Blood pressure and personality

The relationship between hypertension and health-related quality of life: adjusted by chronic pain, chronic diseases, and life habits in the general middle-aged population in Japan

OBJECTIVES

The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan.

METHODS

This study is a population-based cross-sectional study. In this study, 1117 participants aged 40-65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation).

RESULTS

In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = -8.84, 95 % confidence interval (95 % CI) = -13.3 to -4.34, standardized coefficients; β = -0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30-10.0, β = 0.149, p < 0.05) after adjusting by chronic pain and life habits.

CONCLUSIONS

These results may be due to the sex difference in the light of the perception for health.

Does dissociation of emotional and physiological reactivity predict blood pressure change at 3- and 10-year follow-up?

One of the major theories of psychosomatic medicine is that pervasive dissociations between physiological reactivity and simultaneous emotion awareness may be an important marker for the long-term development of cardiac problems. Subjective autonomic discrepancy (SAD) scores are proposed as a method of capturing the dissociation between physiological and emotional reactivity and increasing the explanatory power of predictive models of cardiac health outcomes. It was found that SAD scores for blood pressure indices show trait-like stability over a period of 3 years. Although linear 3-year prediction of systolic blood pressure came close to traditional definitions of significance, neither a linear nor a quadratic model was found to show significant prospective validity in predicting ambulatory blood pressure change over a 10-year period. Dissociation between physiological arousal and emotional awareness does not appear to be an important variable in the identification of individuals at risk for later cardiovascular health problems.

Emotional reactivity and the overreport of somatic symptoms: somatic sensitivity or negative reporting style?

OBJECTIVE

The purpose of this study is to examine the role of emotional reactivity (ER) in symptom reporting and conceptualize somatizing processes as a signal detection task. Emotional reactivity has been theorized to influence symptom reporting through somatic sensitivity as well as via a negative reporting style. We assess the degree to which these two competing theories about the role of ER are accurate within the signal detection framework.

METHODS

We used a multimethod approach that included using both static and prospective self-reports as well as a signal detection task.

RESULTS

Results suggest that ER exerts its influence on somatization tendencies via a negatively biased reporting style and is not mediated by somatic sensitivity as suggested by the somatosensory amplification and the symptom perception hypothesis.

CONCLUSION

Emotional reactivity has yet to be associated with objective measures of somatic sensitivity. Until such an association is found, it is likely that ER influences symptom reports via negatively biased reporting.

Elevated blood pressure and self-reported symptom complaints, daily hassles, and defensiveness

The association between elevated blood pressure and low rates of self-reported problems has been hypothesized to be mediated by defensiveness. In a population screening study in which 1,120 women and 903 men between 20 and 55 years of age participated, multiple resting home blood pressure measurements were performed and questionnaires were administered measuring symptom complaints, daily hassles, and defensiveness. In women, after control for potential confounders, a low number of self-reported symptoms was associated with elevated blood pressure. However, this effect was not mediated by defensiveness, although repressive defensiveness predicted independently elevated blood pressure in women. In men, no significant associations were obtained. Furthermore, no relations emerged between daily hassles and elevated blood pressure. In conclusion, although defensiveness was more prevalent among women with elevated blood pressure, it does not provide a good explanation for the low rates of self-reported symptoms found in these women.

Type D personality is related to cardiovascular and neuroendocrine reactivity to acute stress

OBJECTIVE

The relationship between Type D personality (the joint tendency towards negative affectivity [NA] and social inhibition [SI]) and laboratory indices of cardiovascular health was examined.

METHOD

173 undergraduates (86 male) completed a stress protocol involving a mental arithmetic task with harassment. Blood pressure, heart rate (HR), and salivary cortisol were measured both prior to and during the task.

RESULTS

The relationships between personality and both resting and reactivity levels were examined. Results indicated that socially inhibited men demonstrated heightened blood pressure reactivity. NA was related to dampened HR change during the stress task in men. Correlational analyses indicated that both Type D dimensions were associated with greater cortisol reactivity to stress; however, results no longer remained significant in more stringent regression analyses.

CONCLUSION

Findings are consistent with the noted relationship between Type D and cardiovascular disease (CVD), and suggest a possible pathway to disease via an association with physiological hyperreactivity.

Hypertension awareness and pain reports: data from the NHANES III

BACKGROUND

For this study we investigated the relationship between hypertension, pain reports, and hypertension awareness in a large and diverse sample of men and women.

METHOD

Data collected during the Third National Health and Nutrition Examination Survey (NHANES III) were examined for reports of pain at four body sites (chest, back, legs, and gallbladder) in 9,427 adults. Respondents were classified into four groups based on their self-reports of a previous diagnosis of hypertension (yes, no) and their current blood pressure levels (hypertensive, normotensive).

RESULTS

Logistic regression analyses indicated that hypertensives who were unaware of their condition were significantly less likely to report chest pain than normotensives without a previous hypertension diagnosis; however, these groups did not differ in pain reports at other body sites. In contrast, both hypertensives and normotensives with a previous hypertension diagnosis were significantly more likely to report pain at several body sites as compared to normotensives without a previous hypertension diagnosis. It was also found that when hypertension awareness was held constant, resting systolic blood pressure was negatively associated with the likelihood of reporting chest and gallbladder pain.

CONCLUSIONS

These findings suggest that existing laboratory evidence of hypertension-related hypoalgesia may not translate to decreased daily pain symptoms, although there is intriguing evidence of dampened cardiac pain in hypertensives who are unaware of their condition.

Relationship between personality and self-measured blood pressure value at home: the Ohasama study

We conducted a cross-sectional community survey in northern Japan to assess the relationship between personality and home blood pressure value. The Japanese version of the short-form Eysenck personality questionnaire was used to assess personality. A total of 999 people selected from the general population participated. We showed that the personality extroversion score positively affected the systolic blood pressure value, whereas no significant relationship was observed between personality psychoticism or neuroticism and blood pressure value. This study is the first to clarify the relationship between personality assessed by the Eysenck personality questionnaire and blood pressure measured in a non-medical setting. When physicians investigate the pathogenesis of essential hypertension, they should take psychological factors into consideration, as well as the many environmental and genetic factors.

Relationship of depressive symptoms to hypertension in a household survey in Harlem

OBJECTIVE

Two possible explanations for an hypothesized association between depression and hypertension were examined: (1) shared stress-related risk factors are associated with both depression and hypertension and (2) life-style factors associated with depression lead to hypertension.

METHODS

A predominantly black sample of 695 adults were interviewed in the Harlem Household Survey. Two measures of hypertension were used and compared-1) self-report and 2) elevated blood pressure (above 140/90 mm Hg)-on the basis of the mean of two blood pressure measures. Depressive symptoms were measured by use of a 24-item scale based on the Diagnostic Interview Schedule. Logistic regression models were used to test associations between hypertension and depressive symptoms, stressors, and life-style factors.

RESULTS

Depressive symptoms were associated with self-reported hypertension but not with elevated blood pressure. The association between self-reported hypertension and depressive symptoms was explained partly by shared stress-related risk factors but not by life-style factors. Several stressors and life-style variables were risk factors for elevated blood pressure independently of depressive symptoms. The findings are consistent with studies that have measured hypertension variously by either self-report or blood pressure. Possible explanations were explored (labeling and help-seeking) but were not supported by the data.

CONCLUSIONS

An association was found between self-reported hypertension and depressive symptoms, which was explained partly by shared stress-related risk factors. Elevated blood pressure was associated with stressors and life-style factors but not with depressive symptomatology. Research on illness representations and cultural dimensions of health suggest avenues for further investigation.

Hypertension and appraisal of physical and psychological stressors

OBJECTIVE

In the operant conditioning of hypertension hypothesis, it is assumed that the frequently found diminished sensitivity to painful stimuli in hypertensives can be generalized to sensitivity to other stressors, including psychological stressors. The validity of this assumption is examined in the present study.

METHODS

Unmedicated hypertensives (42) and normotensive controls (21) of both sexes were exposed to a physical stressor (electric current) and psychological active coping (mental arithmetic, free speech) and passive coping (unpleasant films) tasks, while indices of prestressor anxiety and task appraisal were measured.

RESULTS

Hypertensive women, but not men, showed diminished pain sensitivity, together with lower prestressor anxiety and a tendency to lower negative appraisal of the tasks, compared to their normotensive counterparts. In addition, positive correlations were obtained between pain sensitivity and negative appraisal of psychological stressors involving interpersonal threat (speech) and passive coping (films).

CONCLUSION

Preliminary support has been obtained for extrapolation of diminished pain appraisal to appraisal of some psychological stressors (although for a part only in women); an important assumption in the operant conditioning hypothesis of hypertension.

Hypertension and pain sensitivity: effects of gender and cardiovascular reactivity

Repeatedly, hypertensives have been found to appraise physical stressors as less aversive than normotensives. The main aim of the present study was to examine the effects of gender and cardiovascular reactivity in the relationship between hypertension and appraisal of pain. Forty-two unmedicated hypertensives and 21 normotensive controls of both genders were exposed to an electric current stimulus, while various cardiovascular parameters and prestressor anxiety were measured. In general, hypertensive women, but not men, showed diminished pain sensitivity compared to their normotensive counterparts. When the analyses were repeated with controlling for cardiovascular reactivity, the between-group effects were no longer significant. The results indicate that (i) profound gender differences exist in hypertension-related pain sensitivity and (ii) these effects seem to be mediated, at least partly, by cardiovascular reactivity.

Defensive coping in relation to casual blood pressure and self-reported daily hassles and life events

Our aim was to investigate the relationships between defensiveness and repression, on the one hand, and self-reported stressor exposure and resting blood pressure, on the other hand. In addition, different operationalizations of defensiveness and repression were compared. Participants were 310 male and 90 female employees representing a wide range of occupations. Before a medical examination, all subjects completed questionnaires measuring defensiveness, anxiety, repression, daily hassles, and life events. After controlling for potentially confounding variables, multiple regression analyses revealed an inverse association between defensiveness and self-reported number of daily hassles and a positive link between defensiveness and resting systolic blood pressure. In general, the interaction between defensiveness and anxiety (representing repression) did not add to the predictive power of defensiveness and anxiety alone. The results support the notion that defensive individuals tend to underreport problems, while exhibiting elevated resting blood pressures.

Somatotosensory evoked potentials during baroreceptor stimulation in chronic low back pain patients and normal controls

Nineteen chronic low back pain patients (aged 19-63) and 17 controls (aged 20-41) received electrical pain stimuli during manipulation of their carotid baroreceptors. The non-invasive mechanical manipulation of baroreceptors, using the PRES technique (Phase Related External Suction), simulates the end-effects of phasic blood pressure changes. This technique was developed to assess pain responses induced by changes in blood pressure without the typical shortcomings of pharmacological manipulation or lack of a control condition. During maximum baroreceptor activity, there was an unexpected increase in the amplitude of the somatosensory evoked potentials (SEPs) elicited by the electrical pain stimuli condition (N150-P260 peak-to-peak). In most other studies the opposite effect was found, with decreased pain responses during maximum baroreceptor activity. The chronic pain group reported greater pain during highest baroreceptor activation than did the controls. In addition, the chronic pain group showed lower diastolic blood pressure. To determine whether pain and baroreceptor responses observed in the chronic pain group depended on lower blood pressure levels, a second experiment with a non-clinical sample was performed. Results showed that lower tonic blood pressures are associated with greater baroreceptor activity amplifying pain, while higher blood pressure is associated with pain dampening during high baroreceptor activity. Data suggested that the differences in pain responses found in low back pain patients were associated with their lower tonic blood pressure levels. It is proposed that in general, lower blood pressures may be associated with greater pain during baroreceptor activation.

Blood pressure, self-reported symptoms and job-related problems in schoolteachers

The relationship between blood pressure and self-reports of physical symptoms and job-related problems was investigated in a sample of 262 male and female teachers. The subjects were divided into three groups: treated hypertensives (THT, N = 23); untreated hypertensives (UHT, N = 101); and normotensives (NT, N = 123). After controlling for eight potentially confounding variables, the groups differed significantly with respect to reported physical symptoms, with THT reporting the most and UHT the fewest symptoms. Moreover, after controlling for potential confounders, a multiple regression analysis revealed an inverse association between diastolic blood pressure and the number of reported physical symptoms in untreated subjects. A similar trend for systolic blood pressure did not reach significance. In addition, no significant results with respect to work-related problems were obtained, except for a group x gender interaction on job-related irritation: male THT showed lowest and female THT highest irritation scores. The potential role of altered appraisal, diagnosis, and gender are discussed.

Posttraumatic stress disorder, ego defense mechanisms, and empathy among urban paramedics

Although numerous studies have indicated that paramedics experience high occupational stress, there has been a lack of research addressing the mental health implications of this elevated stress on these emergency workers. Related constructs such as the coping mechanisms and personality characteristics of paramedics have also been neglected. Groups of experienced paramedics (n = 120) and paramedic students (n = 105) were, therefore, assessed for Posttraumatic Stress Disorder, the extent and mode of ego defense utilization, and empathy. Analyses indicated that 20% of the experienced paramedics and 22% of the paramedic students appear to be suffering from trauma as measured by the MMPI-2 PK Scale. Denial and Repression scores were significantly high compared to normative samples for both groups, while Regression and Reaction Formation scores were significantly low. Both the paramedics and paramedic students had significantly low scores on Empathy. It is suggested that paramedics may be predisposed to these personality traits and that high denial and low empathy serve as functionally adaptive mechanisms in a chronically stressful work environment.

Hypertension and objective and self-reported stressor exposure: a review

A review of the literature on the relationship between blood pressure and stressor exposure revealed a discrepancy between the results of studies based on objective measures of stressor exposure and studies based on self-reports. Whereas in the studies based on objective measures, a clear predominance of positive associations between blood pressure level and stressor exposure was found, in the studies based on self-reports, the results were highly inconsistent. Several moderator variables have been proposed that could explain the discrepancies found in the literature, such as awareness of hypertension and treatment. In studies in which these moderators were taken into account, inverse associations between blood pressure and self-reported stressor exposure have often been found. It is suggested that this result is brought about by altered appraisal of stressors in hypertensives.

Gender differences in the relation between interview-derived hostility scores and resting blood pressure

We examined the correlations between Structured Interview (SI)-derived hostility scores and resting blood pressure (BP) to see if they would be the same or different for healthy men and women. Standard risk factor information and resting BP measures were obtained from 193 undergraduates (109 men, 84 women), who underwent the SI. Subjects were rated for Potential for Hostility, Hostile Style, Intensity and Content, and completed Antagonism and Neuroticism scales. As expected, SI hostility scores were related to higher resting SBP in men, however; in women, they were related to lower resting SBP and Neuroticism. Regression analyses controlling for standard CHD risk factors indicated that SI-derived hostility predicted resting SBP and hypertensive status in both men and women, though in opposite directions. Thus, SI-derived hostility may assess a different construct in women than in men.

Cardiovascular consequences of expressing, experiencing, and repressing anger

Psychoanalytic theory's pathogenic view of repression gave rise to the widely held belief that the expression of anger is beneficial to mental and physical health. The present paper reviews a number of experimental and correlational studies which demonstrate that the full expression of anger, with its vocal manifestations, is associated with significant cardiovascular hyperreactivity. Furthermore, epidemiological studies indicate that such expression of anger are also related to coronary heart disease (CHD) and to some physiological and hormonal changes that have been implicated in the pathophysiology of CHD. On the other hand, neither the mere experience of anger nor its repression has any of the above negative cardiovascular consequences, although the repression of anger seems to have other untoward health consequences.

Depressive symptoms and adaptive style in children with cancer

OBJECTIVE

This article explores the relationship between a repressive style of adaptation and depressive symptomatology.

METHODS

Thirty-one adolescent cancer patients were compared with 83 healthy high school students. Subjects with repressive adaptation were identified as those reporting low anxiety and high defensiveness. Depressive symptomatology was measured by self-report.

RESULTS

Patients with cancer reported significantly lower levels of depression, and a significantly higher proportion were identified as repressors. Repressor status accounted for significant variance in depression over that explained by illness.

CONCLUSIONS

Adaptive style may be common in medically ill children and may directly and indirectly influence psychological and medical outcome.

Dimensions of anger-hostility and cardiovascular reactivity in provoked and angered men

This study investigated the relationship between two dimensions of anger-hostility--the expression of anger-hostility and the experience of anger-hostility--and cardiovascular reactivity in provoked and angered men. A serial subtraction task was administered to 41 male undergraduates who were provoked and angered. A measure of the expression of anger-hostility correlated positively and significantly with systolic and diastolic blood pressure (BP) reactivity. There were no significant correlations between a measure of the experience of anger-hostility and cardiovascular reactivity. The two types of anger-hostility were also found to relate differentially to life-style variables that have been identified as risk factors for coronary heart disease (CHD), with only the expression of anger-hostility showing positive relationships with these life-style CHD risk factors. These findings are discussed within the context of a similar differential relationship between the two dimensions of anger-hostility and CAD and CHD. Finally, significant negative relationships were obtained between the experience of anger-hostility and resting BP and heart rate levels. These findings are discussed within the context of other data suggesting that trait anxiety-neuroticism may have protective properties.

Types of aggressiveness and catecholamine response in essential hypertensives and healthy controls

Relationships between plasma catecholamine responses, and levels and types of aggression in hyper- and normotensives were investigated by analyses of data obtained in a large psychophysiological experiment on 97 hypertensives (EH) and 98 normotensives (CO) each. Subjects were divided according to levels (high vs low) and types (repressed vs manifest) of aggressiveness according to self rating questionnaire scores. Their plasma catecholamine responses to defined stressors indicating sympathetic arousability were compared by four factor analyses of covariance adjusting for age. Repressed aggression was significantly more frequent among male EH, whereas manifest aggression was significantly more frequent among the male COs. High as compared to low hostility was associated with significantly elevated values of plasma epinephrine in EH but not in CO. The immediate norepinephrine stress response was blunted but showed a delayed increase during the subsequent period of rest in high aggressives of both the EH and CO group, a pattern particularly pronounced in repressed aggressive hypertensives. Neither cardiovascular reactions nor speed of performance were observed to be substantially different in subjects of repressed and of manifest hostility. It was concluded that aggression in general is characterized by a delayed norepinephrine stress response and that an association with high epinephrine is typical for aggressiveness in hypertensives. Repressed hostility, however, does not produce a sympathomedullary pattern substantially different from that of manifest aggression thus casting doubt on the physiological significance of repression claimed by Alexander.

Childhood traumas and psychosocial characteristics of 50-year-old men with essential hypertension

The aim of the present study was to describe childhood traumas and other psychosocial characteristics of middle-aged men with never-treated essential hypertension. Hypertensive (N = 17) and normotensive (N = 18) 50-yr-old men were selected from the Oslo Study of Cardiovascular Diseases based on their age, sex, blood pressure and otherwise healthy condition without chronic medication. They were interviewed semistructurally by a psychiatrist who was unaware of their blood pressure status. Eleven hypertensives and five normotensives (p less than 0.05) had experienced considerable traumas in childhood, e.g. death of a parent, psychotic parent, separation from one or both parents, or beating by an alcoholic father. The hypertensives had fewer siblings and fewer sons than the normotensives (p less than 0.05). The normotensives were better educated; 12 had finished at least 12 yr in school as opposed to one hypertensive (p less than 0.01). The normotensives' parents (p less than 0.05) and spouses (p less than 0.001) were better educated than the hypertensives'. The normotensives' yearly income was higher (p less than 0.05). The hypertensives showed more Type A behaviour patterns (p less than 0.05) and lower Spielberger State Curiosity (p less than 0.05). Although the groups were small, they were rigorously characterized. These results therefore suggest that middle-aged men with essential hypertension have more childhood traumas and lower educational and income levels and that these social characteristics are associated with Type A behaviour patterns. The study favours a psychosocial understanding of the pathogenesis of essential hypertension.

Essential hypertension: the relationship of psychological factors to the severity of hypertension

165 hypertensive patients attending one general practice in Portugal were found to report significantly higher scores on measures of neuroticism, anxiety, depression and general psychological distress than 152 normotensive patients at the same practice. Hypertensive patients with evidence of organ damage exhibited significantly higher depression scores than those without such damage. These differences between normotensives and hypertensives, and between hypertensive with and without organ damage are discussed and previous research in this area is reviewed.

Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples

Women with symptoms indicative of irritable bowel syndrome who had not consulted a physician were compared with female patients at a gastroenterology clinic to investigate whether self-selection for treatment accounts for psychologic abnormalities in clinic patients' with irritable bowel syndrome. Two sets of diagnostic criteria were compared: restrictive criteria based on the work of Manning and conventional criteria (abdominal pain plus altered bowel habits). Lactose malabsorbers were included as a control group because they have medically explained bowel symptoms similar to those that define irritable bowel syndrome. Thus they control for the causative effects of chronic bowel symptoms on psychologic distress. Women who met restrictive criteria for irritable bowel syndrome but had not consulted a physician had no more symptoms of psychologic distress on the Hopkins Symptom Checklist than asymptomatic controls. However, medical clinic patients with both irritable bowel syndrome and lactose malabsorption had significantly more psychologic symptoms than asymptomatic controls or nonconsulters with the same diagnoses. Individuals who met only the conventional criteria for irritable bowel syndrome reported more psychologic distress than controls, whether or not they consulted a physician. These results suggest that (a) symptoms of psychologic distress are unrelated to irritable bowel syndrome but influence which patients consult a doctor and (b) conventional diagnostic criteria identify more psychologically distressed individuals than do restrictive criteria.

The relationship between blood pressure and personality in a large unselected adult sample

As part of a general health survey of a small New Zealand town, the Crow-Crisp Experiential Index, the State-Trait Anxiety Inventory, a shortened version of the Hostility and Direction of Hostility Questionnaire, and the Zung Self-rating Depression Scale were administered to 1173 subjects over the age of 15. Blood pressure was moderately correlated with age and Quetelet's Index, a measure of obesity. Low but significant correlations were found between Somatic Anxiety, Hysteria, and the Urge to Act-out Hostility scale. However, when effects of age were controlled for, in a series of multiple regression analyses, the correlations with psychometric test scores were no longer significant. This study confirms several previous reports that neuroticism, anxiety, depression, and hostility are of little significant in predicting levels of blood pressure in the general population.

Neurosis and mortality: investigating an association

Neurosis is not a cause of death, but at follow-up neurotic patients are found to experience increased premature mortality. Suicide and accidental death are considerably increased in this group. There is also an excess of deaths from natural causes; amongst hypotheses to account for this there is some evidence to incriminate arteriosclerosis, and increased toxicity from cigarette smoke may be a factor. The increased mortality is not explained by confusion over the term depression. Those neurotic patients who subsequently die are more likely to have suffered from a more severe degree of neurosis at the time of initial treatment.

Factors in predicting blood pressure change

A total of 1166 male participants (ages 23--80 years) of the Normative Aging Study who had baseline blood pressure less than 140/90 mm Hg were followed prospectively for 10 years. Blood pressures were taken at 5- and 10-year follow-up examinations. Multiple linear regression analysis indicated that baseline levels of systolic pressure, hematocrit, subscapular skinfold thickness and age were significant predictors of systolic pressure change during the follow-up period. Baseline levels of diastolic pressure, hematocrit, and body mass index were significant predictors of diastolic pressure change. Multiple logistic regression analysis revealed that only baseline blood pressure and hematocrit were significant predictors of subsequent blood pressure elevation to more than 159 mm Hg systolic or 94 mm Hg diastolic. Although the mechanisms by which hematocrit and body build affect blood pressure are unknown, these results suggest that identifying hypertension-prone subjects and delaying or preventing hypertension may be possible.

Psychosocial factors and blood pressure

Blood pressure levels as recorded in a community-wide screening programme were compared with findings in an earlier mental health study for persons who participated in both programmes. Blood pressure was not related to previously ascertained psychosocial characteristics among persons who were not under treatment for hypertension, suggesting that depression, hostility, psychosomatic reactions to stress, or the felt need for help with emotional problems were not important in the pathogenesis of hypertension. Treatment for hypertension, however, was associated with an excess of psychosomatic symptoms, a factor which needs to be taken into account in assessing the benefits of treatment.

Hypotheses linking neuroses with premature mortality

The death risk for psychiatric patients has decreased over the last 30 years but still remains higher than that of the general population. The death risk for patients with a diagnosis of neurosis is higher than that for the general population. Previous studies are enlisted to investigate this mortality for socio-economic characteristics, alcohol and drug abuse, psychopathy and accident proneness. Possible psychosomatic aetiology of disease and subsequent death is examined. Psychological theories for premature death are discussed and some recommendations made for future areas of enquiry.

Blood pressure measurement at screening and in general practice

As part of an epidemiological study of hypertension, an analysis was made of the general practitioner records of all attenders at a screening survey. A blood pressure recording, made before screening, was found in 37-9 per cent of cases. The pressures obtained correlated well with those obtained by the screening unit, though the practitioners' readings tended to be lower. Further cases of hypertension were found, not diagnosed by the screening unit; the estimate made of the prevalence of hypertension at the survey could be corrected by inclusion of these cases. Chest pain, headaches, lightheadedness, and dizziness were common reasons for blood pressure measurement in general practice, but these symptoms were not associated with a rise in the blood pressure; symptoms were not helpful in the diagnosis of hypertension. Some form of screening programme is necessary to detect cases of hypertension. This could be carried out by general practitioners.

Transcendental meditation in hypertension. Individual response patterns

Seven selected hypertensive patients were stabilized on drugs at a research clinic. Subjects learned transcendental meditation (T.M.), were seen weekly, and took their own blood pressure several times daily. After 12 weeks of T.M. six subjects showed psychological changes and reduced anxiety scores. Six subjects also showed significant reductions in home and four in clinic blood-pressures. Six months later four subjects continued to derive psychological benefit and two showed significant blood-pressure reductions attributable to T.M. at home and clinic.

Personality factors in hypertension

This paper describes a study of personality traits and psychological symptoms in hypertensive patients and in subjects with unrecognized elevation of blood pressure. The findings suggest three things. Firstly, hypertensive patients who attended an out-patient clinic showed evidence of psychological disability. Secondly, undiagnosed hypertensives were not distinguished from normotensives according to a variety of questionnaire variables. Thirdly, the existence of a hypertensive personality profile described in great detail by some writers, was not confirmed.