Lynn A. Durel

Associations of blood pressure with self-report measures of anger and hostility among Black and White men and women.

This study examined associations between blood pressure (BP) and dispositional variables pertaining to anger and hostility. Black and White 25- to 44-year old male and female normotensives and unmedicated mild to moderate hypertensives completed four reliable self-report scales--the Cook-Medley Hostility (Ho) Scale, the Trait Anger subscale of the State-Trait Anger Scale (STAS-T), and the Cognitive Anger and Somatic Anger subscales of the Cognitive-Somatic Anger Scale--plus the Framingham Anger Scale and the Harburg Anger Scale. They also engaged in three laboratory tasks--Type A Structured Interview (SI), a video game, and a cold pressor task--that elicit cardiovascular reactivity. Ambulatory BP readings at home and at work were also obtained from most subjects. Blacks had significantly higher Ho and lower STAS-T scores than did Whites. Women reported higher levels of somatic anger than did men. White women showed significant positive correlations between STAS-T and systolic BP (SBP) and diastolic BP (DBP) both at rest in the laboratory and during the SI. Black women revealed significant positive relationships between STAS-T and SBP and DBP at rest in the laboratory and at work as well as with DBP during the cold pressor test. For Black men, cognitive anger and DBP at rest were positively related. In contrast, White men revealed significant negative correlations between Ho scores and SBP at rest and during the video game; these men also showed significant negative relationships between somatic anger and SBP and DBP reactivity during the cold pressor test. Women, but not men, showed significant positive relationships between all four anger measures and ambulatory BP at work. Whereas main effects relating anger and cardiovascular measures were not apparent as a function of race, Blacks demonstrated significantly greater SBP and DBP reactivity than Whites during the cold pressor test, with the converse occurring during the SI. Men demonstrated significantly greater DBP reactivity than women during the video game. The present findings indicate that self-reports on anger/hostility measures and cardiovascular responses to behavioral tasks differ as a function of race but that relationships between anger and BP regulation need to take into account possible race-sex interactions and selection of anger/hostility measures.

How Important is the Perception of Personal Control? Studies of Early Stage Breast Cancer Patients

Two models of cognitive determinants of distress under adversity were tested in the experiences of two samples of newly treated breast cancer patients (ns = 144 and 202). One model emphasizes the role of perceptions of personal control in subjective well-being; the other model emphasizes expectancies of the occurrence of desired outcomes. In this research, the outcome addressed was remaining free of cancer in the future. In these two samples, beliefs about control over remaining free of cancer played no role in predicting distress, although expectancy of remaining cancer free did. Discussion focuses on conceptual boundaries on the concept of control, how difficult it is to assess control separately from expectancy regarding the desired outcome, and how conceptual clarity requires such a separation.

The antianxiety effect of beta-blockers on punished responding

Clinically effective anxiolytic drugs generally increase responding that is suppressed by punishment. Although beta-adrenergic antagonists have been reported to reduce anxiety in humans, such effects have not been reported reliably in animal punishment procedures. In the present study, three pigeons were trained to key peck under a multiple schedule. In the presence of a white light every thirtieth response produced grain. In the presence of a red light every thirtieth response produced grain and electric shock which suppressed responding to approximately 10 percent of that occurring in the alternate component. Propranolol (1.0-5.6 mg/kg) and, less reliably, atenolol significantly increased punished responding in a dose-related manner; propranolol effects were approximately twice as large as those of atenolol. Both drugs no more than weakly increased unpunished response rates at doses that increased punished responding. These results suggest that beta-blockers have an antianxiety effect on punished behavior, and that peripheral beta-blockade, the predominant action of beta-blockers regardless of whether they readily penetrate the brain, is likely to be involved in this effect.

Effects of beta-adrenergic stimulation and blockade on cardiovascular reactivity, affect, and type A behavior.

&NA; The present study examined the acute effects of drugs that stimulate or block sympathetic nervous system activity on components of Type A behavior, affect, and cardiovascular responses to mental stressors. Either propranolol (a beta‐adrenergic blocker), isoproterenol (a beta‐agonist), or placebo was infused intravenously at different times in 12 healthy males. In two sessions, placebo (saline) was administered first, followed by a structured interview, challenging mental arithmetic test, and completion of affect scales. The procedure was then repeated with one of the active drugs, presented in counterbalanced order. Results indicated reliable drug effects on both heart rate (HR) and systolic blood pressure (SBP) reactivity to the tasks, with change scores to the tasks markedly increased by isoproterenol. Anxiety and hostility ratings paralleled results for HR and BP, with much of this effect being due to higher affect ratings for isoproterenol. The effect of the drugs on Type A behavior was unexpected, with global Type A and several components lowered by isoproterenol and unaffected by propranolol. These data are discussed in terms of the interfering effects of anxiety on Type A speech components. The influence of isoproterenol on affect and reactivity might reflect the physiologic action of a beta 2‐adrenergic positive feedback loop which increases release of endogenous norepinephrine, and/or potentiating effects of emotion on reactivity to stress.

Comparative effects of two beta-blockers on cardiovascular reactivity and type A behavior in hypertensives.

&NA; This study compared the effects of beta‐blockers differing in degree of central nervous system penetration on Type A behavior and cardiovascular reactivity to mental stress. Forty‐six male hypertensives were assigned randomly to receive either highly lipophilic and nonselective propranolol, hydrophilic and cardioselective atenolol, the diuretic hydrochlorothiazide, or placebo. Subjects were administered parallel forms of the Structured Interview (SI) and performed mental arithmetic and a cognitive task prior to and after 6 weeks of therapy. Results indicated that diuretic and placebo subjects (subsequently combined into a single control group) did not differ and that both beta‐blockers reduced heart rate but not blood pressure reactivity to mental stress (p less than 0.02), an effect that was strongest during the mental arithmetic test. Analysis of SI components indicated a reduction only in explosive speech for beta‐blockers versus controls (p less than 0.05). For global SI classifications, seven out of 12 subjects (58%) receiving propranolol, three of 12 (25%) receiving atenolol, and four of 22 control subjects (18%) became less Type A (p less than 0.05). These data do not replicate results of a prior study obtained with atenolol and suggest that only a subset of hypertensive individuals show reduced Type A behavior with propranolol. Central nervous system mechanisms may be important in producing these effects.

Effectiveness of Antihypertensive Medications in Office and Ambulatory Settings: A Placebo‐Controlled Comparison of Atenolol, Metoprolol, Chlorthalidone, Verapamil, and an Atenolol‐Chlorthalidone Combination

In a double‐blind, crossover study, five white men with mild‐to‐moderate hypertension received placebo and fixed doses of atenolol, metoprolol, chlorthalidone, Verapamil, and the combination of atenolol and chlorthalidone in a quasi‐random order. Daily dosages were: atenolol, 100 mg; metoprolol, 200 mg; chlorthalidone, 50 mg; verapamil, 240 mg; and the same doses of atenolol and chlorthalidone in combination. Standard office and daytime ambulatory blood pressures were assessed at the end of each month‐long trial. Atenolol, metoprolol, chlorthalidone, and verapamil controlled office blood pressure with similar reductions. Verapamil did not lower ambulatory blood pressure at this dose (which is lower than is now commonly used), but reductions in ambulatory blood pressure were similar for atenolol, metoprolol, and chlorthalidone. The combination of atenolol and chlorthalidone maintained blood pressure control more effectively than the single drug treatments in both office and ambulatory settings, and the combined hypotensive effects were additive. However, reductions in the office due to the combination appeared to overestimate hypotensive effectiveness in the ambulatory setting. This study suggests that the effectiveness of commonly prescribed antihypertensive regimens varies according to setting as well as drug, and that assessment of treatment effectiveness can be improved by automated ambulatory blood pressure monitoring.