Between-person and within-person approaches to the prediction of ambulatory blood pressure: the role of affective valence and intensity

Acute Experiences of Negative Interpersonal Interactions: Examining the Dynamics of Negative Mood and Ambulatory Blood Pressure Responses Among Black and Hispanic Urban Adults

BACKGROUND

Negative interpersonal interactions are associated with acute increases in ambulatory blood pressure (ABP). Yet, the mechanisms underlying this relationship are unclear.

PURPOSE

This study tested whether negative interpersonal interactions predict higher ABP both in the moment and during subsequent observations, and whether increases in negative mood mediate these relations. These associations were tested among Black and Hispanic urban adults who may be at higher risk for negative interpersonal interactions as a function of discrimination. Race/ethnicity and lifetime discrimination were tested as moderators.

METHODS

Using a 24-hr ecological momentary assessment (EMA) design, 565 Black and Hispanic participants (aged 23-65, M = 39.06, SD = 9.35; 51.68% men) had their ABP assessed every 20 min during daytime accompanied by an assessment of negative interpersonal interactions and mood. This produced 12,171 paired assessments of ABP and self-reports of participants' interpersonal interactions, including how much the interaction made them feel left out, harassed, and treated unfairly, as well as how angry, nervous, and sad they felt.

RESULTS

Multilevel models revealed that more intense negative interpersonal interactions predicted higher momentary ABP. Mediation analyses revealed that increased negative mood explained the relationship between negative interpersonal interactions and ABP in concurrent and lagged analyses. Discrimination was associated with more negative interpersonal interactions, but neither race/ethnicity nor lifetime discrimination moderated findings.

CONCLUSIONS

Results provide a clearer understanding of the psychobiological mechanisms through which interpersonal interactions influence cardiovascular health and may contribute to health disparities. Implications include the potential for just-in-time interventions to provide mood restoring resources after negative interactions.

The association between self-reported stress and cardiovascular measures in daily life: A systematic review

BACKGROUND

Stress plays an important role in the development of mental illness, and an increasing number of studies is trying to detect moments of perceived stress in everyday life based on physiological data gathered using ambulatory devices. However, based on laboratory studies, there is only modest evidence for a relationship between self-reported stress and physiological ambulatory measures. This descriptive systematic review evaluates the evidence for studies investigating an association between self-reported stress and physiological measures under daily life conditions.

METHODS

Three databases were searched for articles assessing an association between self-reported stress and cardiovascular and skin conductance measures simultaneously over the course of at least a day.

RESULTS

We reviewed findings of 36 studies investigating an association between self-reported stress and cardiovascular measures with overall 135 analyses of associations between self-reported stress and cardiovascular measures. Overall, 35% of all analyses showed a significant or marginally significant association in the expected direction. The most consistent results were found for perceived stress, high-arousal negative affect scales, and event-related self-reported stress measures, and for frequency-domain heart rate variability physiological measures. There was much heterogeneity in measures and methods.

CONCLUSION

These findings confirm that daily-life stress-dynamics are complex and require a better understanding. Choices in design and measurement seem to play a role. We provide some guidance for future studies.

What Can We Learn From More Than 140,000 Moments of Ecological Momentary Assessment-Assessed Negative Emotion and Ambulatory Blood Pressure? A Systematic Review and Meta-Analysis

OBJECTIVE

Two decades of research has examined within-person associations between negative emotion states and ambulatory blood pressure (ABP) using ecological momentary assessment (EMA), but no meta-analysis has been conducted. We conducted this systematic review and meta-analysis to quantify the magnitude of this association and identify moderators, review strengths and weaknesses in conceptual and measurement approaches, and provide recommendations.

METHODS

We searched databases (PsycINFO, PubMed), identified 15 studies, and obtained data from 13 studies (n = 2511; 142,307 observations).

RESULTS

Random-effects meta-analyses demonstrated small effect r values between momentary negative emotions and systolic ABP (r = 0.06) and diastolic ABP (r = 0.05; p values < .001). Meta-regressions found that effects were larger among studies focused on anxiety, multidimensional negative emotions, predominantly female samples, or less observations of each participant (p values from .003 to .049). A qualitative review found that few studies examined moderators contributing to the substantial interindividual differences in this association.

CONCLUSIONS

The small association between momentary negative emotion and ABP extends laboratory findings on the association between the experiential and physiological aspects of emotion to the daily, natural emotional experiences of individuals. This literature could be strengthened by determining interindividual and intraindividual moderators of this association (e.g., trait negative emotion and state positive emotion), examining differential associations of different negative emotions with ABP, and standardizing EMA protocols. Although the effect is small, to the extent that repeated emotion-related cardiovascular reactivity may contribute to cardiovascular disease risk, identifying daily life triggers of emotion is important.

Intra-individual Associations of Perceived Stress, Affective Valence, and Affective Arousal with Momentary Cortisol in a Sample of Working Adults

BACKGROUND

Research pairing ecological momentary assessment (EMA) methodology and ambulatory cortisol during daily life is still rare, as is careful testing of the within-person associations between stress, affect, and cortisol. Using a circumplex approach, we considered both valence and arousal components of affect.

PURPOSE

To examine the within-person covariation of momentary cortisol with momentary perceived stress, affective valence, and affective arousal in everyday life.

METHODS

115 working adults (Mage = 41.2; 76% women; 76% white) completed six EMA surveys per day over 3 days. Each assessment included reports of perceived stress and affect (used to construct indicators of affective valence and arousal), followed by a saliva sample (from which cortisol was assessed). Multi-level models were used to examine the momentary associations between perceived stress, affective valence, affective arousal, and cortisol.

RESULTS

Moments characterized by higher perceived stress were associated with higher cortisol (p = .036). Affective valence covaried with cortisol (p = .003) such that more positive valence was associated with lower cortisol and more negative valence with higher cortisol. Momentary affective arousal was not related to cortisol (p = .131). When all predictors were tested in the same model, only valence remained a significant predictor of cortisol (p = .047).

CONCLUSION

Momentary perceived stress and affective valence, but not affective arousal, were associated with naturalistic cortisol. Cortisol was more robustly associated with affective valence than perceived stress or affective arousal. These findings extend our understanding of how moments of stress and particular characteristics of affective states (i.e., valence but not arousal) may "get under the skin" in daily life.

Ambulatory blood pressure variability: a conceptual review

Ambulatory blood pressure (ABP) has long been recognized by researchers as the gold standard of blood pressure (BP) measurement. Researchers and clinicians typically rely on the mean measure of ABP; however, there is considerable variability in the beat-to-beat BP. Although often ignored, this variability has been found to be an independent predictor of cardiovascular disease and mortality. The aim of this paper is to provide a conceptual review of ABP variability (ABPV) focusing on the following: associations between ABPV and health, whether ABPV is reliable, how to calculate ABPV, predictors of ABPV, and treatments for ABPV. Two future directions are discussed involving better understanding ABPV by momentary assessments and improving knowledge of the underlying physiology that explains ABPV. The results of this review suggest that the unique characteristics of ABPV provide insight into the role of BP variability in hypertension and subsequent cardiovascular illness.