Subjective social status, objective socioeconomic status, and cardiovascular risk in women.

OBJECTIVE: Subjective perceptions of personal social status may relate to health beyond the effects of objective socioeconomic status (SES). The authors examined the relationship between subjective social status (SSS) and psychosocial, behavioral, and physical cardiovascular risk factors in middle-aged women. DESIGN: Ninety-two women (90.2% White) completed ladder-based, pictorial self-report measures of SSS relative to others in their community and in the United States. Psychosocial measures of depression, anxiety, pessimism, stress, and social support and behavioral risk factors of fruit and vegetable consumption, leisure physical activity, and body-mass index were obtained. In addition, women underwent measurement of clinic blood pressure and assessment of daytime ambulatory systolic and diastolic blood pressure (SBP; DBP) over 2 consecutive days. RESULTS: Community SSS was significantly inversely related to anxiety, pessimism, stress, and daytime ambulatory DBP after controlling for objective SES and U.S. SSS. Women with lower U.S. SSS showed less healthy dietary and exercise behaviors and, contrary to predictions, lower clinic and ambulatory DBP. CONCLUSION: This study provides additional evidence that perceptions of one's position in the social hierarchy could have important health implications beyond the impact of objective SES. Further, the cardiovascular risk implications of perceived community versus U.S. social status appear to be distinct.     

Exploring Emotion-Regulation and Autonomic Physiology in Metastatic Breast Cancer Patients: Repression, Suppression, and Restraint of Hostility

We examined relationships between three emotion-regulation constructs and autonomic physiology in metastatic breast cancer patients (N = 31). Autonomic measures are not often studied in breast cancer patients and may provide evidence of an increase in allostatic load. Patients included participated as part of a larger clinical trial of supportive-expressive group therapy. Systolic and diastolic blood pressure and heart rate were assessed at a semi-annual follow-up. We averaged 3 resting assessments and used measures of Repression, Suppression, Restraint of Hostility, and Body Mass Index as predictors of autonomic response. We found that higher repression was significantly associated with higher diastolic blood pressure, while higher restraint of hostility was significantly associated with higher systolic blood pressure. A repressive emotion regulation style may be a risk factor for higher sympathetic activation possibly increasing allostatic load, while restraint of hostility may be a protective factor for women with metastatic breast cancer.     

Experiences of demand and control in daily life as correlates of subclinical carotid atherosclerosis in a healthy older sample.

Daily experiences of demand and control were examined as correlates of carotid artery atherosclerosis among healthy adults (ages 50-70). Mediating effects of ambulatory blood pressure (ABP) were also explored. Participants (n=337) collected ABP and recorded daily experiences, using electronic diaries, over two 3-day periods. Carotid artery intima-medial thickness (IMT) was assessed using ultrasonography. Participants reporting higher task demands during daily life showed larger IMT, after adjustment for demographic covariates. This association was not limited to workplace ratings or to employed individuals. The association was mediated, in part, by daytime systolic blood pressure. Previous findings linking job stress with cardiovascular disease may reflect the broader impact of daily psychological demands, not necessarily associated with the workplace.     

Psychosocial mediators of racial differences in nighttime blood pressure dipping among normotensive adults.

Shallow declines in nocturnal compared with diurnal blood pressure (BP dipping) have been associated with cardiovascular disease. In U.S. samples, Blacks demonstrate less BP dipping compared with Whites. In a sample of 60 Black and 60 White normotensive adults we examined stress, social integration (including parental status), social support, and hostility as potential mediators of the association between race and BP dipping. The effect of race on diastolic BP dipping was partially mediated by parental status. The effect of race on heart rate dipping was partially mediated by stressful life events. No psychosocial factors mediated the relation between race and systolic BP dipping. Although psychosocial factors appear to account for some of the observed racial differences in nocturnal blood pressure decline, our data suggest that these differences cannot be attributed entirely to covarying psychosocial effects.     

Impact of Stress Reduction Interventions on Hostility and Ambulatory Systolic Blood Pressure in African American Adolescents

This study examined the impact of breathing awareness meditation (BAM), life skills (LS) training, and health education (HE) interventions on self-reported hostility and 24-hour ambulatory blood pressure (ABP) in 121 African American (AA) ninth graders at increased risk for development of essential hypertension. They were randomly assigned to BAM, LS, or HE and engaged in intervention sessions during health class for 3 months. Before, after, and 3 months following intervention cessation, self-reported hostility and 24-hour ABP were measured. Results indicated that between pre- and postintervention, BAM participants displayed significant reductions in self-reported hostility and 24-hour systolic ABP. Reductions in hostility were significantly related to reductions in 24-hour systolic ABP. Between postintervention and follow-up, participants receiving LS showed a significant reduction in hostility but not in 24-hour ABP. Significant changes were not found for the HE group in 24-hour ABP or self-reported hostility, but these change scores were significantly correlated. The implications of the findings are discussed with regard to behavioral stress reduction programs for the physical and emotional health of AAs.     

Ambulatory and laboratory blood pressure in individuals with negative and positive family history of hypertension.

Undertook 24-hr ambulatory blood pressure (BP) monitoring in men and women with and without family history of essential hypertension. Cardiovascular functions were also recorded in the laboratory during mental arithmetic, image star tracing, isometric exercise, and the cold pressor test. Ambulatory daytime, but not nighttime, systolic and diastolic BP as well as heart rate (HR) level and variability was higher in those with than without family history. During sleep, HR level and variability were higher among those with family history; at rest in the laboratory, however, all cardiovascular functions were similar in both groups. The strongest laboratory-based predictor of daytime BP was stress-induced BP levels. BP reactivity also significantly predicted daytime BP but with less accuracy. The best predictor of BP and HR at sleep was resting cardiovascular functions. Thus, ambulatory BP recordings add information to resting and stress-induced levels in identifying cardiovascular risk reactions.     

The effects of racial stressors and hostility on cardiovascular reactivity in African American and Caucasian men.

This study examined the effects of race-related stressors and hostility on cardiovascular reactivity in 31 African American and 31 Caucasian men. Participants viewed 3 film excerpts that depicted neutral, anger-provoking (but race-neutral), and racist situations. Participants exhibited significantly greater diastolic blood pressure reactivity to anger-provoking and racist stimuli compared with neutral stimuli. In addition, high hostility was associated with higher recovery systolic and diastolic blood pressure levels after exposure to the films. Although the results failed to confirm previous reports of greater reactivity to racism in African Americans, the findings suggest that diastolic blood pressure levels may remain elevated after exposure to racist stimuli. These results indicate that even indirect exposure to interpersonal conflict elicits significant reactivity, which can persist after exposure to the stressor, especially among high-hostile men.     

Relationship between mood and blood pressure in the natural environment: an adolescent population

We examined the relation between psychological variables and blood pressure (BP) as 28 adolescents engaged in their customary activities over a 24-hr period in their natural environment. Each subject had previously participated in a laboratory study of cardiovascular reactivity. During the ambulatory monitoring period, subjects monitored mood state, perceptions of the environment, and ambulatory BP at 30-min intervals. Mood ratings and BP were averaged across the waking hours. Systolic blood pressure (SBP) reactivity to laboratory stressors was significantly correlated with average SBP in the home environment. Ambulatory SBP was positively associated with worried, hostile, depressed, and tense mood ratings as well as perceptions of the environment as hostile, demanding, and noisy. Ambulatory diastolic blood pressure was correlated with hostile, depressed, and upset mood ratings as well as with hostile and demanding perceptions of the environment. In general, average ambulatory BP appeared to be associated with negative emotions and perceptions of the environment.     

Hostile affect and casual blood pressure

Abstract

The present study investigated the relation between hostile affect and casual blood pressure in men and women. Data were collected from two independent samples: (1) 204 university students, and (2) 175 adults from the community. Findings on blood pressure-hostile affect linkage are reported with age and body-mass index corrected values. Data were analyzed for subgroups split at the median for hostility and also for tercile subgroups. Median splits revealed no relationship between hostility and blood pressure. Systolic blood pressure tended to be highest in the medium and high hostility terciles. The diastolic pressure-hostility link in men represented a “V”-shaped curve. In women, there was no relationship. Heart rate levels were consistently unrelated to hostile affect. The importance of testing for linear as well as curvilinear relationships in future studies is highlighted.     

餐后低血压的原发高血压患者24h动态血压特点

为了分析餐后低血压（PPH）患者的24h 动态血压变化特点,选择150例原发性高血压患者进行24h 动态血压监测,分成 PPH 组（n＝85）和非 PPH（n＝65）。观察两组平均血压、血压负荷值、晨峰值、血压变异性等指标。结果显示,（1） PPH 组年龄明显高于非 PPH 组（P＜0．05）;（2）PPH 组患者24h 及日间、夜间平均收缩压及平均收缩压负荷高于非PPH 组（P＜0．05）,但舒张压无统计学差异（P＞0．05）;（3） PPH 组患者血压变异性明显高于非 PPH 组（P ＜0．05）;（4） PPH 组患者血压晨峰数值及晨峰发生率明显高于非 PPH 组（P＜0．05）;（5） PPH 组夜间血压下降率及非勺型率较非 PPH 组无统计学差异（P＞0．05）。因此,PPH 患者易发生于高龄患者,且具有收缩压、血压变异性增高,更易发生晨峰现象的特点。     

Domain-specific assessment of anger expression and ambulatory blood pressure

Bongard and al’Absi (2003) proposed domain-specific anger expression as an improved method for measuring the expression of anger with stronger links to cardiovascular parameters. We tested this proposal by relating their domain-specific measure to ambulatory blood pressure. One hundred and forty-nine Singapore young adults responded to a modified version of the State-Trait Anger Expression Inventory that measured anger expression at home, school/work and leisure and then underwent 24 h ambulatory blood pressure monitoring. Results indicated significant differences in reported anger expression in the three domains measured and also showed that domain-specific measures of anger expression were more strongly related to ambulatory blood pressure than was the general measure of anger expression. These results provide additional evidence for the importance of measures of anger expression that take account of the specific context in which anger occurs.     

Age-related differences in ambulatory blood pressure during daily stress: evidence for greater blood pressure reactivity with age

Prior research on age and emotions has found that older adults may show better physiological regulation to stressful stimuli than do younger adults. However, the stress reactivity literature has shown that age is associated with higher cardiovascular reactivity to laboratory stress (J. R. Jennings et al., 1997). The authors investigated these conflicting findings further by examining daily ambulatory blood pressure in 428 middle-aged to older adults. Consistent with the age and reactivity literature, relatively old individuals showed significantly greater increases in ambulatory diastolic blood pressure compared with younger individuals when dealing with daily stressors. However, results also revealed that relatively old individuals reported less of an increase in negative affect during daily stress compared with their younger counterparts. The results of this study are consistent with the age-related increase in cardiovascular risk but highlight the complex links between stress and different facets of the aging process.     

Cardiovascular reactivity and neuroticism: results from a laboratory and controlled ambulatory stress protocol

A laboratory and controlled ambulatory protocol was used to study whether there are differences in the cardiovascular reactivity of persons varying in neuroticism, the disposition to experience negative subjective emotions. Thirty-six individuals (19 men, 17 women) who scored approximately 1 standard deviation above or below the mean on the NEO PI-R Neuroticism scale (Costa & McCrae, 1992) were recruited from a larger pool of undergraduate students. Participants, who had been outfitted with an ambulatory blood pressure/heart rate monitor, were exposed to 5 laboratory stressors and 7 field stressors during a 6-hour protocol. Results indicated that individuals scoring high in neuroticism showed blood pressure reactivity to laboratory and field stressors that was comparable to that of persons low in neuroticism. Aggregrating responses across stressors, there was evidence of exaggerated heart rate responses. The results suggested that, although neuroticism is related to high levels of negative subjective experience, differences between persons scoring high versus low in neuroticism were not exhibited strongly at the cardiovascular level. The implications for stress, coping, and disease are discussed.     

Hostility,oral contraceptive use,and cardiovascular reactivity in women

Abstract

Hostility, task instructions, social desirability and cardiovascular reactivity were investigated in a exploratory study of 70 female college students and employees. Women were administered the Videotaped Clinical Interview (VC1), the Marlowe-Crowne Social Desirability Scale (MC), the Cook-Medley Hostility Scale (CM), the Buss-Durkee Hostility Index (BD) and the Personal Attributes Questionnaire (PAQ) before undergoing a stressful discussion. Oral contraceptive users had significantly higher DBP at baseline. Based on PAQ scores, women were given instructions for the discussion task consistent or inconsistent with their gender-relevant styles. Instruction type predicted heart rate changes, and interacted with hostility to predict DBP reactivity. Interview-based hostility (VCI-H) was associated with increased DBP during the discussion task, as was being high hostile (low MC/high VCI-H). The CM and the BD had less association with heart rate and blood pressure changes. Oral contraceptive (OC) use was associated with higher SBP reactivity under stress, with highest SBP increases in the OC users concerned with social desirability. The complex interaction between trait dimensions like hostility, social desirability, and oral contraceptive use requires further investigation.     

The short-term effects of a hostility-reduction intervention on male coronary heart disease patients.

This preliminary study examined the effects of a hostility-reduction intervention on patients with coronary heart disease (CHD). Twenty-two high-hostile CHD men were matched on age and hostility and then randomly assigned to a hostility intervention (N = 10) or an information-control group (N = 12). Patients were reassessed immediately and 2 months posttreatment on hostility (with self-report and structured interview) and resting blood pressure. The intervention's overall effect size was moderately strong (d' = .62). Intervention patients reported at both reassessments and were observed at follow-up to be less hostile than controls. At follow-up, intervention patients had significantly lower diastolic blood pressure (DBP) than controls. Finally, reductions in hostility were significantly and positively correlated with reductions in DBP. Replication with a larger sample and CHD outcomes is recommended.     

Loneliness is a unique predictor of age-related differences in systolic blood pressure

A population-based sample of Caucasians, African Americans, and Latino Americans, 50-68 years of age (M = 57.5), from Cook County, Illinois (N = 229), was tested to examine how loneliness and co-occurring psychosocial factors (depressive symptoms, perceived stress, social support, and hostility) were related to indices of cardiovascular and endocrine functioning. Extending prior research, the authors found that loneliness was associated with elevated systolic blood pressure (SBP) and age-related increases in SBP, net of demographic variables, health behavior variables, and the remaining psychosocial factors. Loneliness was not associated with differences in autonomic or endocrine functioning. Although the results are limited by the cross-sectional methods used, they are consistent with the hypothesis that cardiovascular disease contributes to increased morbidity and mortality among lonely individuals.     

Functional cerebral asymmetry in hostility: a dual task approach with fluency and cardiovascular regulation

The influence of hostility levels on verbal and nonverbal fluency, and the concurrent cerebral regulation of autonomic nervous system functioning was examined in 48 right-handed males, half classified as low-hostile, and half as high-hostile. Recent research has supported inhibitory roles for the anterior right cerebrum in sympathetic regulation, and the anterior left cerebrum in parasympathetic regulation. Two neuropsychological tests purportedly mediated by left and right anterior cerebral systems, respectively, are the Controlled Oral Word Association Test and the Ruff Figural Fluency Test. Fluency and perseverative errors were assessed using these measures. Systolic and diastolic blood pressure, and heart rate were assessed with a digital blood pressure meter. It was predicted that high-hostile men would evidence interference on cardiovascular regulation concurrent with the nonverbal fluency task in comparison to low-hostile males. Further, interference was expected to manifest in the cognitive variable with more perseverative errors on the nonverbal fluency task in high-hostile males than in low-hostile males. The results support a capacity-limited prediction. High-hostile males evidenced significantly heightened systolic blood pressure during the nonverbal fluency task in comparison with low-hostile males. Further, high-hostile males displayed more perseverative errors in nonverbal fluency than did the low-hostile males. These results support the expectation that differences exist between high- and low-hostile males for right frontal functioning. These findings were discussed within the proposed anterior-posterior inhibition model of hostility.     

Body fat distribution and hemodynamic stress responses in premenopausal obese women: a preliminary study.

To examine the relationship between body fat distribution and hemodynamic stress responses, cardiovascular responses to a speech task and a forehead cold pressor task were evaluated with 24 premenopausal women classified a priori as either centrally or peripherally obese. Results showed that women with central adiposity exhibited greater stress-related increases in diastolic blood pressure and total peripheral resistance, whereas women with peripheral adiposity exhibited greater stress-related increases in cardiac output. Depression, self-consciousness, hostility, and mood scores did not explain significant variance in the stress response differences between regional adiposity groups. The findings suggest that central adiposity may increase the risk of cardiovascular disease in women at least in part by enhancing vascular responses to stress.     

Individual differences and measures of aggression in laboratory studies

After inducing hostility toward a confederate by threatening subjects' self-esteem, subjects were then given the opportunity either to deliver shocks (Experiment 1) or to withhold rewards (Experiment 2) from their confederate. Physiological measures were taken prior to the hostility induction, shortly after the induction and, finally, after the opportunity to aggress. Measures of individual differences relating to aggressive behavior were also considered. While the experimental manipulation was the best predictor in the ‘withholding rewards’ condition, measures of dissipation-rumination tendencies and emotional vulnerability were the best predictors in the ‘shock administration’ condition. In both conditions, systolic blood pressure seemed to reflect differences in arousal as a function of the hostility induction procedure, while subjects in the withhold rewards procedure also showed a decrease in systolic pressure after having an opportunity to aggress toward the confederate. It was concluded that not only is the withholding of rewards a more ethically acceptable procedure than shock administration, but it is also more likely to reflect experimental rather than individual difference affects.     

Locus of Control and Hostility: Sex Differences

The Nowicki-Strickland Internal-External locus of control scale and the Hostility and Direction of Hostility Questionnaire were administered to 35 male and 35 female college students. In both the total sample and the female sample, significant correlations were observed between locus of control and hostility with an external locus of control being associated with greater hostility. Although locus of control was significantly related to all of the hostility scores in the female sample, the male sample generally showed no significant relationship between locus of control and hostility. The sex differences in the data and the possibility of item overlap between the locus of control and hostility measures are discussed.