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Stress and Hypertension

Stress and Hypertension: Examining the Relation between Psychological Stress and High Blood Pressure

Kevin T. Larkin
Copyright Date: 2005
Published by: Yale University Press
Pages: 416
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  • Book Info
    Stress and Hypertension
    Book Description:

    Does living a stress-filled life lead to elevated blood pressure? And if so, do strategies to better manage stress effectively lower blood pressure? In this authoritative and comprehensive book, Kevin T. Larkin examines more than a half-century of empirical evidence obtained to test the common assumption that stress is associated with the onset and maintenance of essential hypertension (high blood pressure).

    While the research confirms that stress does play a role in the exacerbation of essential hypertension, numerous other factors must also be considered, among them obesity, exercise, and smoking, as well as demographic, constitutional, and psychological concerns. The author discusses the effectiveness of strategies developed to manage stress and thereby lower blood pressure and concludes with suggestions and directions for further study.

    eISBN: 978-0-300-12886-4
    Subjects: Health Sciences, Public Health

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Series Foreword
    (pp. ix-x)
    Alan E. Kazdin

    Current Perspectives in Psychology presents the latest discoveries and developments across the spectrum of the psychological and behavioral sciences. The series explores such important topics as learning, intelligence, trauma, stress, brain development and behavior, anxiety, interpersonal relationships, education, child rearing, divorce and marital discord, and child, adolescent, and adult development. Each book focuses on critical advances in research, theory, methods, and applications and is designed to be accessible and informative to nonspecialists and specialists alike.

    Essential hypertension is of epidemic proportions worldwide and is a key contributor to heart disease and stroke. The prevalence rates vary widely across cultures and...

  4. Introduction The Case of Franklin
    (pp. 1-6)

    Franklin is a forty-eight-year-old African American firefighter who was raised in a rural community in the midwestern United States. Although he has had high blood pressure for the past six years and has experienced a few job-related injuries, he has otherwise been healthy for most of his life. He lives in the same town in which he was raised. Both his parents, who live next door, have high blood pressure, and his father had a heart attack three years ago. He is very close to them, attending church with them and eating several meals with them weekly. Franklin is somewhat...

  5. 1 Regulation of Blood Pressure
    (pp. 7-29)

    Blood has long been recognized as a vital body fluid. Prehistoric humans must have observed the spillage of blood that followed aggressive exchanges or accidents and quickly learned that loss of blood resulted in death. It is not surprising, then, that early physicians, including Hippocrates and Galen, placed a great deal of importance on defining blood as an essential bodily humor and that the examination of the pulse was described as the most important component of a correct medical diagnosis inThe Yellow Emperor’s Classic of Internal Medicine,which dates back to medical traditions in China around 2700 B.C. (for...

  6. 2 Measurement of Blood Pressure
    (pp. 30-66)

    Diagnosis and monitoring of treatment of essential hypertension require the accurate repeated measurement of blood pressure. Although on the surface it may seem that measuring blood pressure is simple, many factors need to be considered when obtaining measures of blood pressure for purposes of diagnosing and monitoring essential hypertension. For example, arterial pressure differs depending upon the specific site of the arterial bed from which the measure is obtained; the closer the location is to the heart, the higher the blood pressure. Body position greatly affects blood pressure measurement, as does ingestion of a variety of substances, including alcohol, nicotine,...

  7. 3 Models of Stress
    (pp. 67-91)

    Like many other psychological constructs (for example, personality or intelligence), the construct of ‘stress’ lacks a uniformly accepted definition. Literally, the term was borrowed from physics, in which it referred to a force or mechanical pressure that resulted in strain upon a particular structure. For example, a professional diver creates stress on a diving board in his or her approach to it; the flexibility of the diving board in response to the stress of his or her action represents strain. In this usage, stress leads to strain, with stress serving as a stimulus and strain as the response. This logic,...

  8. 4 Stress and Essential Hypertension
    (pp. 92-126)

    Now that the foundations for both essential hypertension and stress have been established, we can begin to address the primary question of the book, namely, what is the relation between a psychophysiological construct like stress and the physical manifestation of essential hypertension? It has probably become apparent that many of the bodily organs, systems, and mechanisms responsible for regulating arterial pressure are the same organs, systems, and mechanisms that have served usefully in explaining how environmental stress leads to physical disease. These include the branches of the autonomic nervous system, hormone and steroid release from the neuroendocrine system, and various...

  9. 5 Acute Stress Responses: How Do Environmental Stressors Lead to Essential Hypertension?
    (pp. 127-180)

    Although stress is clearly implicated in the etiology of essential hypertension, it is not easy to explain how a characteristic of a job, like degree of psychologic demand or job control, or exposure to an earthquake results in the physiologic tissue damage (like vascular hypertrophy) or altered regulatory system functioning (like baroreceptor insensitivity) observed in chronic hypertension. Just how can a characteristic of an environmental stimulus lead to these physiologic changes? Several of the theoretical perspectives that were highlighted in Chapter 4 hypothesized that the intensity, pattern, and duration of the acute blood pressure response to stress are important to...

  10. 6 Individual Differences and Essential Hypertension: Constitutional and Lifestyle Factors
    (pp. 181-213)

    From evidence presented in Chapter 5, it appears that the intensity, duration, or patterning of the acute physiological response to stress is the most likely candidate for mediating the stress–hypertension relation. Certainly, among all other aspects of the acute stress response, physiological reactions are the most plausible mediators. If acute cognitive, behavioral, or affective responses were shown to mediate the stress–hypertension relation, we would still be left with quite a challenge of establishing how a specific thought, behavior, or emotion could possibly lead to vascular hypertrophy or baroreceptor insensitivity associated with the condition of prolonged essential hypertension. At...

  11. 7 Individual Differences and Essential Hypertension: Psychological and Social Factors
    (pp. 214-256)

    From evidence presented in Chapter 6, it is quite obvious that constitutional and lifestyle factors influence the relation between stress and hypertension. They probably did in Franklin’s case. Many of these same variables were shown to also be associated with elevated cardiovascular responses to stress, a hypothesized mediator of the stress–hypertension relation. However, when we applied our knowledge of these constitutional and lifestyle variables in the case of Franklin’s hypertension, it became clear that the influence of several other variables was still unknown, namely, those pertaining to Franklin’s psychological state both prior to and following the traumatic incident. Additionally,...

  12. 8 Treatment and Prevention of Essential Hypertension
    (pp. 257-306)

    Given the evidence that has accumulated over the past half century, it is not surprising that Franklin’s physician prescribed an antihypertensive medication to treat his hypertensive condition. Among all interventions that have been tested to lower blood pressure, antihypertensive medications have clearly shown the most efficacy. However, like many patients, Franklin experienced some noticeable side effects associated with the medicine that led to periods of non-adherence and, consequently, his current state of uncontrolled blood pressure. Franklin was not taking his medication during the day in which ambulatory measures of his blood pressure were obtained (see Figure 2.1), and the profile...

  13. 9 Conclusions and Future Directions
    (pp. 307-322)

    Just what should be done with a patient like Franklin? Although his case may appear quite complicated, involving multiple etiologic factors including exposure to a stressful job, a genetic propensity for developing hypertension, and an array of lifestyle factors that may increase his risk, it is really a fairly typical case of essential hypertension. Most individuals with hypertension are exposed to some degree of environmental stress and exhibit a wide range of lifestyle behaviors that may be linked to increased risk for developing it. However, these characteristics are common among most normotensive individuals as well. Therefore, it is quite difficult...

  14. References
    (pp. 323-397)
  15. Index
    (pp. 398-406)