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

Cardiovascular reactivity to video game and mental arithmetic stressors was compared among three groups of men: aerobically trained mild hypertensives, untrained mild hypertensives, and a comparison group of untrained normotensives. Relative to the untrained hypertensives, the trained hypertensives reacted to the video game with marginally smaller systolic blood pressure and diastolic blood pressure, but there were no significant differences between these groups in reactivity during the mental arithmetic task. Comparisons between each hypertensive group and the normotensive group showed that 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. These 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.     

Neuropeptide and cardiovascular responses to intravenous catheterization in normotensive and hypertensive blacks and whites

Research suggests that heightened cardiovascular and neuroendocrine (typically catecholamine) responses to stressors may lead to the development of hypertension and that there may be race differences in patterns of reactivity that are potentially pathogenic. Certain neuropeptides exert profound effects on blood pressure (BP) and heart rate (HR), yet no published studies have examined relationships between these peptides, hypertensive status, race, and reactivity. Seventeen Black and 20 White normotensive and borderline-hypertensive male 19- to 50-year-olds underwent intravenous catheterization while cardiovascular and neuropeptide responses to the stress of being catheterized were examined. Results indicate that, in response to the stressor, Black hypertensives, showed significantly lower endorphin levels compared to Black normotensives, and White hypertensives showed significantly higher levels of beta-endorphin compared to White normotensives. Groups were not significantly different in endorphin levels at recovery. Black hypertensives also showed significantly higher stressor-induced HR and systolic and diastolic BP compared to White hypertensives and normotensives. Lower levels of beta-endorphin and lower urine sodium excretion were associated with higher BP and HR.     

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.     

Blood pressure estimation and beliefs among normotensives and hypertensives

Although health professionals believe that blood pressure (BP) is asymptomatic, most diagnosed hypertensives are confident that they experience specific symptoms and emotions that help them detect their BP levels. Several months after screening interviews that elicited subjects' BP beliefs, 14 medicated hypertensives, 15 nonmedicated mild hypertensives (diastolic BP greater than or equal to 90 mm Hg), 39 normotensives, and 13 hypotensives (systolic BP less than or equal to 100 mm Hg) participated in a 1- to 2-hr laboratory experiment that assessed each subject's symptoms, moods, and estimates of systolic BP (SBP) relative to actual SBP levels. Several self-reports and autonomic measures were collected 45 times during and after each of 22 tasks. Subjects never received SBP feedback during the experiment. Within-subject correlations indicated that all subject groups could estimate SBP at levels greater than chance (mean estimated SBP-actual SBP correlation = .25). Further, 68% of the subjects evidenced at least one significant symptom-SBP correlation. Although medicated hypertensives believed they could estimate their BP more accurately than other groups by using their symptoms and emotions, they were actually no more accurate than the other groups. They also evidenced far fewer empirically derived symptom-SBP and emotion-SBP correlations than any other group. Overall, BP beliefs were largely inaccurate. If these erroneous beliefs can be eliminated, subjects may be able to estimate BP fluctuations more accurately.     

Behavioral predictors of blood pressure variation in hypertensives and normotensives

This study examined the relative impact of five behavioral factors--activity, posture, location, social involvement, and tension--on the 24-hr blood pressure (BP) variability of 21 normotensives, 18 borderline hypertensives, and 18 sustained essential hypertensives. Multiple-regression analyses indicated that within each diagnostic group, activity accounted for more variance in BP variability than any other behavioral dimension. For each behavioral dimension examined, the magnitude of the relationship with BP was generally greater for the normotensives than for both hypertensive groups. In contrast, variation due to individuals was a better predictor of BP variability for the two hypertensive groups than for the normotensive group. Number of months hypertensive and use of antihypertensive medication were related to BP variability for the sustained hypertensive group. Findings have implications for the use of ambulatory BP monitors and interpretation of resulting data.     

Differences in personality between sustained hypertension,isolated clinic hypertension and normotension

The aim of this study was to determine whether there are differences in personality between hypertension and normotension. Forty‐two male patients with essential hypertension were divided into two groups after self‐assessment of blood pressure, 18 with sustained hypertension and 24 with isolated clinic (white coat) hypertension, and were compared with 25 men with normotension on Spielberger's State‐Trait Anxiety Inventory and the Jenkins Activity Survey. In line with hypotheses, the sustained hypertensive group showed higher levels of trait anxiety, Type A behaviour pattern, and hard‐driving behaviours/competitiveness than the normotensive group, whereas isolated clinic hypertensives occupied an intermediate position between those two groups. Results provide support to the hypothesised relationship between personality and hypertension and stress the need of distinguishing sustained hypertension from isolated clinic hypertension. Copyright © 2006 John Wiley & Sons, Ltd.     

Poor emotional responsiveness in clinical hypertension: Reduced accuracy in the labelling and matching of emotional faces amongst individuals with hypertension and prehypertension

Psychological factors are known to play an important part in the origin of many medical conditions including hypertension. Recent studies have reported elevated blood pressure (even in the normal range of variation) to be associated with a reduced responsiveness to emotions or ‘emotional dampening’. Our aim was to assess emotional dampening in individuals with more extreme blood pressure levels including prehypertensives (N = 58) and hypertensives (N = 60) by comparing their emotion recognition ability with normotensives (N = 57). Participants completed novel facial emotion matching and facial emotion labelling tasks following blood pressure measurement and their accuracy of emotion recognition and average response times were compared. The normotensives demonstrated a significantly higher accuracy of emotion recognition than the prehypertensives and the hypertensives in labelling of facial emotions. This difference generalised to the task where two facial halves (upper & lower) had to be matched on the basis of emotions. In neither the labelling nor matching emotion conditions did the groups differ in their speed of emotion processing. Findings of the present study extend reports of ‘emotional dampening’ to hypertensives as well as to those at-risk for developing hypertension (i.e. prehypertensives) and have important implications for understanding the psychological component of such medical conditions as hypertension.     

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.     

Voluntary Blood Pressure Control: Operant Conditioning by a Continuous Blood Pressure Feedback Technique

Abstract

The present study evaluated a single session operant conditioning of blood pressure in borderline hypertensives. A double blind randomized two period (each lasting for 20 minutes) cross over study consisting of a treatment (operant conditioning of mean arterial blood pressure) and a control condition (heart rate) was performed. Sequence of treatments was randomly assigned. Fourteen borderline hypertensive subjects participated and were trained to decrease their continuously measured blood pressure (Finapres) and heart rate. Subjects receiving blood pressure feedback during the first session showed a significant (4.3 mmHg) decrease in diastolic blood pressure. In contrast, subjects receiving blood pressure training during the second session showed a non-significant increase in diastolic blood pressure. Treatment consisting of more sessions is a promising adjunct to antihypertensive regimens.     

THE EFFECTS OF FEEDBACK ON BLOOD PRESSURE DISCRIMINATION

Discrimination of blood pressure in the natural environment as a function of feedback was assessed. Seventeen normotensives screened for blood pressure lability were randomly assigned to two groups. These subjects were then asked to estimate their systolic and diastolic blood pressure values two times per day over a 4-week period. Feedback for accuracy of blood pressure discriminations was implemented across the two groups in a multiple baseline fashion, using a feedback withdrawal condition in Group I to assess maintenance effects over time. Results showed improvement in discrimination accuracy for subjects in both groups when feedback was used, and no decrement in performance over a 2-week period after feedback was removed for subjects in Group I. Discrimination of systolic pressures improved at a slightly faster rate than discrimination of diastolic pressures.     

Instrumental and disinhibited financial risk taking: Personality and behavioural correlates

Risk taking, including that within the financial domain, is often considered to represent a unidimensional personality trait. This paper considers the relatively unexplored construct of instrumental financial risk taking: a class of behaviours that while inherently risky, are entered into with a greater degree of consideration than more impulsive or disinhibited forms of risk taking. Participants (N = 1043) completed a novel questionnaire assessing instrumental and disinhibited financial risk taking as part of a battery including measures of: sensation-seeking, impulsivity, psychopathic personality traits and real life financial outcomes. Correlations revealed a divergent pattern of relationships supporting the utility of characterising these different forms of financial risk. Scores on the novel instrument are shown to explain more than 10% of the variance in the use of riskier, more productive savings products, over and above the influence of demographics and financial status.     

Effects of beta blockade with metoprolol on simple and complex task performance

The effect of treatment with the beta-blocker metoprolol on several indicants of task performance was investigated. Twenty-five male hypertensives were treated for 2 weeks each with drug and placebo in a double-blind crossover design. Comparisons to 25 matched untreated normotensives were made. Participants responded twice to a Mood Adjective Check List (MACL) and the Stroop Color-Word Test. In addition, they participated in two parallel decision-making simulations. Normotensives and hypertensives on drug or placebo did not differ on MACL and Stroop scores. Comparisons on 12 validated simulation measures showed that drug treatment with metoprolol aided complex task performance. Drug treatment improved strategic capacity and the ability to deal effectively with emergencies. Preliminary evidence that treatment with metoprolol might help restore performance capacity that may have been lost due to hypertensive disease was also obtained.     

Identifying the psychopath: The relation of Cleckley's criteria to the interpersonal domain

The relationship between interpersonal behaviour variables has been shown to be defined by a circular ordering, or circumplex, within the framework of a two-dimensional space. It is proposed that Cleckley's criteria of psychopathy represent one axis of this system, hostility vs warmth. It is also proposed that these criteria alone are not sufficient to identify a homogeneous group of deviant persons. Observer ratings of the behaviour of institutionalized mentally-disordered offenders were obtained for Cleckley's criteria and for behavioural dimensions of impulsive aggression and sociability. Cleckley's criteria were found to describe a unitary dimension whose relationship to other variables was consistent with the circumplex model. Cluster analysis of the ratings identified two distinct groups of high scorers on Cleckey's criteria, who were also significantly differentiated by self-report personality variables. Only one of these groups showed the combination of lack of warmth or affection and lack of behavioural control which several investigators consider necessary to define psychopathy. Relationships among individual rating items and some of the personality variables closely approximated the expected circular ordering. Reference to this interpersonal circumplex appears to reconcile some of the differences in current conceptualizations of psychopathic personality.     

Adult ADHD: Associations with Personality and Other Psychopathology

The goals of this study were to explicate adult ADHD’s relations with personality at both the domain and facet levels and to examine its associations with other psychological symptoms. Community members (N?=?294) completed measures assessing ADHD inattentive and hyperactive/impulsive symptoms, five-factor model personality domains and facets, and other internalizing and externalizing symptoms. Inattentiveness showed strong negative relations with conscientiousness and extraversion and strong positive relations with neuroticism; in contrast, hyperactivity/impulsivity related negatively to agreeableness, positively to extraversion, and weakly to neuroticism. Whereas inattentiveness emerged as a positive predictor of internalizing psychopathology—and depression in particular—hyperactivity/impulsivity related weakly to internalizing but more strongly to externalizing psychopathology. Thus, inattentive and hyperactive/impulsive symptoms showed differential relations with personality—at both the domain and facet levels—and with other psychological symptoms. These results demonstrate the value in examining ADHD’s relations with personality facets and with a wide range of psychopathology within the same study.     

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.     

Comorbid attention-deficit/hyperactivity disorder in borderline patients defines an impulsive subtype of borderline personality disorder

In order to examine the impulsive profile of a BPD sample with comorbid ADHD, adult patients who met criteria for BPD were assessed for ADHD with the CAADID and the WURS. A high rate of ADHD in the BPD sample was found, with sixty-nine (38.1%) BPD patients diagnosed as having comorbid adult ADHD. BPD-ADHD group had higher rates of general substance use disorder (59.4% vs. 38.4%), antisocial personality disorder (7.2% vs. 0.9%) and obsessive-compulsive personality disorder (21.7% vs. 6.3%). The BPD group without comorbid adult ADHD showed a higher rate of mood disorders (62.5% vs. 37.7%), panic disorders (54.5% vs. 23.1%) and benzodiazepine abuse (18.8% vs. 5.8%). Only in BPD patients without ADHD was comorbid avoidant personality disorder found. BPD patients could be distinguished in two clear subgroups related to the adult ADHD comorbidity. BPD-ADHD patients showed a more homogeneous and impulsive profile while BPD without ADHD comorbidity had more anxiety and depressive disorders.     

Impulsivity and speed and errors in a reaction time task: a contribution to the construct validity of the concept of impulsivity

Acting on the spur of the moment without considering the effects is one of the core attributes of the extraversion-impulsivity concept. Performance in a choice-reaction time task may reflect this tendency. Reaction time and number of errors were studied in a group of 55 boys (15–17 years). Extraversion-impulsivity, anxiety proneness and some other personality characteristics were measured by inventory scales. As hypothesized more impulsive subjects had shorter reaction times and made more errors than less impulsive. This relationship was rather stable over a period of one month. Subjects with higher scores in the Psychoticism scale of the Eysenck Personality Questionnaire tended to make more errors. A considerable amount (36%) of the variance in the number of errors variable could be predicted from the three personality variables Impulsiveness, Muscular Tension and Psychoticism.     

Are the interpersonal and identity disturbances in the borderline personality disorder criteria linked to the traits of affective instability and impulsivity?

This study examines the degree to which two putative biologically influenced personality traits, affective instability and impulsive aggression, are associated with some of the interpersonal and intrapsychic disturbances of borderline personality disorder (BPD) and with choice of defense mechanism. In a sample of 152 personality disorder patients, affective instability and impulsive aggression were measured. Defense mechanisms were assessed in 140 of these patients using the Defensive Style Questionnaire (DSQ). The correlations between the traits of affective instability and impulsive aggression and the eight DSM-III-R criteria for borderline personality disorder and 20 DSQ defenses were examined. Affective instability was significantly correlated with the DSM-III-R criteria of identity disturbance, chronic emptiness or boredom, inappropriate anger, suicidality, and the affective instability criteria. It also was associated with the defenses of splitting, projection, acting out, passive aggression, undoing, and autistic fantasy. Impulsive aggression was related to unstable interpersonal relationships, inappropriate anger and impulsiveness and with the defense of acting out. It was negatively correlated with the defenses of suppression and reaction formation. A number of the interpersonal and experiential disturbances and defense mechanisms that are features of BPD are associated with the traits of affective instability and impulsive aggression among patients with personality disorders.     

Risk-taking and impulsive personality traits in proficient downhill sports enthusiasts

Although past studies have examined how personality traits may motivate participation in high-risk sports, few previous studies have examined impulsive personality correlates with risk-taking within a group of sports enthusiasts. We examined relationships between measures of personality and risk-taking on the slopes as measured by a sport-specific Sensation Seeking Scale in a sample of proficient-level skiers and snowboarders (N = 123, 61% male). Significant correlations were found between risk-taking and multiple traits including Reward Sensitivity, Punishment Sensitivity, and Sensation Seeking, implying that some traits that motivate participation in high-risk sports also lead to more risky behavior while participating in said sports. Rash Impulsivity, though not found to distinguish participants from non-participants in previous studies, did correlate with risk-taking behavior on the slopes. The results of this study show that while some aspects of impulsive personality may motivate risky sport participation, other traits may be related to risky behavior once engaged in the sport.     

Psychoneurocardiology: Psychosomatic and somatopsychic approaches to hypertension research

We introduce the field of psychoneurocardiology, and cite examples of research into psychosomatic and somatopsychic bases for hypertensive development. Beta-adrenergic hyperreactivity (a possible precursor of hypertension), as indexed by electrocardiographic T-wave amplitude suppression, was greater during active than passive coping tasks. The rise in tonic mean arterial blood pressure in normotensives over a 19-month period was a joint function of self-reported daily stress and baroreceptor-dependent pain dampening (as determined by the PRES method of noninvasive controlled carotid baroreceptor manipulation). The latter finding provides support for the learned model of hypertension. In this model, phasic blood pressure increases stimulate the baroreceptors, which in turn dampen pain and stress. The long-term effect of this relief is initially to increase the frequency of such phasic increases, and eventually to produce a tonic elevation in blood pressure.