Joanna M. Polefrone

Hypertension and neuropsychological performance in men: interactive effects of age.

Potentially interactive effects of hypertension and age on the performance of neuropsychological and information processing tests were examined in 123 untreated hypertensive and 50 normotensive men. After covarying education, average alcohol consumption, trait anxiety, and depression scores, results indicated an interaction of age and hypertension. Young hypertensive men (23-40 years) scored significantly worse than young normotensive men on tests of attention/executive function and working memory; middle-aged hypertensive (41-56 years) and normotensive participants were not distinguished by any measures. Hypertensive men performed significantly more poorly than normotensive men on tests of manual dexterity. Results suggest that neuropsychological sequelae of hypertension are more pronounced in young than in middle-aged hypertensive individuals and are independent of various demographic, psychosocial, and alcohol-related factors.

Effects of six anti-hypertensive medications on cognitive performance

Objective To describe and compare the effects of six different antihypertensive medications on cognitive performance. Design Prospective, randomized, and double-blind with treatment cross-over. Setting University hypertension clinic and neuropsychology laboratory. Participants Ninety-eight Caucasian men between 25 and 55 years of age with mild-to-moderate essential hypertension (88 of whom completed the study), and 32 normotensive men with similar socio-demographic characteristics. Interventions Six-week treatment periods with atenolol, metoprolol, hydrochlorothiazide, methyldopa, enalapril and verapamil, and 2-week placebo baseline and wash-out periods. Main outcome measures In-depth neuropsychological assessments and several mood questionnaires were completed during placebo (baseline) periods and active treatment periods. Practice effects due to repeated neuropsychological testing were estimated from data collected concurrently in the normotensive participants. Results The antihypertensive treatments lowered blood pressure comparably and did not affect mood or anxiety. Small treatment effects were noted in four of seven domains of cognitive performance. Irrespective of medication type, treatment reduced the simple motor speed (P < 0.001), and slowed completion of two tests measuring perceptuo-motor speed and mental flexibility (P ⩽ 0.05). Manual dexterity declined somewhat with metoprolol and methyldopa (P = 0.01). In contrast, all antihypertensive agents favorably affected performance on several tests that require working memory (P < 0.01). Performance on other tests assessing grip strength, learning and memory, attention and executive function was not affected. Conclusion Short-term treatment with standard antihypertensive medications was associated with some small decrements in psychomotor performance and small improvements in working memory, without notable drug-class differences. Long-term effects await further study.

Effects of menstrual phase and parental history of hypertension on cardiovascular response to cognitive challenge.

&NA; The effects of parental history of hypertension and menstrual phase on systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) responses to two frustrating cognitive tasks were examined in 47 normotensive, young adult women. Subjects with and without a parental history of hypertension were scheduled to be tested during either the follicular (days 7–11 of a 28‐day cycle) or luteal (days 17–22) phase of the menstrual cycle. During the laboratory session, HR, SBP, DBP, and self‐report of affective states were measured while subjects performed two cognitive tasks (mental arithmetic and concept formation). Results indicated that the magnitude of SBP responses to the two tasks was significantly greater in subjects tested during the follicular phase than in subjects tested in the luteal phase of the menstrual cycle. No effect of parental hypertension was observed on cardiovascular response measures, though offspring of hypertensive parents reported experiencing significantly less anger during the tasks than subjects with normotensive parents.

Absence of Enhanced Sympathoadrenal Activity and Behaviorally Evoked Cardiovascular Reactivity among Offspring of Hypertensives

To determine whether offspring of hypertensives show enhanced sympathetic nervous system activity, we evaluated several indices of sympathoadrenal activation and cardiovascular responsiveness to behavioral stimuli among 90 normotensive, young adult men having either one or two hypertensive parents (PH+(-), PH++) or normotensive parents only (PH--) (n = 30/group). Measurements included heart rate (HR) and blood pressure (BP) reactions to three mental stressors (the Stroop test, mental arithmetic, mirror tracing), a cold pressor test, postural adjustment (60 degrees upright tilt), isometric exercise and bicycle ergometry, as well as the 24-h excretion of catecholamines (epinephrine [E], norepinephrine [NE]) and venous plasma catecholamine concentrations, both at rest (seated and supine) and in response to the Stroop test and upright tilt. The three groups did not differ in age, education, body mass index (BMI), estimated aerobic fitness, resting HR, cardiac preejection period (PEP) and PEP:LVET (left ventricular ejection time) ratio, 24-h Na or K excretion, or fasting lipids, insulin or plasma renin activity. Resting systolic and diastolic BP varied as a function of parental hypertension, and were significantly higher in PH++ than among PH-- subjects (P < .05). No significant group difference was observed on any measure of plasma or urinary catecholamines, nor did offspring of hypertensives (PH++ or PH+-) showed greater HR or BP reactions than PH-- subjects to any of the several laboratory challenges. In sum, we find no evidence of enhanced sympathetic activity or heightened cardiovascular responsiveness among normotensive young adults who are familially predisposed to essential hypertension.

Relationship of cardiovascular reactivity and anger expression to serum lipid concentrations in healthy young men.

The relationship between behaviorally evoked cardiovascular reactivity, preferred mode of anger expression, and serum lipid concentrations was examined in 63 healthy, young adult males. Subjects derived from three studies, each evaluating cardiovascular response to laboratory stressors. All participants completed the Spielberger Anger Expression Scale and provided fasting blood samples for lipid determinations. A significant negative correlation, calculated by meta-analytic procedures, was noted between a baseline-free measure of heart rate reactivity and high density lipoprotein-cholesterol (HDL-C) concentrations (r = -0.26, p = 0.05). However, the previously reported relationship between cardiovascular reactivity and elevated total serum cholesterol (TSC) was not found. Additionally, men scoring high on a self-report measure of the tendency to express anger outwardly had significantly higher HDL-C concentrations than men scoring low on this measure (r = 0.30, p = 0.02); when subjects were stratified by level of cardiovascular reactivity, this relationship was apparent only among those showing the greatest magnitude of heart rate and blood pressure responses to acute mental stress.

Neuropsychological performance of young men who vary in familial risk for hypertension.

&NA; Neuropsychological performance was examined as a function of parental history of hypertension. Thirty‐five normotensive offspring of two hypertensive parents (PH+/+) were compared to 35 offspring of two normotensive parents (PH‐/‐) and 35 offspring of one hypertensive and one normotensive parent (PH+/‐) on tests of abstract reasoning, attention/mental flexibility, memory, perception, psychomotor skills, and visuospatial/constructional abilities. Results indicated that PH+/+ offspring performed more poorly than PH‐/‐ offspring on tests of visuospatial/constructional and visuoperceptual ability; PH+/‐ offspring tended to score lower than PH‐/‐ offspring on these tests. These findings were independent of age, education, diastolic blood pressure levels, average alcohol consumption, trait anxiety, and depression. Results of this study may indicate subtle central nervous system involvement associated with familial risk for hypertension.

Task Influences on Behaviourally-Elicited Cardiovascular Reactions

Task characteristics strongly influence both the patterning and magnitude of behaviourally-elicited cardiovascular responses. The major stimulus determinants of cardiovascular reactions include: (a) attentional requirements for sensory intake versus sensory rejection; (b) situational demands for active versus passive coping; (c) the nature of emotional or affective states elicited; and (d) associated task attributes such as novelty, difficulty and the presence of performance-contingent incentives. The interest of many clinical investigators in the assessment of psychophysiologic responses follows from recent speculation that a cardiovascular hyperreactivity to stress may be implicated in coronary heart disease (CHD) and/or essential hypertension. In this regard, it is important to examine effects of stimulus variables on the measurement of individual differences in cardiovascular reactivity and on the relationship of such differences to CHD, hypertension and risk for cardiovascular disease. Available data are mixed concerning the stability of idiosyncratic heart rate and blood pressure responses across varying stimulus conditions; some investigators report substantial intertask correlations, whereas others find only moderate, or little, consistency of responses across tasks. Concerning samples of clinical interest, an increased cardiovascular reactivity among hypertensive patients and in persons with a family history of hypertension is observed most frequently during tasks that require subjects to engage in active coping or mental work (sensory rejection). Situational variables are also important in studies of the psychophysiologic correlates of the Type A (coronary-prone) behaviour pattern. Here, the heightened cardiovascular reactivity of Type A individuals appears to be influenced both by the formal nature of the task employed (ie, active versus passive coping, etc) and by the interpersonal and instructional context in which experimental stimuli are presented.

Behavioral Aspects of Arterial Hypertension and Its Treatment

Diseases of the heart and the vasculature account for more than half of all deaths occurring annually in the United States. Among the disorders contributing to this statistic, coronary heart disease and stroke are by far the most significant. These clinical manifestations often result from a lifelong accumulation of fatty lesions (atherosclerosis) in the intima, or inner layer, of arteries carrying blood to the heart muscle and the brain. Atherosclerosis produces no symptoms in its early stages of development, but after decades of continued growth and complication, such lesions begin to encroach on the interior of arteries. Ultimately, such obstructions can compromise blood flow to tissues supplied by the affected vessels. A complete blockage of the arterial blood flow, often associated with sudden formation of a clot (or thrombus) within the artery, results in death or degeneration of the distal tissue; this damage is referred to as infarction and has ominous consequences when affecting either the heart (heart attack) or the brain (stroke). It is also possible to experience either heart attack or stroke in the absence of appreciable atherosclerosis, due, respectively, to spasm of the coronary arteries and to embolism or hemorrhaging of the cerebral blood vessels.