resting HR and systolic BP reactivity to both interactions than FH– counterparts. Analyses of behavioral responses for both interactions revealed significantly more negative verbal and nonverbal behavior and less positive nonverbal behavior among FH+ as compared with FH– Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiovascular reactivity to and recovery from psychological challenge as predictors of 3-year change in blood pressure.

The authors examined whether cardiovascular reactivity to and recovery from psychological challenge predict 3-year change in blood pressure (BP) among 216 initially normotensive, community-dwelling adults. Clinic BP assessments were conducted at baseline and follow-up. BP and heart rate (HR) readings were obtained before, during, and after 5 psychological tasks at baseline. Following adjustment for traditional predictors of BP and lifestyle factors, poorer systolic BP recovery across the tasks was associated with greater 3-year increases in clinic systolic and diastolic BP. Both diastolic BP recovery and HR recovery were also related to 3-year change in clinic BP, though cardiovascular reactivity measures were not. These findings suggest that the duration of stress-related cardiovascular responses may be important for predicting longitudinal changes in BP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reproducibility of the circadian systolic blood pressure variation in the elderly

OBJECTIVES: To establish the reproducibility of the nocturnal systolic blood pressure (SBP) change in elderly subjects and to examine the use of cumulative sums (cusums) analysis in the assessment of circadian SBP variation. SUBJECTS: Forty-two untreated elderly subjects (35 hypertensive, 7 normotensive) of mean age 75.5 years from the hypertension clinic at a large teaching hospital participated in a reproducibility study. METHODS: Twenty-four-hour ambulatory blood pressure monitoring was performed and repeated at a median interval of 2 months (range 2 weeks to 9 months). OUTCOME MEASURES: Reproducibility of circadian SBP variation from fixed time analysis of day-night SBP difference and from cusums-based parameters. RESULTS: Twenty-four-hour SBP values were highly reproducible with a coefficient of variation of 5.8%. However, the day-night SBP difference for fixed time periods was poorly reproducible, with a coefficient of variation > 130%. A substantial proportion of subjects (36-43%) altered their 'dipping status' between visits. The use of cusums analysis improved the reproducibility of measures of circadian SBP change (cusums plot height and maximum circadian variation) with coefficients of variation falling to 40 and 38%, respectively. CONCLUSIONS: The use of fixed time definitions results in poor reproducibility of the circadian SBP change in the elderly, which will lead to regression dilution bias when studying the relationship of circadian SBP variation to outcome measures in hypertension. The notion of dipping and non-dipping circadian blood pressure patterns should be abandoned in favour of more reproducible cusums-based measures of circadian blood pressure variation.     

Social relationships and ambulatory blood pressure: Structural and qualitative predictors of cardiovascular function during everyday social interactions.

Healthy normotensive men and women (N=102) underwent a 3-day ambulatory blood pressure (BP) assessment in which a BP reading was taken 5 min into each social interaction. After each interaction, participants completed a diary that included structural categorization of the relationship and ratings of the quality of the relationship with the interaction partner. Random regression analyses revealed that interactions with family members and spouses were associated with lower ambulatory BP. Interactions with ambivalent network members (characterized by both positive and negative feelings) were associated with the highest ambulatory systolic BP, an effect that was independent of the familial effects on BP. Although there were psychological correlates associated with both structural and functional aspects of relationships, no evidence was found that these mediated the primary findings involving ambulatory BP. These data highlight the influence of both structural and qualitative aspects of relationships on ambulatory BP and possibly health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-monitoring and blood pressure.

Examined the association between self-monitoring (regulation and control of nonverbal and expressive behavior) and blood pressure (BP) among 594 municipal employees. For Ss not taking antihypertensive medication, scores on an acting/extraversion scale were mildly positively associated with resting BP among Whites in general, blue collar, clerical, and professional groups. Stronger positive correlations were obtained for attorneys and customer-service representatives. Results are contrasted with slightly negative associations for Blacks in general, 1st-level supervisors, and a group of previously studied union stewards. An interactive effect was also obtained between acting/extraversion and relative participation in work vs nonwork groups and activities; acting/extraversion and systolic BP were inversely related for Ss more active in extrawork groups. Differential consequences of greater or lesser interpersonal involvement and emotional regulation in different jobs are considered. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives

Direct evidence about the effects of antihypertensive treatment on vascular disease in older patients is available from five randomized trials conducted exclusively in patients over the age of 60 years. These trials involved a total of 12,483 individuals with systolic or diastolic hypertension (mean age = 72 years, mean entry blood pressure = 181/88 mmHg). Over an average follow-up period of 4.7 years, a 15/6 mmHg difference in blood pressure between study and control groups was achieved. Among those patients assigned active treatment, stroke incidence was reduced by 34% SD6 and coronary heart disease incidence was reduced by 19% SD7. These proportional reductions were of similar size to those observed in trials in predominantly younger patients. However, the absolute benefits observed in older patients were more than twice as great as those observed in younger patients. The results suggest that over 10 years, treatment would prevent at least one major vascular event among every 10 elderly patients at similar risk to those enrolled in the trials.     

Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population

OBJECTIVE: To measure the magnitude and timing of seasonal variation of blood pressure and related factors in the elderly living in the community, and to assess their potential impact on cardiovascular risk. DESIGN: Prospective study; from January 1991 to February 1992 blood pressure and other variables were measured at 2-monthly intervals in each subject in their own homes. SUBJECTS: Ninety-six men and women, age range 65-74 years, recruited from a single group general practice in Cambridge. MAIN OUTCOME MEASURES: Seasonal variation of blood pressure, seasonal variation of prevalence of hypertension, seasonal variation of ambient temperature and body mass index. RESULTS: Both systolic (SBP) and diastolic blood pressure (DBP) were greatest during the winter across the whole distribution of blood pressure. There was a fourfold increase in the proportion of subjects with blood pressures > 160/90 mmHg in winter compared with in summer. Regression analysis revealed highly significant seasonal differences in both SBP and DBP. After adjustment for confounding seasonal effects, a 1 degree C decrease in living-room temperature was associated with rises of 1.3 mmHg in SBP and 0.6 mmHg in DBP. CONCLUSIONS: Seasonal variation of blood pressure is heightened in older adults and may partly explain the greater cardiovascular disease mortality of elderly subjects during the winter. The blood pressures of elderly people may be inversely related to the ambient temperature. The public health implications of these findings deserve further investigation.     

Behavioral and attitudinal effects of large-scale variation in the physical environment of psychiatric wards.

Conducted extensive physical remodeling of a psychiatric admissions ward to investigate the relationship between ward design and patient behavior. An identical but unchanged ward functioned as an experimental control. Groups of 25 new patients were selected for study on each ward; experimental measures included behavioral observations and individual interviews. Experimental hypotheses generally were supported. Significantly more socializing and less passivity occurred on the remodeled than on the control ward, and Ss on the remodeled ward demonstrated more positive attitudes toward the physical environment. The relation between Ss' behavior scores and their interviews demonstrated important differences between the 2 wards. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical activity, change in blood pressure and predictors of mortality in older South Africans--a 2-year follow-up study

OBJECTIVE: A 2-year follow-up study of a cohort of 200 historically disadvantaged older South Africans was conducted to: (i) characterise current levels of habitual physical activity; (ii) relate physical activity to current risk factors for chronic disease; and (iii) identify risk factors associated with 2-year mortality. The baseline sample, drawn in 1993, was found to have a high prevalence of hypertension (71.7%). RESEARCH DESIGN: Retrospective cohort study. METHODS: A baseline sample of 200 persons aged > or = 65 years, resident in the Cape Peninsula, was randomly drawn by means of a two-stage cluster design. Baseline measurements included: anthropometry, waist/hip ratio, systolic and diastolic blood pressure, body mass index (BMI), serum albumin, serum ferritin, haemoglobin and fasting plasma glucose levels, plasma lipid profiles, oral glucose tolerance test and self-reported health status. Subjects were revisited after 2 years, at which time an adapted version of the Yale Physical Activity Survey was administered and measurements of blood pressure and anthropometry were repeated. STATISTICAL ANALYSES: Spearman's rank-order correlations were used to describe relationships between various current risk factors and physical activity. Logistic regression was used to determine predictors of 2-year mortality from baseline data. RESULTS: At follow-up, 142 of the subjects (66 men, 76 women) were traced and measurements collected. Thirty-two subjects were reported to have died by relatives living in the same household (22 men, 10 women). Levels of reported physical activity in the survivors were two-thirds lower than those reported in a sample of North Americans of similar age. There was an inverse association between age and physical activity (r = -0.31; P < 0.0005) and a positive association between BMI and physical activity (r = 0.29; P < 0.005). There was, however, no association between physical activity and systolic or diastolic blood pressure. In men, BMI in the lower tertile (P = 0.07) and serum ferritin levels were positively associated with increased mortality. Serum albumin levels were protective over the 2-year follow-up period (OR = 0.85; P < 0.05). In women, being diabetic (OR = 4.88; P = 0.06) and having a waist/hip ratio in the upper tertile (OR = 3.26; P = 0.06) were associated with mortality. CONCLUSIONS: Physical activity levels in this sample of older historically disadvantaged South Africans were habitually low. Simple anthropometric assessments incorporating weight and waist/hip ratio, together with serum albumin measurements, may be useful to screen general health risk for older adults at primary care level and provide indications for social or medical intervention. Further, strategies for earlier detection and effective management of diabetes, particularly in older women, may reduce premature mortality in this population.     

Diet and exercise intervention have favourable effects on blood pressure in mild hypertensives: the Oslo Diet and Exercise Study (ODES)

The purpose of this study was to investigate the effect of 1-year diet intervention, exercise intervention and both combined on blood pressure (BP) in normotensives and mild hypertensives. Two hundred and nineteen sedentary middle aged men and women with slightly deranged coronary heart disease (CHD) risk factors were randomised to a control, a diet, an exercise and a diet + exercise group. Based on baseline diastolic BP, participants were divided into tertiles, giving baseline average BP of 141.4/96.7 in tertile 1, 130.7/87.6 in tertile 2 and 121.9/79.0 in tertile 3. The 1-year net-difference in BP between the intervention groups and the control group decreased across the tertiles; in tertile 1 being -11.2/-6.7 (p < 0.05), -11.3/-6.7 (p < 0.05 for systolic BP only) and -7.0/-5.1 (NS) in the combined, diet and exercise group respectively. Triglycerides, HDL cholesterol, and insulin variables were significantly and favourably changed, the changes being most marked in the combined group. The results show that diet and diet + exercise are about equally effective in reducing BP, and the effects may be dependent on the baseline level. Within the upper tertile of baseline BP, the decline in BP in the combined intervention and the diet group are almost comparable to those obtained with drug treatment. In addition, other important CHD risk factors were all changed in a beneficial direction.     

Psychological correlates of blood pressure.

As a physiological measure of emotion, blood pressure has been relatively neglected in recent years. This review considers 3 questions: Do certain stimuli produce replicable changes in blood pressure? Do cognitive states influence blood pressure reactivity? Is there a causative relationship between personality and high blood pressure? Available research indicates that the 1st 2 questions can be answered affirmatively, though there are a number of methodological problems yet to be resolved. No direct evidence is available for the 3rd question and tangential studies offer conflicting results. (78 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)