Lecture 5 Cardiovascular reactivity and essential hypertension

Lecture 5, Hypertension and cardiovascular reactivity An excellent introduction to the field is provided by Andrew Steptoe 1998 “Psychophysiological basis of disease” in D & M Johnston, Health Psychology Vol 8 of Comprehensive Clinical Psychology. In library under series title. A good general source on hypertension is the chapter on “Cardiovascular disorders” by Krantz & Lundgren in Johnston & Johnston, Health Psychology. Page (some overlap with an Annual Review paper)

Krantz DS & McCeney MK (2002) Effect of psychological and social factors on organic disease: a critical assessment of research on coronary heart disease. Annual Review Psychology, 53, Another good review, strong on hypertension is Treiber FA, Kamarck, T., Schneiderman, N., Sheffield, D, Kapuka, G., & Taylor, t (2003). Cardiovascular reactivity and development of preclinical and clinical disease states. Psychosomatic Medicine, 65, (Worth reading quite short and covers lot or material)

High blood pressure (essential hypertension) is a risk factor for cardiovascular disease (myocardial infarction and stroke). Is cardiovascular reactivity a risk factor for high blood pressure, and can stress reduction reduce that risk?

Hypertension is a risk factor

Does CV reactivity predict later hypertension? Treiber review suggests that findings variable but fairly positive results for long term prediction (more than 20 years) from response to Cold Pressor test, but studies all quite old. Recent studies mixed in effects

Markovitz et al (1998). Cardiovascular reactivity to video games predicts subsequent blood pressure increases in young men: the CARDIA study. Psychosomatic Medicine, 60, participants aged followed up for 5 years. BP reactions to active & passive tasks assessed at start. SBP response to active challenge predicted significant rise in BP in men. Men whose SBP increased during video game by more than 30 mm Hg twice as likely to have rise in BP as men with average reaction of 10 mm Hg

Does the response to a mental stressor (Ravens matrices) predict blod pressure 10 years later? 796 male civil servants. Initial BP 122/77 10 years later 123/78 i.e., very little change- weakens study Response to mental stress 20/8 mm Hg Predictors of SBP 10 years later Initial SBP r=.5 SBP reactivity r=.21 When Initial SBP controlled SBP reactivity only predicted 1% of final BP and did not predict hypertension. Perhaps participants not exposed to sufficient stress? Carroll, D, Davey Smith G., Shipley, MJ., Steptoe, A., Brunner, EJ & Marmot M. (2001). Blood pressure reactions to acute psychological stress and future blood pressure status: a 10 year follow-up of men in the Whitehall II study. Psychosomatic Medicine, 63,

Tuomisto examined effects of type of stressor in predicting BP and need for treatment in 82 middle aged males over 9-2 years. Participants : approx equal numbers of normal, borderline and hypertensives Stressors Active (eg video game) Social (eg problem solving) Passive (eg Cold pressor) Casual BP at start 140/87; 9-12 years later 142/96 (some increase in DBP) 1. Predictors of 24 hour SBP Initial SBP, Active task SBP (explaining 17%) “, Social task SBP ( “ 12%) “, Passive task SBP ( “ 17%) DBP responses not strong predictor of later DBP 2. Predictors of starting anti-hypertensive medication. a. SBP Minor predictive role for SBP response to active tasks b. DBP. DBP response to all types of stressor main predictor medication use. Tuomisto concludes that reactivity is predictive Tuomisto, MT, et al, (2005). Psychological stress tasks in the prediction of blood pressure level and need for antihypertensive medication: 9-12 year follow-up. Health Psychology, 24, 77-87

CV Reactivity. Causal role in disease? Risk marker Direct cause

Interventions. Method of establishing causality

Patel,C,Marmot,MG,Terry,DJ,Carruthers,M,Hunt,B,Patel,M, (1985)Trial of relaxation in reducing coronary risk: four year follow up. British Medical Journal,290,1103,1106 Johnston,DW,Gold,A,Kentish,J,Smith,D,Vallance,P,Shah,D,Lea ch,G,Robinson,B,(1993) Effect of stress management on blood pressure in mild primary hypertension. British Medical Journal, 306,963,966, Schneider,RH,Staggers,F,Alexander,CN,Sheppard,W,Rainfort H,M,Kondwani,K,Smith,S,King,CG,(1995) A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension,26,820,827 Recent review (available on web) Linden, W & Moseley, JV (2006). The efficacy of behavioural treatments for hypertension. Applied psychophysiology and biofeedback, 31, Linden suggests there are modest effects of behavioural interventions

Stress Management in the reduction of hypertension. Patel’s approach involves 1.Live relaxation training 2.Regular home practice 3.Application in reallife 4.Simple counselling

Final study in a series of positive studies by Patel. Participants at increased risk of CHD because high on 2 of 3 risk factors, BP, smoking or cholesterol. Not all hyperternsive.

Tightly controlled trial of stress management (like Patel), in approx. 100 mild hypertensives. Flexibility exercises used as control group. Long baseline (3 months), clinic ambulatory and stress testing of BP

No effect on 12 hour ambulatory BP

Perhaps an effect of BP response to stressful interview?