Hyperperfusion syndromes: insight into the pathophysiology and treatment of hypertensive encephalopathy

Hypertensive encephalopathy is one of the manifestations of a hypertensive crisis. It is not the absolute value of the blood pressure that causes the encephalopathy, rather the presence of an abrupt rise in pressure. In terms of clinical and radiographic findings, there are many similarities among a group of entities, including hypertensive encephalopathy, eclampsia, and immunosuppressant neurotoxicity. Hyperperfusion syndromes may represent these clinical disease states that may share the same pathophysiology. Magnetic resonance imaging fluid attenuated inversion recovery sequences have recognized the prominent cortical involvement of the disease that had been previously missed on computed tomography. Studies have found cortical involvement in 94% of their patients, particularly in mild cases. Animal models demonstrate endothelial damage and enhanced pinocytosis in the cortex as reasons why edema may begin in that region of the brain. Patients diagnosed with hypertensive encephalopathy should be diagnosed and treated promptly in order to avoid further neurological complications. The mean arterial pressure should be lowered by 20% to 25% within the first hour of patient presentation, followed by further gradual reduction in blood pressure over the following 24 hours. Hypertensive emergency in acute ischemic stroke should be managed with more caution. According to the 2003 American Stroke Association treatment guidelines, for patients with ischemic stroke not eligible for thrombolytic therapy, target blood pressures are a diastolic blood pressure <120 mmHg and systolic blood pressure <220 mmHg. The systolic pressure must be <185 mmHg and diastolic pressure <110 mmHg at all times if eligible for thrombolytic therapy.     

Common-sense models of illness: the example of hypertension

Our premise was that actions taken to reduce health risks are guided by the actor's subjective or common-sense constructions of the health threat. We hypothesized that illness threats are represented by their labels and symptoms (their identity), their causes, consequences, and duration. These attributes are represented at two levels: as concrete, immediately perceptible events and as abstract ideas. Both levels guide coping behavior. We interviewed 230 patients about hypertension, presumably an asymptomatic condition. When asked if they could monitor blood pressure changes, 46% of 50 nonhypertensive, clinic control cases said yes, as did 71% of 65 patients new to treatment, 92% of 50 patients in continuing treatment, and 94% of 65 re-entry patients, who had previously quit and returned to treatment. Patients in the continuing treatment group, who believed the treatment had beneficial effects upon their symptoms, reported complying with medication and were more likely to have their blood pressure controlled. Patients new to treatment were likely to drop out of treatment if: they had reported symptoms to the practitioner at the first treatment session, or they construed the disease and treatment to be acute. The data suggest that patients develop implicit models or beliefs about disease threats, which guide their treatment behavior, and that the initially most common model of high blood pressure is based on prior acute, symptomatic conditions.     

Women with diarrhoea-predominant irritable bowel syndrome show an increased pressure response to 35% carbon dioxide stress challenge

The responses to inhalation of 35% carbon dioxide (CO(2)) as a stressor were compared in female irritable bowel syndrome (IBS) patients and healthy controls to assess potential differences in cardiovascular, neuroendocrine and behavioural responses to stress. A total of 22 women (12 patients with ROME II defined diarrhoea-predominant IBS and 10 aged-matched controls) were challenged with a single vital capacity breath of 35% CO(2) (with 65% oxygen). Beat-to-beat blood pressure and heart rate were recorded prior to, during and after the inhalation. Serum cortisol concentration and behavioural ratings were measured pre- and post-inhalation. A typical pattern of responses to CO(2) was observed, characterised by a reduction in heart rate and increases in serum cortisol and anxiogenic symptoms; however, these responses did not differ between groups. Both groups also demonstrated an increase in systolic blood pressure; however, this response was significantly enhanced in IBS patients compared to healthy controls (P < 0.05). These findings demonstrate that females with diarrhoea-predominant IBS have an exaggerated pressor response to 35% CO(2) stress challenge, suggesting a more stress-responsive sympathetic nervous system.     

Hypertension reduction through forgiveness training

The objective of this study was to determine if patients with diagnosed stage-1 hypertension could benefit by a forgiveness training program to achieve measurable reductions in anger expression and blood pressure. Twenty-five participants were randomly divided into wait-listed control and intervention groups. The control group monitored blood pressure while the intervention group participated in an 8-week forgiveness training program. At the end of eight weeks, the wait listed group became an intervention group. Those who received forgiveness training achieved significant reductions in anger expression when compared to the control group. While reductions in blood pressure were not achieved by all the participants, those participants who entered the program with elevated anger expression scores did achieve significant reductions in blood pressure. It is suggested that forgiveness training may be an effective clinical intervention for some hypertensive patients with elevated levels of anger.     

个体化降压的临床意义

高血压是由多种病因和发病机制引起的一种慢性疾病,可以导致多种靶器官功能损害,并最终导致严重的心、脑血管并发症,危及人类的健康和生命。如何做到有效的预防和治疗是目前面,临的问题。本文分析了高血压控制的现状,以矛盾的特殊性原理为指导,从高血压的病因和发病机制、临床特点以及药物对个体的敏感性等诸多方面出发,阐述了高血压患者个体差异性。高血压患者个体差异性决定每一个个体综合控制策略的不同,运用“具体问题具体分析”的方法,为每一个个体制定个体化的血压控制方案,以期达到理想的高血压整体控制水平。     

Anxiety management training in the treatment of essential hypertension

The study was conducted to assess the efficacy of Anxiety Management Training as an adjunctive treatment for essential hypertension. Twenty-one patients with essential hypertension, all but one of whom were on antihypertension medication, were randomly assigned either to an Anxiety Management Training condition or a waiting-list control condition. At the time of a posttest assessment session, compared to subjects in the control condition, subjects in the Anxiety Management Training condition manifested a decrease in resting systolic and diastolic blood pressure and a decrease in systolic and diastolic blood pressure following a stressful task. At the time of a follow-up assessment session, subjects in the Anxiety Management Training condition not only manifested good maintenance of reduced blood pressure but also exhibited a further decrease in resting systolic blood pressure and a decrease in systolic blood pressure during the stressful task.     

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.     

An evaluation of the Takeda UA751 automatic sphygmomanometer

The Takeda UA751, a simple automatic blood pressure measuring device, was compared with standard osciltatory measurement. There was little or no systematic difference in pressure determined by the automatic or manual method and the correlation between the two devices for both systolic and distolic pressure was satisfactory. This suggests that the Takeda UA751 is an appropriate device for patient self monitoring of blood pressure or as a measure of pressure in group outcome trials. The results essential replicate an evaluation by Steptoe and Molineux (Behav. Res. Ther. 24 223-226, 1986) of an earlier version of the Takeda (the Copal UA251) that used a different method for determining blood pressure.     

Aerobic cycle exercising in a rehabilitation program with a wider choice of intensity

When patients in rehabilitation programs use cycle ergometers for aerobic fitness training, the exercise intensity is often restricted to a small range of heart rate. In this study, a wider choice of intensities was left to the patients without giving up the potential to reduce cardiac risks factors. 24 patients in 3-wk. rehabilitation programs could choose the exercise intensity up to a workload limit preset by the physical therapist. 20 of them exercised at an intensity covering the full range between the aerobic and anaerobic lactate threshold and 4 a little above. The opportunity to vary the workload was frequently used by 67%. In 75% of the exercise sessions, the patients' average heart rates exceeded moderate heart-rate targets recommended in rehabilitation and health promotion for people with moderate cardiac risks without a graded exercise test. In 72% of these sessions, the anaerobic lactate threshold at 4 mmol/L was not exceeded. But a tendency of 33% of the patients to exercise at higher blood lactate or blood pressure levels underlined the necessity of limiting the exercise intensity.     

The use of restricted environmental stimulation therapy (REST) in the treatment of essential hypertension: Two case studies

The previous paper (Suedfeld et al., 1982, pp. 553–559) reported the use of Restricted Environmental Stimulation Therapy (REST) in treating hypertension. This paper reports the response of two patients to 24 hr of a similar treatment offered as an adjunct to a weight-control program. In both patients blood pressure dropped immediately following the REST session and remained lower for up to 9 months. The initial drop in blood pressure was independent of weight loss. These results are interpreted in terms of a psychobiological model of self-regulation.     

The effects of muscle relaxation and stress on the blood pressure levels of normotensives

Shoemaker and Tasto (1975) found that progressive muscle relaxation lowers the blood pressure levels of essential hypertensives to within a normal range under laboratory conditions. As a sequel to this study the effects of muscle relaxation and stress on the blood pressure levels of normotensives were studied. One group was taught relaxation, one group was stressed, one group read, and one group did nothing. Blood pressure measurements taken immediately after the completion of these tasks indicated that muscle relaxation does not lower the blood pressure levels of normotensives but that stress significantly raises both the systolic and diastolic levels.Level of arousal can, at least in one sense, be viewed as occurring on a dimension defined by extreme anxiety at one end and extreme relaxation at the other. Research on the physiological correlates and/or defining properties of arousal has produced inconsistent and equivocal results. Little work has been done relating blood pressure levels to arousal, however. Shoemaker and Tasto (1975) found a consistent and predictable drop in the blood pressure levels of essential hypertensives as a result of progressive muscle relaxation. In their study those subjects with the highest blood pressure levels showed the greatest drop while those with moderately high levels showed moderate drops and those with the lowest levels (yet still above normal) showed the least amount of change. The amount by which blood pressure dropped as a result of progressive relaxation was positively correlated with the pretreatment level of blood pressure. The result of progressive relaxation was to lower blood pressure levels to within a normal range, with all subjects appearing to approach a lower asymptotic level. Because of the consistent picture which began to emerge, the question arose as to whether blood pressure might be a reliable physiological correlate of the relaxation-anxiety dimension.The more specific questions emanating from this issue were: what effect does progressive relaxation have on the blood pressure levels of normotensives; what effect does stress have on the blood pressure levels of normotensives; and, what effect does stress have on the blood pressure levels of essential hypertensives? Since we could not immediately foresee the benefits that would outweigh the potential harm that might arise by placing hypertensives under stress, this study was limited to addressing the first two questions.Since the blood pressure levels of normotensives are probably at an optimal level for the physiological functioning of the organism, lower levels would be physiologically nonadaptive. and thus progressive relaxation should not lower the blood pressure levels of normotensives as it does those of essential hypertensives. On the other hand, if the elevated blood pressure levels of essential hypertensives are at least in part the result of a stress reaction, it would be expected that the blood pressure levels of normotensives might rise under stress conditions.     

Social support group attendance is related to blood pressure, health behaviours, and quality of life in the Multicenter Lifestyle Demonstration Project

Changes in coronary risk factors, health behaviours, and health-related quality of life (HRQOL) were examined by tertiles of social support group attendance in 440 patients (21% females) with coronary artery disease. All patients participated in the Multicenter Lifestyle Demonstration Project (MLDP; eight hospital sites in the USA), an insurance-covered multi-component cardiac prevention program including dietary changes, stress management, exercise and group support for 1 year. Significant improvements in coronary risk factors, health behaviours, and HRQOL were noted at 1 year. Several of these improvements (i.e. systolic blood pressure, health behaviours, HRQOL) were related to social support group attendance, favoring those who attended more sessions. The associations between support group attendance to systolic blood pressure and to four HRQOL subscales (bodily pain, social functioning, mental health, and the mental health summary score) remained significant when controlling for changes in health behaviours, but dropped to a non-significant level for the HRQOL subscales 'physical functioning', 'general health' and 'role-emotional'. These results suggest an independent relationship of social support group attendance to systolic blood pressure while improvements in quality of life may be in part due to improved health behaviours facilitated by increased social support group attendance.     

Age-related effects of blood pressure on everyday cognitive function in community-dwelling women

ABSTRACT

Objectives: Blood pressure is an indicator of vascular health that has been associated with cognition and quality of life in older age. Few studies have examined blood pressure across everyday cognitive tasks, which may have superior predictive functional utility than traditional cognitive measures. We explored blood pressure as a predictor of everyday problem solving (EPS) performance in middle-aged and older women. Method: Community-dwelling women (age: 51–91) with low-normal blood pressure to mild hypertension underwent traditional and everyday cognitive testing. EPS was determined by the number of safe/effective solutions generated for real-world scenarios. Results: Analyses revealed that lower systolic blood pressure and pulse pressure were associated with worse EPS ability after controlling for age, education, and traditional cognitive abilities. Discussion: These results support that blood pressure may be an important predictor of everyday cognitive abilities in older age. Potential implications for real-world functioning are discussed.     

糖尿病高血压和糖尿病肾病患者血清MMP-2及TIMP-1的表达及意义

为了探讨MMP-2、TIMP-1在DMEH和DN发病中的意义,随机收集T2DM患者146例,其中SDM 57例,DMEH 38例,DN 51例,健康对照38例。用ELISA法测定MMP-2、TIMP-1的含量。结果显示,DM患者尤其是DMEH和DN患者血清MMP-2明显低于健康对照组,P均〈0.01,且随病情发展呈逐渐降低趋势。而血清TIMP-1随病情的发展则呈现明显的上升趋势,SDM、DMEH组和DN组与健康对照组比较,分别为P〈0.05,P〈0.01和P〈0.01。因此,MMP-2和TIMP-1可能参与了DMEH和DN的发生发展过程,定期检测DM患者血清MMP-2和TIMP-1的含量变化有助于DM并发症的早期诊断和疗效观察。     

A cry unheard: sudden reductions in blood pressure while talking about feelings of hopelessness and helplessness.

This paper describes sudden extreme drops in blood pressure in both experimental and clinical situations when a person is talking about or describing situations of hopelessness and helplessness. These changes are discussed in the context of historical perspectives about the cardiovascular system. A new perspective is introduced, one in which these blood pressure changes are seen as part of an unheard cry for understanding. It is hypothesized that such changes do not occur in response to a person's attempts to communicate a sense of hopelessness, but rather are the biological foundations of the hopelessness itself. Viewed from such a context an entirely new therapeutic approach is outlined regarding the treatment of patients suffering from a wide variety of psychosomatic as well as psychological disturbances.     

"I can tell when my blood pressure is up, can't I?"

Forty-four insurance company employees were measured on blood pressure, moods, symptoms, and predictions of their blood pressures, twice daily for 10 days. Twenty subjects had elevated blood pressure and 24 did not. The measures were correlated within-subjects to determine if blood pressure predictions were associated with moods, symptoms, or blood pressure readings, and if moods and symptoms were related to blood pressure. Predictions of pressure were expected to be correlated with symptoms and moods, but not with blood pressure. No strong relationship was expected when blood pressure was compared to symptoms or to moods. The data showed that self-predictions of blood pressure were most strongly associated with reported symptoms, next with reported moods, and least with actual blood pressure. A comparison of subjects who were accurate in predicting their blood pressure with those who were not showed no differences in blood pressure levels, systolic blood pressure variation, self-esteem, or private body-consciousness. Subjects' beliefs that they could monitor blood pressure were little influenced by contrary information. The results suggest it would be an error to encourage subjects to believe they can successfully treat blood pressure elevations by monitoring symptoms related to blood pressure change.     

Blood pressure reactivity to active and passive behavioral conditions in hypertensives and normotensives

Blood pressure reactivity and passive behavioral tasks was studied in patients with mild essential hypertension and normotensive controls. The passive condition included 10 presentations of a 6 sec, 78 dB, 1000 Hz tone without any response requirements. In the active condition subjects were given an additional 10 tone presentations and asked to press a push-button at tone termination. The absolute and percent increase in systolic blood pressure from rest was greater in hypertensives than normotensives in response to the active condition but similar to the passive condition. It is concluded that patients with hypertension compared to normotensive controls show exaggerated blood pressure reactivity to tasks involving active but not passive coping efforts. Since the tasks used to induce active and passive coping in the present study were identical apart from coping requirements, the notion that the activity dimension in and of itself modulates reactivity differences between patients and controls is supported.     

Effects of Medical Resonance Therapy Music on patients with psoriasis and neurodermatitis--a pilot study.

Stress medicine has shown that emotional disharmony can be a substantial factor for skin diseases. The harmonisation of the emotional status and a corresponding reduction of stress hormones by the Medical Resonance Therapy Music (MRT-Music) as shown in other studies (1,2,3,4) inspired us to investigate its benefits for patients with psoriasis vulgaris and neurodermatitis (neurodermatitis constitutionalis atopica). Over a period of 14 days we measured the parameters of blood pressure, heart rate, stimulus to scratch and the degree of sickness in two, respectively four groups of 68 patients in total: two experimental groups (psoriasis/neurodermatitis) and two control groups. All patients received the normal treatment of our hospital, the experimental groups were additionally treated with 3 x 30 minutes of MRT-Music per day, while the controls were asked to somehow relax during this time. In the experimental groups the measurements showed a reduction of blood pressure and heart rate and revealed an enhanced reduction of the stimulus to scratch and an enhanced reduction in the degree of sickness. Interestingly the effects of MRT-Music were stronger with the psoriasis patients than with the neurodermatitis patients. The results of this pilot study convinced us to offer the treatment with the Medical Resonance Therapy Music to all our patients.     

A cry unheard: Sudden reductions in blood pressure while talking about feelings of hopelessness and helplessness

This paper describes sudden extreme drops in blood pressure in both experimental and clinical situations when a person is talking about or describing situations of hopelessness and helplessness. These changes are discussed in the context of historical perspectives about the cardiovascular system. A new perspective is introduced, one in which these blood pressure changes are seen as part of an unheard cry for understanding. It is hypothesized that such changes do not occur in response to a person’s attempts to communicate a sense of hopelessness, but rather are the biological foundations of the hopelessness itself. Viewed from such a context an entirely new therapeutic approach is outlined regarding the treatment of patients suffering from a wide variety of psychosomatic as well as psychological disturbances.     

Global Versus Health-Specific Social Support and Match of Preferred and Perceived Social Support Levels in Relationship to Compliance and Blood Pressure of Hypertensives1

A comparison of the relative usefulness of a standardized measure of global perceived social support (Procidano and Heller, 1983) with a health-specific index showed that the latter was a better predictor of compliance for a sample consisting mostly of older female hypertensives. However, the relationship of support and compliance to actual health, as measured by blood pressure levels at two times separated by 3 to 6 months, was found to be weak. The hypothesis that the degree of fit between preference for social support and amount of perceived support would affect compliance was not upheld. A model of social support as the positive reaction of others to patients with good health status was proposed as an alternative or complement to the prevalent model in which support is viewed as an antecedent of compliance, and eventually, of improved health.