Iris B. Goldstein

AMBULATORY BLOOD PRESSURE, HEART RATE, AND NEUROENDOCRINE RESPONSES IN WOMEN NURSES DURING WORK AND OFF WORK DAYS

OBJECTIVE This study examined womens cardiovascular and neuroendocrine responsiveness to work. METHODS Ambulatory blood pressure (BP) and heart rate (HR) were recorded over 24-hour periods on 2 work and 2 off days during the luteal and follicular phases of the menstrual cycle in 138 registered nurses, aged 25 to 50 years. Urinary catecholamines and cortisol were measured for day and night periods. RESULTS During waking hours systolic BP (SBP), HR, and epinephrine were higher on work than off days. Diastolic BP (DBP) and HR were highest at work. Nurses scoring high on job demands had elevations in daytime SBP, daytime HR only on work days, and nighttime epinephrine on work days. Compared with those with short work histories, nurses employed longer had consistently higher norepinephrine levels during days and nights, and higher nighttime DBP during off days. In unmarried nurses compared with married nurses, nighttime cortisol was lower during all 4 days and norepinephrine was lower during days off. All findings were independent of actigraph-recorded activity. CONCLUSIONS Although the work environment leads to increased activity of the cardiovascular and sympathoadrenal medullary system in healthy women, the effects are modified by the womans domestic role, by the length of her employment, and by the demands of her job.

Relationship Between Blood Pressure and Subcortical Lesions in Healthy Elderly People

BACKGROUND AND PURPOSE The relationship between blood pressure (BP) and heart rate (HR) and MRI assessments of subcortical T2 hyperintensities was evaluated in healthy elderly men and women. METHODS Casual and 24-hour ambulatory BPs and HR measurements were taken of 144 elderly individuals, aged 55 to 79 years. Subjects had no evidence of previous health disorders. MRI scans of white matter, subcortical gray matter, and insular subcortex were coded for severity of hyperintensities. RESULTS Mean casual BP for the group was 120/72 mm Hg. With age and sex accounted for, individuals with the highest severity rating of white matter hyperintensities had higher casual, awake, and sleep systolic BPs; higher awake diastolic BPs; greater awake systolic BP variability; and a smaller nocturnal fall in systolic and diastolic BPs than individuals with less severe ratings. Higher severity ratings for subcortical gray matter hyperintensities were associated with elevations in casual, awake, and asleep systolic BPs and a smaller HR drop during sleep. Subjects with higher ratings for the insular subcortex had higher systolic and diastolic BPs (casual, awake, and asleep), greater HR variability during sleep, and a smaller nocturnal fall in HR. CONCLUSIONS Casual and 24-hour ambulatory BPs and some ambulatory HR measures are associated with subcortical lesions of the brain. Longitudinal studies are needed to further explore the relationship between white matter lesions and cardiovascular measures, as well as the significance of these lesions for cerebrovascular disease in healthy elderly subjects.

Ambulatory blood pressure and the brain A 5-year follow-up

Objective: To determine if initial values of casual and ambulatory systolic blood pressure (SBP) predict white matter hyperintensities, insular subcortex hyperintensities, and brain atrophy 5 years later in a group of healthy elderly individuals. Methods: The authors studied 155 healthy men and women, aged 55 to 79 years. Two 24-hour ambulatory blood pressure (BP) sessions assessed BP level and variability during waking and sleep. Hyperintensities and total brain volume were quantified by MRI. Procedures were repeated 5 years later in 78% (121) of subjects. Results: Hyperintensities and brain atrophy increased over time, with greater increases among older subjects. The presence of increased BP level and variability initially and again 5 years later had negative consequences for the brain. Independent of age, the greater the initial SBP, the greater the likelihood that individuals would have severe white matter hyperintensities after 5 years. Also, elevated casual SBP was associated with severe insular subcortex hyperintensities and greater SBP sleep variability with increased brain atrophy. Conclusions: Among healthy elderly individuals whose initial, average, casual blood pressure (BP) was relatively low (116.9/71.1 mm Hg), small increases in casual and 24-hour ambulatory BP measures were associated with greater brain atrophy and subcortical lesions after 5 years.

Effects of Cynical Hostility, Anger Out, Anxiety, and Defensiveness on Ambulatory Blood Pressure in Black and White College Students

This study asked whether individual differences in four personality traits (cynical hostility, anger out, anxiety, and defensiveness) would predict waking and sleeping ambulatory blood pressure and heart rate and whether information about these traits would provide a source of racial and gender differences in these measures.Ambulatory blood pressure and heart rate were recorded over a 24-hour period in 58 black and 86 white college students equally divided by gender. Waking and sleeping values were examined as a function of gender, race, and personality factors. Independent of personality factors, women had lower ambulatory blood pressure and higher heart rate than men, and black subjects had higher blood pressure levels and less of a decrease in heart rate from waking to sleeping than white subjects. The above differences were associated with personality factors. Black subjects scoring high on cynical hostility had elevated daytime and nighttime systolic pressure. Black subjects scoring high on both anxiety and defensiveness had higher waking diastolic blood pressure. Additional effects were shown for heart rate as a function of anger out, anxiety, and defensiveness. Given the special significance of ambulatory blood pressure for cardiovascular disease, these findings underscore the importance of personality factors for cardiovascular risk and their relevance for race and gender differences in this risk.

THE RELATIONSHIP OF MUSCLE TENSION AND AUTONOMIC ACTIVITY TO PSYCHIATRIC DISORDERS.

&NA; Physiologic recordings of palmar resistance, respiration rate, heart rate, blood pressure, and muscle action potentials in seven different skeletal muscles were recorded among psychiatric patients and normal persons during a resting state and in response to a white noise. Results showed that these patients, all in the early stages of illness, responded at physiologic levels which were at least as high as those of the normals. Psychotic and depressive disorders were two types of mal‐adjustment characterized by exaggerated physiologic responses. This was particularly true for the skeletal muscles in response to the auditory stimulus.

Striking a chord: Moods, blood pressure, and heart rate in everyday life

The objective of this study was to assess the relation between the intensity of single moods and of mood combinations on blood pressure (BP) and heart rate (HR). The subjects were 203 healthy registered nurses, all women, who were studied on two work and two off days. Ambulatory BP and HR were recorded every 20 min. On each occasion subjects rated their moods on a 5-point scale. Graded increases in BP and HR were shown with higher ratings of negative moods and decreases for a mood related to energy level. Little change was observed for a positive mood. These effects depended on concurrent changes in other moods. A positive mood countered the effects of a negative mood, whereas two negative moods resulted in unique patterns of BP and HR. The energy level mood moderated the cardiovascular effects of positive and negative moods. Ambulatory methods provide a way of probing into the nature and consequences of everyday emotional experiences.

The autonomic phenotype of rumination

Recent studies suggest that ruminative thoughts may be mediators of the prolonged physiological effects of stress. We hypothesized that autonomic dysregulation plays a role in the relation between rumination and health. Rumination was induced by an anger-recall task in 45 healthy subjects. Heart rate variability (HRV), baroreflex sensitivity (BRS), and baroreflex effectiveness index (BEI) change scores were evaluated to obtain the autonomic phenotype of rumination. Personality traits and endothelial activation were examined for their relation to autonomic responses during rumination. Degree of endothelial activation was assessed by circulating soluble intercellular adhesion molecule-1 (sICAM-1). Vagal withdrawal during rumination was greater for women than men. Larger decreases in the high frequency component of HRV were associated with higher levels of anger-in, depression, and sICAM-1 levels. BRS reactivity was negatively related to trait anxiety. BEI reactivity was positively related to anger-in, hostility, anxiety, and depression. Lower BEI and BRS recovery were associated with lower social desirability and higher anger-out, anxiety, and depression. Findings suggest that the autonomic dysregulation that characterizes rumination plays a role in the relationships between personality and cardiovascular health.

Ambulatory blood pressure and brain atrophy in the healthy elderly.

BackgroundBrain lesions and atrophy increase with age and hypertension. ObjectiveTo evaluate the relationship of age and ambulatory blood pressure (BP) to brain atrophy in healthy elderly individuals. MethodsMRI volume measurements (normalized to intracranial volume) were taken of total brain and lateral and third ventricles in 155 healthy men and women who went through extensive medical examinations. Younger (56 to 66 years old) and older (67 to 80 years old) subgroups were compared on casual and 24-hour ambulatory BP values and MRI volume measurements. Results Older subjects had smaller brain volumes and larger lateral and third ventricles. Compared with women, men had larger lateral and third ventricles. With age controlled for, greater sleep systolic BP (SBP) variability was associated with smaller brain volumes; greater waking and sleep SBP variability were associated with larger lateral and third ventricles. Subjects with higher casual and waking SBP and waking diastolic BP had larger lateral ventricles. Among older subjects, only those with elevated SBP had smaller brain volumes and larger lateral ventricles. Conclusions These results indicate that if BP levels are within the upper normal range, even healthy individuals with no prior diagnosis of hypertension are more likely to have brain atrophy than those with lower BP. Moreover, not only do BP level and variability relate to brain atrophy, but the combination of high level and greater variability shows an even stronger relationship to brain atrophy than either one of these variables alone.

Ambulatory stress psychophysiology : the study of compensatory and defensive counterforces and conflict in a natural setting

&NA; Thirty years ago, Donald Oken raised basic questions about psychophysiological research strategies for the study of the “psychological stress response” in the laboratory. Is it possible to simulate in the laboratory the situations one normally encounters? Do laboratory stimuli provoke affective arousal? Are different classes of stress stimuli associated with specific physiological response patterns? How do ones characteristic “defenses” and coping styles modulate ones responses? This paper describes a novel ambulatory research strategy in which the laboratory is moved into the natural setting. The advantages of this strategy are exemplified in studies of paramedics in whom 24‐hour recordings were made of ambulatory blood pressure and heart rate. The ambulatory physiological data were then related to information about specific work location and subjective ratings of stress made in a diary at the time of each reading, objective assessments of the different stressful situations encountered, and the role of individual differences in anger expression and defensiveness in modulating these relationships. The findings illustrate the ability of real‐life stressors to bring out relationships not typically obtained in the laboratory. Moreover, the natural setting permits individuals to respond to behavioral challenges using their preferred mode of coping with stress, as opposed to the constraints imposed on them in the laboratory. This research strategy has also helped uncover the significance of conflict about the expression of hostility, rather than hostility per se, as a key factor in the “stress response.”

Wrist actigraph measures of physical activity level and ambulatory blood pressure in healthy elderly persons

A sensitive electronic monitor (Mini-Motionlogger, Ambulatory Monitoring Inc.) attached to the wrist was used to record movements during two 24-hr days of ambulatory blood pressure (BP) and heart rate (HR) recording in 65 women and 54 men between the ages of 55 and 79 years, all of whom were in good health. The objective was to examine the relationship between various measures of physical activity and ambulatory BP and HR during waking and sleeping periods and during various diary-defined behaviors. For waking and sleeping periods, neither the mean nor the variability of the activity measure was associated with the mean or variability of the ambulatory BP and HR measures in between-subjects correlational analyses. Within-subject analyses showed little evidence of significant covariation between activity and BP or HR during either waking or sleeping conditions with most participants showing a slightly positive association. The activity measure discriminated between behaviors associated with little effort (watching television) versus more energetic behaviors (walking). Activity accounted for a relatively small amount of the difference in BP or HR related to overall state (wake, sleep), posture (stand, sit), and social condition (being with family vs. being with friends). The utility of electronic activity monitoring for studies of BP and HR in natural settings is discussed.