Ambulatory blood pressure responses and the circumplex model of mood: a 4-day study

Testing the Associations Between State and Trait Anxiety, Anger, Sadness, and Ambulatory Blood Pressure and Whether Race Impacts These Relationships

BACKGROUND

Anxiety, anger, and sadness are related to elevated ambulatory blood pressure (ABP), yet it is unclear whether each emotion exerts unique effects. Moreover, an understanding of who might be most susceptible to the negative effects of these emotions is limited, with the trait tendency to experience them or one's race as potential moderators.

PURPOSE

The study examined the potential for differential effects of momentary anxiety, anger, and sadness on ABP. The study assessed whether a trait tendency to experience these negative emotions and/or race (Black vs. non-Black) would moderate these relationships.

METHODS

Participants (n = 153) completed trait anxiety, anger, and depressive symptoms measures at baseline. ABP was collected over two 24-hour periods 3-4 months apart. Momentary measures of anxiety, anger, and sadness were assessed via ecological momentary assessment (EMA) after each ABP reading.

RESULTS

Momentary anxiety consistently predicted diastolic blood pressure but not systolic blood pressure. Momentary anger and sadness did not predict blood pressure (BP). Conditional effects were found with momentary anxiety and anger predicting elevated BP in those individuals with trait anxiety/anger at its mean. Trait anxiety and depression consistently predicted heightened BP in Black participants. Trait anger did not moderate the relationships between negative emotions and ABP.

CONCLUSIONS

Findings suggest that momentary anxiety and anger should be given attention as potential risk factors for hypertension and highlight the unique perspective of EMA methods. Black participants who were more anxious and depressed experienced heightened BP, with anxiety and depression providing possible intervention targets in improving racial disparities in cardiovascular health.

Modifying the Trier Social Stress Test to Induce Positive Affect

Studies comparing the effects of positive and negative affect on psychological outcomes are limited by differences in the situations that evoke these states and in the resulting levels of arousal. In the present research, we adapted the speech portion of the Trier Social Stress Test (TSST) to create conditions with similar situational features that induce either positive, negative, or neutral affective states (N = 301). Pre-post emotion ratings showed that negative affect increased in the negative condition but decreased in the positive and neutral conditions. Positive affect increased in the positive condition, remained unchanged in the neutral condition, and decreased in the negative condition. Participants' post-speech ratings of their positive and negative emotions differed significantly between the positive and negative conditions, which has not been accomplished in previous attempts to create a non-stressful positive TSST. Importantly, participants in the positive and negative conditions did not differ in self-reported levels of arousal and showed similar changes in mean arterial pressure across the speech period, although heart rate was relatively higher during the speech for participants in the negative compared to positive and neutral conditions. Findings demonstrate the effectiveness of a modified TSST for inducing positive affect with similar levels of emotional arousal to the traditional negative TSST.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s42761-021-00074-6.

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.

Taking context to heart: Momentary emotions, menstrual cycle phase, and cardiac autonomic regulation

Emotions have long been discussed in conjunction with the autonomic nervous system. Most research on emotion-autonomic linkages does not consider sex differences or an evident underlying mechanism for sex differences: menstrual cycle phase. Further, most research is limited to cross-sectional and laboratory studies. The degree to which emotion-autonomic associations manifest in everyday life may be different and may vary by sex and, for women, by menstrual cycle phase. This study employs the ambulatory monitoring of cardiovascular measures (e.g., heart rate and heart rate variability; HRV) and concurrent emotional states (e.g., sadness, stress, anxiety, anger, and happiness) in everyday life to better characterize emotion-autonomic associations as a function of sex and menstrual cycle phase. Participants (N = 174; 87 female) ages 18 to 46 (31.23 ± 6.49) were monitored over a 5-day observation period (one 2- and one 3-day session), using an ambulatory 24-hour electrocardiogram to monitor heart rate and ecological momentary assessment to record emotions every ~30 min. Women were monitored in both the early to mid-follicular and -luteal phases and men in two comparably distanced sessions. Multilevel models indicated that across sex, negative emotions and happiness were associated with elevated heart rate. Relative to men, women exhibited an elevated heart rate and reduced HRV during reports of anger. For women, during the luteal phase, but not follicular phase, momentary sadness, stress, and anxiety predicted increased heart rate and reduced HRV. These findings demonstrate the importance of considering sex and menstrual cycle phase in research investigating emotion-autonomic linkages.

Assessing New Methods to Optimally Detect Episodes of Non-metabolic Heart Rate Variability Reduction as an Indicator of Psychological Stress in Everyday Life: A Thorough Evaluation of Six Methods

Frequent or chronic reduction in heart rate variability (HRV) is a powerful predictor of cardiovascular disease, and psychological stress has been suggested to be a co-determinant of this reduction. Recently, we evaluated various methods to measure additional HRV reduction in everyday life and to relate these reductions to psychological stress. In the current paper, we thoroughly evaluate these methods and add two new methods in both newly acquired and reanalyzed datasets. All of these methods use a subset of 24 h worth of HRV and movement data to do so: either the first 10 min of every hour, the full 24 h, a combination of 10 min from three consecutive hours, a classification of level of movement, the data from day n to detect episodes in day n + 1, or a range of activities during lab calibration. The method that used the full 24 h worth of data detected the largest percentage of episodes of reduced additional HRV that matched with self-reported stress levels, making this method the most promising, while using the first 10 min from three consecutive hours was a good runner-up.

Change in urinary cortisol excretion mediates the effect of angry/hostile mood on 9 month diastolic blood pressure in HIV+ adults

Cardiovascular disease is a growing concern in HIV disease management and nearly 1 out of 3 persons living with the virus is hypertensive. Biobehavioral factors such as anger, hostility, and HPA axis reactivity are emperically linked to blood pressure regulation. Whether HPA axis or mood disturbance increases risk for hypertension remains unclear in HIV disease. The aim of this study was to determine whether 9-month change in angry/hostile mood predicts alterations in systolic (SBP) or diastolic blood pressure (DBP), and whether this change is mediated by 24-h urinary cortisol (CORT) output. Sixty-one HIV positive adults, aged 41.1 ± 8.6 years, assigned to the control condition of a stress management intervention provided blood samples, 24-h urine specimens, blood pressure in-office, and self-reported mood at baseline and a 9-month follow-up. CORT was tested as a mediator in two separate models controlling for baseline BP, CD4 count, HIV-1 viral load, protease inhibitor use, body mass index, smoking status, and family history of cardiometabolic disease. Increase in angry/hostile mood was associated with greater SBP (β = 0.33, CI 0.09, 0.56, p = 0.01) and DBP (β = 0.39, CI 0.16, 0.62, p < 0.001) at follow-up. CORT partially mediated the effect of angry/hostile mood on DBP (β = 0.28, CI 0.03, 0.54, p = 0.03). Change in CORT was not related to SBP (β = 0.12, CI -0.20, 0.44, p = 0.46). The final mediation model accounted for 41.2% of the variance in 9-month DBP. Angry or hostile mood may contribute to increased risk for hypertension in persons treated for HIV via disturbance of the HPA-axis.

Effects of Mood States and Anxiety as Induced by the Video-Recorded Stroop Color-Word Interference Test in Simple Response Time Tasks on Reaction Time and Movement Time

Mood states and anxiety might alter performance in complex tasks whereas in more simple tasks such as stimulus-response, high anxiety could provoke bias in mechanisms of attention leading to better performances. We investigated the effects of anxiety, tension, and fatigue induced by the video-recorded Stroop Color-Word Interference Test on either reaction or movement time. 61 subjects performed a visual and an auditory response-time test in Control and Anxiogenic conditions during which heart rate was measured. Tension and anxiety states were assessed using self-evaluation. Analysis showed auditory response time was improved for both reaction and movement times in the Anxiogenic condition. These data suggest that the increased attention underlying anxiety and mood responses could have favored auditory response time by leading subjects to process stimuli more actively. In addition, state-anxiety and tension could have influenced muscular tension, enhancing the movement time in the auditory task.

New and Future Directions in Integrative Medicine Research Methods with a Focus on Aging Populations: A Review

This review discusses existing and developing state-of-the-art noninvasive methods for quantifying the effects of integrative medicine (IM) in aging populations. The medical conditions of elderly patients are often more complex than those of younger adults, making the multifaceted approach of IM particularly suitable for aging populations. However, because IM interventions are multidimensional, it has been difficult to examine their effectiveness and mechanisms of action. Optimal assessment of IM intervention effects in the elderly should include a multifaceted approach, utilizing advanced analytic methods to integrate psychological, behavioral, physiological, and biomolecular measures of a patient's response to IM treatment. Research is presented describing methods for collecting and analyzing psychological data; wearable unobtrusive devices for monitoring heart rate variability, activity and other behavioral responses in real time; immunochemical methods for noninvasive molecular biomarker analysis, and considerations and analytical approaches for the integration of these measures. The combination of methods and devices presented in this review will provide new approaches for evaluating the effects of IM interventions in real-life ambulatory settings of older adults, and will extend the concept of mobile health to the domains of IM and healthy aging.

Scratching under positive and negative arousal in common marmosets (Callithrix jacchus)

Scratching has been widely used as an indicator of anxiety in many primate species. However, a handful of studies have shown no change in scratching under anxiety-provoking circumstances. In addition, the existing literature has investigated scratching only in relation to negative arousal (i.e., anxiety), even though anxiety and excitement (positive arousal) share important physiological and behavioral correlates, including increased heart rate, blood pressure, and locomotion. In the current study, we scored all instances of scratching in 11 outdoor-housed captive common marmosets (Callithrix jacchus) during three contexts that were intended to be negatively arousing and three contexts that were intended to be positively arousing during a baseline, manipulation, and post-induction period. Summed across the three negative arousal contexts, the results showed that subjects exhibited significantly lower scratching rates during the manipulation than during either the baseline or post-induction periods, and the pattern of means was the same for all three of those contexts. Under the three contexts of positive arousal, subjects exhibited different patterns of scratching rates during the manipulation periods (play = increases, foraging = decreases, food anticipation = no change). Data from the current study, and a close examination of data from studies showing no change in scratching under anxiety-provoking circumstances, suggest that the anxiety-scratching relationship may be more complex than has been reported previously. Our results raise a potential concern about the unchallenged use of scratching as a behavioral indicator of anxiety in captive non-human primates, with important implications for welfare and management of these species.

(Non)cooperative dialogues: the role of emotions

OBJECTIVE

The effect of emotion on (non)cooperation in unscripted, ecological communication is investigated.

BACKGROUND

The participants in an interaction are generally cooperative in that, for instance, they tend to reduce the chance of misunderstandings in communication. However, it is also clear that cooperation is not complete. Positive and negative emotional states also appear to be connected to the participants' commitment to cooperate or not, respectively. So far, however, it has proven remarkably difficult to test this because of the lack of entirely objective measurements of both cooperation levels and emotional responses.

METHOD

In this article, the authors present behavioral methods and coding schemes for analyzing cooperation and (surface) indicators of emotions in face-to-face interactions and show that they can be used to study the correlation between emotions and cooperation effectively.

RESULTS

The authors observed large negative correlations between heart rate and cooperation, and a group of facial expressions was found to be predictive of the level of cooperation of the speakers.

CONCLUSION

It is possible to develop reliable methods to code for cooperation, and with such coding schemes it is possible to confirm the commonsense prediction that noncooperative behavior by a conversational participant affects the other participant in ways that can be measured quantitatively.

APPLICATION

These results shed light on an aspect of interaction that is crucial to building adaptive systems able to measure cooperation and to respond to the user's affective states.The authors expect their methods to be applicable to building and testing such interaction systems.

The influence of different movements on ambulatory blood pressure in hypertensive subacute stroke patients

OBJECTIVE

This study evaluated variation in blood pressure (BP) in hypertensive subacute stroke patients performing eight different types of active movement, and variations in BP over time.

METHODS

The study included 35 subacute stroke patients (60 - 74 years old) and 15 age-matched healthy volunteers. Ambulatory systolic and diastolic BP was measured over 4 consecutive days, before and during active movement.

RESULTS

The greatest effect of the different active movements in stroke patients was on mean systolic BP variability (BPV). There was a significant difference in systolic and diastolic BPV between stroke patients at different time-points and compared with healthy volunteers. Systolic BPV during shifting from the ward to the rehabilitation centre was significantly higher than for all other active movements. Mean systolic BPVs during the sessions on the first and second days were significantly higher than for the sessions on the third and fourth days in stroke patients and compared with healthy volunteers.

CONCLUSIONS

Systolic BP was found to be increased in hypertensive subacute stroke patients during their first and/or second attempts at performing active movements. Therapists should consider the BP of hypertensive subacute stroke patients during these first two attempts, especially for activities involving the patient moving from the ward to the rehabilitation centre.

Psychosocial determinants of hypertension: laboratory and field models

Tom Pickering had a profound influence on the study of biobehavioral factors in the development, diagnosis, and misdiagnosis of hypertension. His contributions influenced several avenues of research, including ecological momentary assessments of the sources and causes of diurnal blood pressure variation, the evaluation and impact of job strain on blood pressure and cardiovascular disease, and the role of blood pressure reactivity and recovery to acute stress in hypertension development. This overview approaches these topics by examining the seminal role of the work by Tom et al. in the current understanding of how biobehavioral factors contribute to hypertension.

The influence of trait and state rumination on cardiovascular recovery from a negative emotional stressor

The purpose of this study was to evaluate the influence of trait and state rumination on cardiovascular recovery following a negative emotional stressor. Cardiovascular data was collected from 64 undergraduate women during a 10-min baseline period, 5-min emotional recall stress task, and a 15-min recovery period. Trait rumination was assessed using the Stress Reactive Rumination Scale and state rumination was assessed 5 and 10 min after the stressor, using a thought-report technique. Results indicated that trait and state rumination interacted such that low trait ruminators who were ruminating at 10 min after the termination of the stressor had poorer diastolic blood pressure and high-frequency heart rate variability recovery compared to low trait ruminators who were not ruminating. State rumination was not associated with cardiovascular recovery in high trait ruminators. Results suggest that rumination may play a role in the association between stress and hypertension by prolonging cardiovascular activation following stress.

The Learning Affect Monitor (LAM)

Abstract. The Learning Affect Monitor (LAM) is a new computer-based assessment system integrating basic dimensional evaluation and discrete description of affective states in daily life, based on an autonomous adapting system. Subjects evaluate their affective states according to a tridimensional space (valence and activation circumplex as well as global intensity) and then qualify it using up to 30 adjective descriptors chosen from a list. The system gradually adapts to the user, enabling the affect descriptors it presents to be increasingly relevant. An initial study with 51 subjects, using a 1 week time-sampling with 8 to 10 randomized signals per day, produced n = 2,813 records with good reliability measures (e.g., response rate of 88.8%, mean split-half reliability of .86), user acceptance, and usability. Multilevel analyses show circadian and hebdomadal patterns, and significant individual and situational variance components of the basic dimension evaluations. Validity analyses indicate sound assignment of qualitative affect descriptors in the bidimensional semantic space according to the circumplex model of basic affect dimensions. The LAM assessment module can be implemented on different platforms (palm, desk, mobile phone) and provides very rapid and meaningful data collection, preserving complex and interindividually comparable information in the domain of emotion and well-being.

Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception

The current study assessed how negative and positive stress is related to dyspnea perception. The participants were 25 young women with a medical diagnosis of severe asthma, and 15 matched controls. Stress was induced during repeated rollercoaster rides. Results showed that negative emotional stress and blood pressure peaked just before, and positive emotional stress and heart beat peaked immediately after rollercoaster rides. Dyspnea in women with asthma was higher just before than immediately after rollercoaster rides, even in women with asthma with a rollercoaster-evoked reduction in lung function. These results suggest that stressed and highly aroused individuals with chronic asthma tend to perceive dyspnea in terms of acquired, familiar associations between dyspnea and positive versus negative feeling states, favoring either underperception or overperception of dyspnea, depending on the emotional valence of a situation.

Does positive affect influence health?

This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with increased longevity among older community-dwelling individuals. The literature on PA and surviving serious illness is inconsistent. Experimentally inducing intense bouts of activated state PA triggers short-term rises in physiological arousal and associated (potentially harmful) effects on immune, cardiovascular, and pulmonary function. However, arousing effects of state PA are not generally found in naturalistic ambulatory studies in which bouts of PA are typically less intense and often associated with health protective responses. A theoretical framework to guide further study is proposed.

Blood pressure changes highlight gender differences in emotional reactivity to arousing pictures

The current study was aimed at investigating the effects of gender on the magnitude and patterning of blood pressure responses to specific pleasant and unpleasant, arousing visual stimuli. Systolic and diastolic blood pressure (SBP and DBP), as well as heart rate (HR) and skin conductance (SCR) responses were investigated during picture viewing in 21 female and 25 male students. The pattern of SCR and HR reactivity across emotional categories was found to be similar for men and women. Gender was found to be an effective moderator of BP responses specifically to sexual stimulus content, which prompted greater reactivity in men than in women. These findings extend prior research on gender differences in autonomic responding to emotional visual stimuli and suggest that BP changes might reflect sexual peripheral arousal more than other autonomic measures.

Job strain and autonomic indices of cardiovascular disease risk

BACKGROUND

Despite the epidemiological evidence linking job strain to cardiovascular disease, more insight is needed into the etiologic mechanisms. This, in turn, would help to more precisely identify risk.

METHODS

We measured Job Strain using the Job Content Questionnaire, 8/day diary reports, and nationally standardized occupational code linkage, as well as autonomic regulation utilizing heart rate variability including spectral-derived components and QT interval variability in 36 healthy mid-aged males with varying strain jobs. The subjects wore Holter-monitors for 48 hr; this included a work and rest day.

RESULTS

Job strain (P = 0.02) and low decision latitude (P = 0.004) were associated with a reduction in cardiac vagal control (HFP) persisting throughout the 48 hr. Job strain was also associated with elevations in sympathetic control during working hours (P = 0.003).

CONCLUSIONS

The disturbed cardiovascular regulatory pattern associated with job strain may help explain the increased risk of cardiovascular diseases linked with occupational exposure.

Heart rate response is longer after negative emotions than after positive emotions

Summary. Recent ambulatory findings showing comparable cardiovascular effects of positive and negative emotions are not consistent with the assumed etiological role of negative affect in stress-related diseases. We tested the hypothesis that regardless of initial reactivity, responses associated with negative emotions would be prolonged compared to responses associated with positive emotions. During 8 h, 33 healthy subjects from a general population reported their emotional arousal, emotional valence and physical activity and recorded their heart rates (HR) after a beep at each 60th min ('initial HR'; T0), followed by two 'prolonged activation' recordings, respectively 5 min later (T1) and 10 min later (T2). While emotional arousal and activity predicted initial HR, prolonged activation at T1 was solely predicted by emotional valence (negative affect) at T0, independent of emotional recovery. The results lend support to the hypothesis that cardiovascular activation after negative emotions last longer than after positive emotions. This finding is consistent with the view that prolonged activation, and not so much reactivity, might be a mechanism underlying the etiological role of negative emotions ('stress') in somatic disease. Perseverative cognition (worry, rumination) might be responsible for this prolonged activation.

Developmental, gender, and ethnic group differences in moods and ambulatory blood pressure in adolescents

BACKGROUND

Adolescence is characterized by profound changes in physical, psychological, and social functioning thought to be accompanied by intense and varying moods.

PURPOSE

Within a psychophysiological framework, this study examined the prevalence of 12 self-reported mood states of adolescents; investigated associations between specific mood states and ambulatory blood pressure readings; and explored effects of interactions among moods, gender, ethnic group, and maturation on ambulatory blood pressures.

METHODS

The sample included 371 African American, European American, and Hispanic American adolescents 11 to 16 years old. Systolic (SBP) and diastolic (DBP) blood pressures were measured every 30 min with an ambulatory monitor and were synchronized with electronic activity monitoring and moods self-recorded during waking hours in a checklist diary.

RESULTS

Moods differed significantly by gender, ethnic group, and maturation. Controlling for height, maturation, gender, ethnic group, mother's education, position, location, activity, other moods, and interactions of moods with other variables in a multilevel, random coefficients regression model, both positive and negative mood states were associated with higher levels of SBP and DBP; being relaxed or bored, or having a feeling of accomplishing things were associated with lower SBP and DBP. There were significant interaction effects of moods with physical maturity, gender, and ethnic group on ambulatory SBP and DBP.

CONCLUSIONS

Further study of the modifying effects of gender, ethnic group, and stage of development on reports of moods, and their associations with cardiovascular responses is recommended.

Does nondipping of blood pressure at night reflect a trait of blunted cardiovascular responses to daily activities?

BACKGROUND

Individuals who fail to show a decline in blood pressure (BP) when asleep or at night (labeled nocturnal nondippers) are at elevated risk for hypertension and associated target-organ damage.

PURPOSE

We tested whether the well-established changes in BP exhibited in response to daily activities are also blunted in nocturnal nondippers.

METHODS

Cross-sectional study of 41 women and 56 men, aged 27 to 71 years, residing in Benin, Nigeria, enrolled in a health survey of civil servants. Ambulatory 24-hr BP monitoring was performed with concurrent diary recordings of physical activity level, posture, location, state of mental activity, interpersonal interaction, and mood obtained during the waking hours.

RESULTS

Nocturnal nondippers exhibited smaller cardiovascular responses to changes in posture (from lying to sitting or to standing, ps <.02), location (from home to work or to driving/riding in a car, ps <.02), mental activity (from relaxed to active, p =.02), and mood (from feeling mellow to feeling elated-happy, p =.05) than did dippers. Statistical controls for posture substantially reduced the effects of nondipping status on responses to other daily activities and mood. Lack of systolic BP responsiveness to postural changes during the day is a strong predictor of nondipping status.

CONCLUSIONS

Nondipping at night appears to extend to decreased cardiovascular responses to changes in activities during daytime hours.

Moods in everyday situations: effects of menstrual cycle, work, and personality

OBJECTIVE

This study examined women's moods on work and off days during different phases of the menstrual cycle.

METHOD

Self-reports of the moods angry, happy, sad, stressed, tired, and anxious were obtained on two work and two off days during the luteal and follicular phases of the menstrual cycle in 203 nurses. Individual differences in anger expression, anxiety, and hostility were assessed.

RESULTS

Ratings of anxious, stressed, and tired were higher and happy and sad were lower on the workday than the off day. Menstrual cycle phase was associated with mood differences depending on the day (work, off work) and individual differences in personality traits.

CONCLUSIONS

The experience of moods in everyday life is affected by overall levels of stress and phase of the menstrual cycle. The findings suggest the need to refine sociopsychobiological and clinical models of mood regulation and of risk for disease.

Autoregulation of blood pressure and thought: preliminary results of an application of brain imaging to psychosomatic medicine

OBJECTIVE

This presentation seeks to demonstrate the use of brain imaging techniques for understanding the interaction between hypertension and psychosocial function.

METHODS

The historical background for the study of brain function among hypertensive patients is reviewed. An initial and a current project examining rCBF with 15O water radiotracer and PET in unmedicated hypertensives and normotensives are described. The rCBF response is assessed during the performance of spatial and verbal working memory tasks of increasing memory load. The assessment also addresses the influence on rCBF and performance of white matter hyperintensities and the presence of carotid artery thickening.

RESULTS

Initial results suggest that hypertensives relative to normotensives show less CBF and less posterior parietal rCBF in response to increases in memory load. Hypertensives, however, increase lateral prefrontal (Broca's area)/insula and amygdala/hippocampal rCBF more than normotensives.

CONCLUSION

Initial results are sufficient to show that hypertension induces changes in rCBF. A tentative hypothesis is that a relatively general decrease in rCBF responsivity induces specific compensatory cognitive strategies as well as subcortical activation. The rCBF changes appear to have implications for information processing and, as such, hold promise for understanding prior reports relating hypertension to affective regulation and cardiovascular reactivity. Imaging techniques provide a powerful tool for psychosomatic research.

Are changes in blood pressure and total cholesterol related to changes in mood? An 18-month study of men and women

The authors investigated the within-person association of reported mood with blood pressure and total cholesterol (TC) levels, each assessed 4 times over an 18-month period in 128 men and 154 women. Change over time in tense arousal was significantly positively associated with changes over time in systolic blood pressure (SBP) and diastolic blood pressure (DBP) but not TC. A change in hedonic tone was significantly associated with SBP (an increase in negative affect was associated with an increase in SBP) but not with DBP or TC. There were no sex differences in associations of mood with SBP or TC. However, increases in tense arousal and negative affect were significantly associated with an increase in DBP for women but not men.

Interpersonal behavior and resting blood pressure in college women: a daily monitoring study

Psychological factors have long been implicated in the development of hypertension. Most studies exploring this relationship employed questionnaires administered on only one occasion.

OBJECTIVE

to evaluate the relation between blood pressure and social behavior in the natural environment over an extended period of time.

METHOD

40 healthy young adult women at varying risk for hypertension were asked to record their behavior and affect following social interactions, three times a day for 32 days. Behaviors were representative of the interpersonal circumplex: dominance, submissiveness, agreeableness, and quarrelsomeness.

RESULTS

Casual blood pressure was significantly correlated with submissive behavior (r=.45, P<.05) and inversely correlated with agreeable behavior (r=-.35, P<.05). ANOVAs confirmed these findings and further revealed that offspring of hypertensives with relatively elevated blood pressure were most quarrelsome.

CONCLUSION

These results concur with the literature on the relationship between hostility and blood pressure but also suggest the importance of submissiveness in college women.

Similar patterns of cardiovascular response during emotional activation as a function of affective valence and arousal and gender

OBJECTIVE

Laboratory studies of emotion-induced cardiovascular responses have been conducted predominantly with a specific affects approach rather than a dimensional approach. The purpose of this study was to apply the principles of the Circumplex Model of Affect (i.e., valence and arousal) to investigate cardiovascular reactivity during emotional activation in men and women.

METHODS

Forty-two healthy university students (mean age = 19.45, 52% women, 58% Caucasian) engaged in personally relevant recall tasks that varied as a function of valence and arousal. Self-reported valence and arousal, systolic and diastolic blood pressure (SBP and DBP, respectively), heart rate (HR), preejection period (PEP), stroke index (SI), cardiac index (CI), and total peripheral resistance (TPR) were measured during baseline and task periods.

RESULTS

Cardiovascular responses were found to be largely comparable across the recall tasks and were characterized by significant increases in blood pressure, HR, and TPR, and decreases in SI (Ps < .001). In addition, SBP during negative valence tasks was significantly higher than during positive valence tasks (P < .03), and PEP lengthened more during low as compared to high arousal tasks (P < .03).

CONCLUSIONS

These results highlight the similarity of hemodynamic adjustments during the verbal expression of emotion across gender and the dimensions of valence and arousal. The overall response pattern suggests alpha-adrenergically mediated sympathetic activation and vagal withdrawal.

Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability

Work stress has repeatedly been associated with an increased risk for cardiovascular disease. This study tested whether this relationship could be explained by exaggerated cardiovascular reactivity to work or impaired recovery in leisure time. Vagal tone was assessed as a possible determinant of these work stress effects. Participants included 109 male white-collar workers (age, 47.2+/-5. 3) who were monitored on 2 workdays and 1 nonworkday for ambulatory blood pressure, heart rate, and heart rate variability. Chronic work stress was defined according to Siegrist's model as (1) high imbalance, a combination of high effort and low reward at work, or (2) high overcommitment, an exhaustive work-related coping style indexing the inability to unwind. All findings were adjusted for possible differences in posture and physical activity between the work stress groups. High imbalance was associated with a higher heart rate during work and directly after work, a higher systolic blood pressure during work and leisure time, and a lower 24-hour vagal tone on all 3 measurement days. Overcommitment was not associated with an unfavorable ambulatory profile. Logistic regression analysis revealed that heart rate [odds ratio 1-SD increase 1.95 (95% CI, 1.02 to 3.77)] and vagal tone [odds ratio 1-SD decrease 2.67 (95% CI, 1.24 to 5.75)] were independently associated with incident mild hypertension. Surprisingly, the values during sleep were more predictive for mild hypertension than the values during work. The results from the present study suggest that the detrimental effects of work stress are partly mediated by increased heart rate reactivity to a stressful workday, an increase in systolic blood pressure level, and lower vagal tone.