Ethnicity, sex, trait anger, and nocturnal blood pressure decline

Do Hypertensive Men Spy With an Angry Little Eye? Anger Recognition in Men With Essential Hypertension - Cross-sectional and Prospective Findings

BACKGROUND

Higher trait anger has inconsistently been associated with hypertension and hypertension development, but social context in terms of recognition of other persons' anger has been neglected in this context.

PURPOSE

Here, we investigated anger recognition of facial affect and trait anger in essential hypertensive and normotensive men in addition to prospective associations with blood pressure (BP) increases.

METHODS

Baseline assessment comprised a total of 145 participants including 57 essential hypertensive and 65 normotensive men who were otherwise healthy and medication-free. Seventy-two eligible participants additionally completed follow-up assessment 3.1 (±0.08 SEM) years later to analyze BP changes over time. We assessed emotion recognition of facial affect with a paradigm displaying mixed facial affect of two morphed basic emotions including anger, fear, sadness, and happiness. Trait anger was assessed with the Spielberger trait anger scale.

RESULTS

Cross-sectionally, we found that with increasing BP, hypertensive men overrated anger displayed in facial expressions of mixed emotions as compared to normotensive men (ps ≤ .019) while there were no differences in trait anger (p = .16). Prospectively, the interaction between mean anger recognition and trait anger independently predicted BP increases from baseline to follow-up (ps ≤ .043), in that overrating displayed anger predicted future BP increases only if trait anger was high.

CONCLUSIONS

Our findings indicate an anger recognition bias in men with essential hypertension and that overrating displayed anger in combination with higher trait anger seems to predict future BP increases. This might be of clinical relevance for the development and progression of hypertension and cardiovascular disease.

Sex differences in blood pressure responsiveness to spontaneous K-complexes during stage II sleep

K-complexes are a key marker of nonrapid eye movement sleep, specifically during stages II sleep. Recent evidence suggests the heart rate responses to a K-complexes may differ between men and women. The purpose of this study was to compare beat-to-beat blood pressure responses to K-complexes in men and women. We hypothesized that the pressor response following a spontaneous K-complex would be augmented in men compared with women. Ten men [age: 23 ± 2 yr, body mass index (BMI): 28 ± 4 kg/m²] and ten women (age: 23 ± 5 yr, BMI: 25 ± 4 kg/m²) were equipped with overnight finger plethysmography and standard 10-lead polysomnography. Hemodynamic responses to a spontaneous K-complex during stable stage II sleep were quantified for 10 consecutive cardiac cycles, and measurements included systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and heart rate. K-complex elicited greater pressor responses in men when blood pressures were expressed as SAP (cardiac cycle × sex: P = 0.007) and DAP (cardiac cycle × sex: P = 0.004). Heart rate trended to be different between men and women (cardiac cycle × sex: P = 0.078). These findings suggest a divergent pressor response between men and women following a spontaneous K-complex during normal stage II sleep. These findings could contribute to sex-specific differences in cardiovascular risk that exist between men and women.NEW & NOTEWORTHY K-complexes during stage II sleep have been shown to elicit acute increases in blood pressure and heart rate, but the role of sex (i.e., male vs. female) in this response is unclear. In the present study, we demonstrate that the pressor response following spontaneous K-complexes were augmented in men compared to age-matched women. The augmented blood pressure reactivity to spontaneous K-complexes during stage II sleep in men advance the field of cardiovascular sex differences, with implications for nocturnal blood pressure control.

Fibromyalgia and nondipper circadian blood pressure variability

BACKGROUND AND OBJECTIVES

Aberrant circadian rhythm with persistent nocturnal sympathetic hyperactivity has pointed out malfunctioning autonomic nervous system in fibromyalgia (FM) patients. This is a common pathogenesis shared also by patients with nondipping blood pressure (BP) pattern. Therefore, we aimed to investigate the frequency of nondipping BP pattern in normotensive women with newly diagnosed FM compared with healthy women.

METHODS

Sixty-seven normotensive women with new diagnosis of FM and 38 age-matched healthy volunteer women were recruited into the study. All subjects underwent 24-hour ambulatory BP monitoring on a usual working day. Individuals were defined as "dippers" if their nocturnal BP values decreased by more than 10% compared with daytime values; defined as "nondippers" in case of a decline less than 10%. Serum creatinine, fasting blood glucose, cholesterol levels, albumin, and thyroid-stimulating hormone levels were assessed.

RESULTS

Ambulatory measurements showed significantly higher diastolic BP values in patients with FM for both average of 24-hour recordings. Patients with FM had significantly lower systolic (9.1 ± 3.9 vs 11.5 ± 4.9, P = 0.010) and diastolic dipping ratios (12.3 ± 6.1 vs 16.1 ± 6.4, P = 0.004). The number of nondippers in the FM group was significantly higher than that of controls for both systolic (66% vs 34%, P = 0.002) and diastolic BP measurements (42% vs 21%, P=0.031). Patients with FM were 3.68 times more likely to be systolic nondipper and 2.69 times more likely to be diastolic nondipper.

CONCLUSIONS

We have demonstrated a significant relationship between FM and nondipping BP pattern, and we suggest that nondipping profile, which has been closely associated with cardiovascular morbidity, may appear as an additional risk factor in patients with FM.

Cardiovascular responses to stress in Singapore and India

BACKGROUND

Epidemiological studies have shown significant ethnic differences in coronary heart disease death rates with South Asians showing significantly greater coronary heart disease mortality than other groups.

PURPOSE

This research examined ethnic differences in cardiovascular reactivity (CVR) among Chinese, Malays and Indians in Singapore as well as a sample of Indians living in India.

METHODS

Experiment 1 examined differences across 303 Chinese, Malay and Indian undergraduates in Singapore, while Experiment 2 looked at differences in CVR between Indian participants from Singapore, and 145 Indians living in India. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), cardiac index (CI) and total peripheral resistance index (TPRI) were measured during baselines and five laboratory tasks.

RESULTS

Ethnicity main effects for SBP and CI reactivity were obtained in Experiment 1, with Indians showing significantly lower BP and CI reactivity than the Chinese and Malays. Significant main effects for sex were found with females showing lower reactivity than males for TPRI, and greater reactivity than males for HR and CI. Experiment 2 found that participants from India showed higher reactivity for SBP, HR and CI, while Indian participants from Singapore showed higher TPRI reactivity. These differences, however, often varied by task.

CONCLUSIONS

These results point to differences in CVR among ethnic groups in Singapore as well as between Indians living in India and those living in Singapore. These differences may reflect cultural differences and need to be explored further with respect to their relationship to different rates of coronary heart disease among these groups.

Socioeconomic status, nocturnal blood pressure dipping, and psychosocial factors: a cross-sectional investigation in Mexican-American women

BACKGROUND

Despite established links between reduced nocturnal blood pressure (BP) dipping and cardiovascular disease, BP dipping research in Hispanics is limited.

PURPOSE

This study investigated socioeconomic status (SES) as a predictor of BP dipping and the contributions of psychosocial factors to this relationship. Analyses were conducted for the overall sample and separately for higher and lower acculturated women.

METHODS

Mexican-American women (N = 291; 40-65 years) reported demographics and completed psychosocial assessments and 36-h ambulatory BP monitoring.

RESULTS

Lower SES related to reduced BP dipping in the overall sample and in more US-acculturated women (r's = .17-.30, p's < .05), but not in less-acculturated women (r's = .07, p's > .10). An indirect effect model from SES to BP dipping via psychosocial resources/risk fits well across samples.

CONCLUSIONS

In Mexican-American women, the nature of SES gradients in BP dipping and the roles of psychosocial resources/risk differ by acculturation level.

Ethnicity, gender, genotype, and anger as related to nocturnal dipping

Bishop, Pek, and Ngau (2005) found a significant interaction in Singapore between anger and nocturnal dipping among Indians but not Chinese and Malays. The current study examines the role of 5-HTTLPR genotype in this relationship. Two hundred thirty-one undergraduates participated in up to 4 days of 24-h ambulatory monitoring, completed the State-Trait Anger Expression Inventory, and provided blood samples for genotyping of 5-HTTLPR. Results indicated individuals with two copies of the short allele (SS) showed reduced dipping when they were high in Outward Anger (OA) but increased dipping when they were low in OA. Further, for Indian men only, dipping was reduced for individuals having the SS genotype when they were low on Anger In and increased when they were high on Anger In. These data provide further evidence for the role of 5-HTTLPR in cardiovascular risk as well as ethnic differences in the 5-HTTLPR-phenotype relationship. They also provide further evidence for 5-HTTLPR as a "plasticity gene."

Hemodynamic response to postural shift in women with multiple chemical sensitivities

Multiple chemical sensitivity (MCS) is a chronic condition prevalent in women; the symptoms are reproducible with repeated low-level chemical exposure. Evidence gathered through clinical observations suggests that women with MCS may be at risk for autonomic nervous system dysfunction as evidenced by abnormal heart rate and pulse pressure responses to exercise. The primary objective of this study was to describe the hemodynamic response to postural shift in 17 women with MCS. Using impedance cardiography, hemodynamic measures were taken while sitting and immediately upon standing. The hemodynamic response to standing was increased heart rate (p < .0001), decreased stroke volume (p = .002), decreased left ventricular ejection time (p < .0001), increased diastolic blood pressure (p = .01), and increased systemic vascular resistance (p =.002). Although this pattern of hemodynamic response was normal, the magnitude of the changes was considerably less than those observed previously in healthy participants. These findings warrant further investigation.

Ambulatory impedance cardiography in hypertension: a validation study

The management of hypertension is improved by knowledge of the hemodynamics underlying blood pressure. Impedance Cardiography (ICG) provides data on a range of hemodynamic variables that affect blood pressure. However, ICG captures only fixed descriptions of hemodynamic characteristics. Improvements in ambulatory technology have led to the development of the Ambulatory Impedance Monitor (AIM) which records hemodynamic data during the activities of daily living. The purpose of this study was to evaluate the sensitivity of the AIM to detect hemodynamic changes associated with postural shift in persons with hypertension. Using a repeated measures cross-over design, sitting and standing hemodynamic measures were taken in seventeen persons with hypertension while wearing the AIM-BpTRU system designed for standard office use and the AIM-Spacelabs system designed for ambulatory monitoring. Both AIM-blood pressure monitoring systems detected significant changes from sitting to standing posture in heart rate (p=0.03), stroke volume (p=0.002), left ventricular ejection time (p<0.001), systemic vascular resistance (p=0.03) and diastolic blood pressure (p<0.001). Additionally, both systems generated measures of cardiac function that were positively correlated (p<0.001) and not significantly different (p>0.05). Our findings support previous work and demonstrate that the AIM provides valid and reliable estimates of cardiac function in persons with hypertension.

Racism and ambulatory blood pressure in a community sample

OBJECTIVE

Racism has been identified as a psychosocial stressor that may contribute to disparities in the prevalence of cardiovascular disease. The goal of the present article was to investigate the relationship of perceived racism to ambulatory blood pressure (ABP) in a sample of American-born Blacks and Latinos.

METHODS

Participants included English-speaking Black or Latino(a) adults between the ages of 24 and 65. They completed daily mood diaries and measures of perceived racism, socioeconomic status, and hostility. Participants were outfitted with ABP monitors; 357 provided data on waking hours only, and 245 provided data on both waking and nocturnal ABP.

RESULTS

Perceived racism was positively associated with nocturnal ABP even when controlling for personality factors and socioeconomic status.

CONCLUSIONS

The results suggest that racism may influence cardiovascular disease risk through its effects on nocturnal BP recovery.

Ambulatory impedance cardiography: a systematic review

BACKGROUND

Standard noninvasive impedance cardiography has been used to examine the cardiovascular responses of individuals to a wide range of stimuli in critical care and laboratory settings. It has been shown to be a reliable alternative to invasive thermodilution techniques and an acceptable alternative to the use of a pulmonary artery catheter. Ambulatory impedance cardiography provides a similar assessment of cardiac function to standard noninvasive impedance cardiography, but it does so while individuals engage in activities of daily living. It offers portability and the option of managing complex patients in outpatient settings.

OBJECTIVE

To critically examine through a literature analysis the validity, reliability, and sensitivity of ambulatory impedance cardiography for the assessment of cardiac performance during activities of daily living.

METHODS

The Cochrane Database of Systematic Reviews (CDSR), The Cochrane Database of Methodology Reviews (CDMR), The Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA), and The Cochrane Methodology Register (CMR; 1966-2005); MEDLINE (1950-2005); and CINAHL (1982-2005) were searched using the following terms: ambulatory cardiac performance, impedance cardiac performance, AIM cardiac performance monitor, thoracic electrical bio-impedance, impedance cardiography, ambulatory impedance monitor, bio-impedance technology, ambulatory impedance cardiography, bio-electric impedance; also included were reference lists of retrieved articles. Studies were selected if they used an ambulatory impedance monitor to examine one or more of the following cardiovascular responses: pre-ejection period (PEP), left ventricular ejection time (LVET), stroke volume (SV), or a combination of these.

RESULTS

Studies have been predominantly descriptive and have been focused on a young, male population with a normal body mass index (BMI; 25-29 kg/m). Inconsistencies in determining specific markers of cardiac function (e.g., PEP and SV) across studies necessitated that results be reported by outcome for each study separately.

DISCUSSION

Ambulatory impedance monitors are valid and reliable instruments used for the physiologic measurement of cardiac performance. Sensitivity is established utilizing within-individual measurements of relative change. This is especially important in light of an aging population and technical advances in healthcare. Further research is warranted using nursing interventions that focus on an older, female population who have a BMI greater than 30 kg/m. Availability of noninvasive ambulatory measures of cardiac function has the potential to improve care for a variety of patient populations, including those with hypertension, heart failure, pain, anxiety, and depressive symptoms.

Blunted cardiovascular responses to daytime activities as related to reduced nocturnal blood pressure decline

BACKGROUND

Individuals showing less than a 10% decline in blood pressure at night ("nondippers") are known to be at increased risk for hypertension and other cardiovascular conditions.

PURPOSE

This research tested the assertion by Räikkönen et al. (1) that nondippers show blunted cardiovascular responses to activities during daytime hours.

METHODS

Ambulatory blood pressure and impedance monitoring was performed with 149 young adults in Singapore. At each daytime blood pressure reading, participants completed a computerized questionnaire indicating location, posture, physical activities, feelings, and social interactions.

RESULTS

Significant interactions between dipper status and feeling tired, location, posture, and physical activity provided qualified support for the blunting hypothesis. However, blunting of BP responses was not attributable to blunting of either cardiac output or total peripheral resistance responses.

CONCLUSION

Nondippers appear to show blunted daytime responses to certain types of daytime activities. However, these effects are limited and appear to be the result of different mechanisms than those responsible for reduced nighttime blood pressure decline.