Personality traits in young males at risk for hypertension

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.

Thermoregulatory response to passive body heating in borderline hypertension

Sweating and vasodilatation in the cutaneous circulation were investigated during passive body heating in eight borderline hypertensive subjects and in eight normotensive controls, matched for age, sex and body mass. Blood flow through the finger and forearm was examined in relation to changes in oral temperature; blood pressure, heart rate and sweating in the forehead and forearm were also measured. Systolic blood pressure decreased in borderline hypertensive subjects during the early stages of heating and then returned to baseline, but increased in normotensives. Increases in skin blood flow and decreases in cutaneous vascular resistance were similar in both groups. Thus, cutaneous vasodilatation during moderate body heating did not differ between normotensive subjects and subjects with mildly elevated blood pressure. These findings do not rule out attenuation of cutaneous vasodilatation in mildly hypertensive subjects during more intense heating.

Hypertension, cardiac disease, and compliance in minority patients

In minorities, as in the general population, hypertension is taken seriously because it is a risk factor for cardiovascular disease. Until recently, our understanding of the role that hypertension plays in the heart disease seen in minorities has been limited by a paucity of prospective data regarding the prevalence, natural history, and pathophysiology of the disease process in minority populations. In the last few years large-scale epidemiologic studies and well-controlled clinical studies alike have confirmed usually high rates of hypertension-related morbidity and mortality in minorities, particularly blacks and Hispanics. The severity of end-organ damage, both cardiac and renal, that is seen in these patients--especially when coupled with the severe cerebrovascular damage that is also more common in black and Hispanic hypertensives--mandate that more effective public health measures be taken to reduce the incidence of hypertension in these patient populations. Because hypertension is usually without significant clinical symptoms, noncompliance with drug therapy and high dropout rates are common in all patient populations. They are strikingly higher in inner-city populations, however, where illiteracy, poverty, homelessness, and high rates of chemical dependency combine to exacerbate an already serious problem in treating hypertensive patients. Inner-city patients are, increasingly, black and Hispanic patients, and these patients are more likely to be underinsured or uninsured, to be functionally illiterate in English, to be disinclined to seek health care, and to be less capable of following a prescribed regimen than the populace as a whole. The nature of the therapeutic regimen itself is probably the most important determinant of compliance, and compliance with drug therapy will be improved if the clinic chooses a simplified drug regimen and avoids drugs that produce intolerable side effects. Once-a-day--or, with transdermal clonidine, one-a-week--single-drug therapy may not be possible in all patients, but multiple drug therapy and multiple daily dosing schedules should be avoided wherever possible.

Understanding hypertensives' behaviour. II: Perceived social approval and blood pressure reactivity

The influence of perceived social approval on blood pressure reactivity was investigated in two stages. Initially, a new procedure was devised to measure the reaction to initial stimuli in subjects where base rate determination had not occurred. Minimal public self disclosure was shown to have a greater pressor effect for borderline hypertensives than normotensives. The two groups remained clearly distinguishable after exercise. Perceived level of social approval on physiological response in two groups of reactive borderline hypertensives was then investigated in the laboratory. Blood pressure level rose during an arithmetic task for all subjects. A large increase in blood pressure variability was specific to the self disclosure task and only for those who perceived low social approval. The ramifications are discussed.

Checklists for measuring response style in hypertensives

The need for more clearly identifying the reporting behaviour of hypertensives was addressed. An objective method of measuring reporting behaviour was developed: the Life Concerns checklist. This checklist was able to discriminate subjects defined as introspective self-doubters from those who reported either psychosomatic disorders or who blamed the environment for their problems. This checklist was also able to verify that hypertensives do have lower report rates than normotensives. The Perception of Social Acceptability of Reporting Concerns Checklist (Persolac) measured the number of specific concerns perceived to be socially acceptable to report, of which there were less for males and which in all cases varied according to whom the concerns were to be disclosed. The two checklists are presented as adjuncts to other questionnaires for use in exploring the response of individuals with essential hypertension.

Cardiovascular risk factors in affective disorder

100 patients with affective disorder (unipolar affective disorder and bipolar affective disorder) were evaluated for evidence of increased risk for the major cardiovascular risk factors including hypertension, hypercholesterolemia, obesity, and cigarette use. Unipolar affective disorder patients showed no evidence of increased cardiovascular risk compared to population controls. Bipolar affective disorder patients displayed increased systolic blood pressure, definite hypertension, and use of cigarettes. These findings are consistent with a link between affective disorders and excess cardiovascular mortality.

Cardiovascular reactivity in mild hypertension

Blood pressure and heart rate were monitored in 18 mild hypertensives and 18 normotensive controls matched for age and sex during rest, isometric exercise, carbon dioxide rebreathing, cold pressor test, head-up tilt, radiant heat, head-back tilt and mental arithmetic. Blood pressure and heart rate were higher in the hypertensive than in the normotensive group at rest. During the instructions prior to the mental arithmetic and head-back tilt tests, heart rate increased more in the hypertensive than in the normotensive group while during mental arithmetic performance, blood pressure levels increased more in hypertensives than in normotensive controls. Diastolic blood pressure levels increased more in hypertensives during head-up tilt. In all other conditions, cardiovascular responses were similar in both groups. The results support the view that the sympathetic nervous system contributes to hypertension since the cardiovasculature of mild hypertensives was hyperreactive during tests where sympathetic activity was likely to predominate.