Attenuation of positive and negative affect in men and women at increased risk for hypertension: a function of endogenous barostimulation?

Behavioural approach-avoidance tendencies among individuals with elevated blood pressure

Emotional dampening (blunted responses to affective stimuli or experiences) has been reported in individuals with clinical and subclinical levels of elevated blood pressure (BP). Our aim in the present study was to explore how the basic motivational systems of approach and avoidance to positively- and negatively-valenced stimuli are affected in elevated BP. High BP (n = 27) and Low BP (n = 29) participants completed an approach-avoidance task. In this task, participants pulled the joystick towards them when viewing a happy face (approach) and pushing it away when viewing an angry face (avoid) in the congruent condition, and reversed these action-to-emotion pairings in the incongruent condition. A mixed-design ANOVA revealed a significant main effect of condition, such that overall participants were faster across trials in the congruent than trials of the incongruent condition. There was also an emotion x BP interaction. Among the Low BP group, there were no RT differences to happy and angry expressions (across congruent and incongruent conditions) but those with High BP were quicker to respond to actions paired with angry than happy facial expressions (across conditions). Findings suggest that valence-specific motivational reactions are not dampened with an increase in BP, and are rather sensitized for the negative emotion of anger.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04337-2.

Blood Pressure, Emotional Dampening, and Risk Behavior: Implications for Hypertension Development

OBJECTIVE

Elevated resting blood pressure (BP) is associated with risk for hypertension and emotional dampening, including reduced responses to emotionally meaningful stimuli. Perception of threat is a critical motivator in avoidance of risky health-damaging behavior. We hypothesize that BP-associated dampening of threat appraisal may increase risk-taking behavior.

METHODS

We measured resting BP, perception of affect, and risk behavior in 92 healthy women (n = 49) and men (n = 43) recruited from university students and staff as well as members of the surrounding community. Mean (SE) age for the sample was 21.5 (4.3) year. BP was measured using an automated BP monitor, and risk behavior was assessed with a modified National College Health Risk Behavior Survey. We also measured recognition of affect using the Perception of Affect Task (PAT).

RESULTS

Risk-taking behavior was positively correlated with both systolic (r(89) = .278, p = .008) and diastolic BP (r(89) = .309, p < .003). Regression analyses indicated that the association between risk-taking behavior and BP was not mediated by PAT scores.

CONCLUSIONS

Results show that persons with higher resting BP levels report increased risk-taking behavior. PAT scores, while correlated with systolic BP, did not mediate the relationship between BP and risk. The relationship between BP and risk behavior reflects the potential involvement of central nervous system regulation of both BP and emotional responsivity, and its relationship to health-damaging behavior and risk for hypertension.

Poor emotional responsiveness in clinical hypertension: Reduced accuracy in the labelling and matching of emotional faces amongst individuals with hypertension and prehypertension

Psychological factors are known to play an important part in the origin of many medical conditions including hypertension. Recent studies have reported elevated blood pressure (even in the normal range of variation) to be associated with a reduced responsiveness to emotions or 'emotional dampening'. Our aim was to assess emotional dampening in individuals with more extreme blood pressure levels including prehypertensives (N = 58) and hypertensives (N = 60) by comparing their emotion recognition ability with normotensives (N = 57). Participants completed novel facial emotion matching and facial emotion labelling tasks following blood pressure measurement and their accuracy of emotion recognition and average response times were compared. The normotensives demonstrated a significantly higher accuracy of emotion recognition than the prehypertensives and the hypertensives in labelling of facial emotions. This difference generalised to the task where two facial halves (upper & lower) had to be matched on the basis of emotions. In neither the labelling nor matching emotion conditions did the groups differ in their speed of emotion processing. Findings of the present study extend reports of 'emotional dampening' to hypertensives as well as to those at-risk for developing hypertension (i.e. prehypertensives) and have important implications for understanding the psychological component of such medical conditions as hypertension.

Assessing emotional processing difficulties in normotensive individuals with high and isolated blood pressure elevations

This study examined the effect of sense modality (auditory/visual) on emotional dampening (reduced responsiveness to emotions with elevation in blood pressure). Fifty-six normotensive participants were assessed on tasks requiring labelling and matching of emotions in faces and voices. Based on median split of systolic and diastolic blood pressures (SBP and DBP, respectively), participants were divided into low BP, high BP and isolated BP groups. On emotion-labelling tasks, analysis revealed reduced emotion recognition in the high BP than the low BP group. On emotion-matching tasks, reduced emotion recognition was noted in high and also isolated BP group as compared to low BP group for the task that required matching a visual target with one of the four auditory distractors. Our findings show for the first time that even isolated elevations in either SBP or DBP may result in emotional dampening. Furthermore, the study highlights that the emotional dampening effect generalises to explicit processing (labelling) of emotional information in both faces and voices-and that these effects tentatively occur during more pragmatic and covert (matching) emotion recognition processes too. These findings require replication in clinical hypertensives.

Affective impairment in chronic low blood pressure

OBJECTIVE

Physical complaints such as faintness, dizziness, cold limbs and headaches have been well-established in chronic low blood pressure (hypotension). This study investigated the occurrence of adverse emotional states and the symptoms of depression in this condition. As autonomic dysregulation, particularly diminished sympathetic tone, is believed to be involved in the etiology of hypotension, the impact of different facets of autonomic cardiovascular control on mood and depressive symptoms was also explored.

METHODS

Forty individuals with chronic hypotension and forty normotensive control persons were presented with the Mood Scale and Beck Depression Inventory. Stroke volume, cardiac output, pre-ejection period, Heather index and aortic peak blood flow velocity were recorded under resting conditions as indices of beta-adrenergic inotropic drive. Respiratory sinus arrhythmia and baroreflex sensitivity were additionally obtained.

RESULTS

Hypotensive individuals scored markedly higher on both questionnaire scales than controls, indicating an adversely affected emotional state and more severe depressive symptoms. In the entire sample, cardiac output, Heather index, and aortic peak blood flow velocity correlated negatively with the questionnaire scores; according to regression analysis, the Heather index explained the largest proportion of test score variance.

CONCLUSION

Although hypotension does not constitute a serious medical condition, the findings of an adverse affective state and increased burden with depressive symptoms corroborate the view that it can have a considerable impact on wellbeing and quality of life. The correlations of the beta-adrenergic indices with the questionnaire scales indicate that cardiac sympathetic regulation plays a key role in the psychophysiological mediation of hypotension-related mood impairment.

The behavioral impact of baroreflex function: a review

The baroreflex consists of a negative feedback loop adjusting heart activity to blood pressure fluctuations. This review is concerned with interactions between baroreflex function and behavior. In addition to changes in baroreflex cardiac control subject to behavioral manipulations, interindividual differences in reflex function predicted psychological and central nervous features. The sensitivity of the reflex was inversely related to cognitive performance, evoked potential amplitudes, experimental pain sensitivity, and the severity of clinical pain. Possible variables moderating the strength of the associations are tonic blood pressure, gender, and psychiatric disease. It is suggested that these observations reflect inhibition of higher brain function by baroreceptor afferents. While in many cases increased baroreflex function implies stronger inhibition, individual and situational factors modulate the behavioral impact of cardiac regulation.

From Brain to Behavior: Hypertension's Modulation of Cognition and Affect

Accumulating evidence from animal models and human studies of essential hypertension suggest that brain regulation of the vasculature is impacted by the disease. Human neuroimaging findings suggest that the brain may be an early target of the disease. This observation reinforces earlier research suggesting that psychological factors may be one of the many contributory factors to the initiation of the disease. Alternatively or in addition, initial blood pressure increases may impact cognitive and/or affective function. Evidence for an impact of blood pressure on the perception and experience of affect is reviewed vis-a-vis brain imaging findings suggesting that such involvement in hypertensive individuals is likely.

Cardiovascular-emotional dampening: the relationship between blood pressure and recognition of emotion

OBJECTIVE

Persons with elevated blood pressure (BP) show dampened emotional responses to affect-laden stimuli. We sought to further examine cardiovascular-emotional dampening by examination of the relationship between resting hemodynamic measures and recognition of emotion in an African American community-based sample.

METHODS

Participants were 106 African American men and women (55 women; mean age = 52.8 years), mainly low in socioeconomic status, and part of the Healthy Aging in Nationally Diverse Longitudinal Samples pilot study. Participants evaluated emotional expressions in faces and sentences using the Perception of Affect Test (PAT). Resting BP, total peripheral resistance (TPR), cardiac output, and heart rate were obtained continuously using a Portapres BP monitor.

RESULTS

Total PAT scores were inversely related to systolic (r = -0.30) and diastolic (r = -0.24) BPs, TPR (r = -0.36), and age (r = -0.31; p values < .01) and were positively related to cardiac output (r = 0.27) and education (r = 0.38; p values < .01), as well as with mental state (r = 0.25) and body mass index (r = -0.20; p values < .05). Accuracy of emotion recognition on the PAT tasks remained inversely related to TPR and BP after adjustment for demographic variables, medication, mental state, and body mass index.

CONCLUSIONS

Elevated BP and TPR were associated with reduced perception of affect. TPR was the most consistent independent hemodynamic correlate of emotional dampening for the PAT scores. These results suggest potentially important links among central nervous system regulation of emotions, hemodynamic processes, and hypertension development.