William Gerin

Working Group on Blood Pressure Monitoring of the European Society of Hypertension International Protocol for validation of blood pressure measuring devices in adults

Working Group on Blood Pressure Monitoring of the European Society of Hypertension International Protocol for validation of blood pressure measuring devices in adults Eoin O’Brien,Thomas Pickering, Roland Asmar, Martin Myers, Gianfranco Parati, Jan Staessen, Thomas Mengden, Yutaka Imai, Bernard Waeber and Paolo Palatini and with the statistical assistance of Neil Atkins and William Gerin, on behalf of the Working Group on Blood Pressure Monitoring of the European Society of Hypertension

Physiological stress reactivity and recovery: Conceptual siblings separated at birth?

This article discusses theoretical assumptions underlying physiological stress reactivity research. It examines early conceptualizations of activation and recovery and contrasts these with current practices in designing, analyzing, and reporting stress reactivity studies. Study protocols from four major journals covering the last 2 years of publication were examined for current practices. Of the 105 studies which tested physiological reactivity, 63% collected recovery data but only 23% reported the recovery data. We concluded that stress recovery issues are neglected and a renewed case is made for their conceptual and ecological importance. The case for studying recovery is further supported by a selective review of studies using recovery protocols that revealed positive findings not apparent in reactivity comparisons only. Finally, options for sound design of recovery protocols, statistical processing of resulting data, and interpretation of findings are presented.

Toward a causal model of cardiovascular responses to stress and the development of cardiovascular disease

Objective Cardiovascular reactivity is hypothesized to mediate the relationship between stress and cardiovascular disease. We describe three considerations that are crucial for a causal model of cardiovascular responses to stress: the need for laboratory-life generalizability, the role of interactions between environmental exposures and individual response predispositions, and the importance of the duration of both stressor exposure and cardiovascular responding. Methods We illustrate current understanding of stress–cardiovascular disease relationships with examples from the human and animal psychophysiology, epidemiology, and genetics literature. Results In a causal model of reactivity, the usefulness of laboratory assessment rests on the assumption that laboratory-based cardiovascular reactivity predicts responses in the natural environment. We find only limited generalizability and suggest that cardiovascular responses to stress can be better understood when examined in the natural environment. The interaction of individual response predispositions and stressor exposures contributes to the development and progression of cardiovascular disease; stress-disease relationships could therefore be better understood if predispositions and exposures were assessed simultaneously in interactive models. Cardiovascular responses to stress are likely to be most deleterious when responses are prolonged. Responses may vary in their magnitude, frequency, and duration; however, reactivity captures only response magnitude. The assessment of anticipatory and recovery measures, with response magnitude, may therefore lead to a more useful model of the stress-disease relationship. Conclusions A causal model of cardiovascular responses to stress should generalize to the real world, assess interactions between individual predispositions and environmental exposures, and focus on sustained pathogenic exposures and responses.

Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique.

Racial disparities in health, including elevated rates of hypertension (HT) among Blacks, are widely recognized and a matter of serious concern. Researchers have hypothesized that social stress, and in particular exposure to racism, may account for some of the between-group differences in the prevalence of HT and a portion of the within-group variations in risk for HT However, there have been surprisingly few empirical studies of the relationship between perceived racism and blood pressure (BP) or cardiovascular reactivity (CVR), a possible marker of mechanisms culminating in cardiovascular disease. This article reviews published literature investigating the relationship of perceived racismto HT-relatedvariables, including self-reported history of HT, BP level, or CVR. Strengths andweaknesses of the existing research are discussed to permit the identification of research areas that may elucidate the biopsychosocial mechanisms potentially linking racism to HT We hope to encourage investigators to invest in research on the health effects of racism because a sound and detailed knowledge base in this area is necessary to address racial disparities in health.

The role of rumination in recovery from reactivity: cardiovascular consequences of emotional states.

Objective While most investigations of the link between blood pressure responses and later disease have focused on acute reactivity during stressful tasks, there is some theoretical and empirical reason to believe that examining recovery and later re-creations of BP responses may also be useful. Two experiments explored situational determinants of sustained BP elevations, examining whether the extent of recovery and the ability to later mentally recreate the response are influenced by the magnitude or emotionality of the initial task and also whether preventing rumination after a stressor has ended speeds recovery. Method Experiment 1, with 72 normotensive male and female undergraduates, examined BP and heart rate before, during, and after a task and also before, during, and after the mental re-creation of that task. Four tasks were used, designed to produce high initial reactivity with an emotional component (mental arithmetic with harassment), low reactivity with emotion (shock avoidance), high reactivity without emotion (physical exercise), or low reactivity without emotion (cold pressor). Experiment 2, with 20 normotensive male and female undergraduates, compared the cardiovascular recovery of persons who were either given a distractor task or just sat quietly immediately after a mental arithmetic task. Results Study 1 revealed that only the emotional tasks were associated with delayed BP recovery and elevations during later rumination. Blood pressure during recovery and later rumination was independent of the original reactivity. Experiment 2 found that participants with the distractor, who presumably could not ruminate, showed better BP recovery. Conclusions Situations that put people at risk may include not just those that cause large BP elevations, but also emotion-producing situations that lead to sustained and recurring elevations.

Social support in social interaction: a moderator of cardiovascular reactivity.

&NA; This study examines the possibility that social support operates as a moderator of cardiovascular reactivity, which may be a factor in the development of heart disease and hypertension. An experiment was performed in which each of 40 subjects was the object of verbal attack in a discussion of a controversial issue. In each session, one subject and three confederates participated. Two of the confederates argued with the subject; in half the groups, a third confederate defended the subjects position (social support condition); in the other half, the third confederate sat quietly (no support condition). The subjects blood pressure and heart rate were continuously monitored. Subjects in the social support condition showed significantly smaller increases in cardiovascular measures than subjects in the no support condition. The results are discussed in terms of small group dynamics and Social Comparison Theory.

The Role of Angry Rumination and Distraction in Blood Pressure Recovery From Emotional Arousal

Objective: Cardiovascular recovery of prestress baseline blood pressure has been implicated as a possible additional determinant of sustained blood pressure elevation. We hypothesize that angry ruminations may slow the recovery process. Method: A within-subjects design was used in which resting baseline blood pressure and heart rate measurements were assessed on 60 subjects, who then took part in two anger-recall tasks. After each task, subjects sat quietly and alone during a 12-minute recovery period randomized to with or without distractions. During baseline, task, and recovery, blood pressure was continuously monitored; during recovery, subjects reported their thoughts at five fixed intervals. Results: Fewer angry thoughts were reported in the distraction condition (17%) compared with no distraction (31%; p = .002); an interaction showed that this effect was largely the result of the two intervals immediately after the anger-recall task. Trait rumination interacted with distraction condition such that high ruminators in the no-distraction condition evidenced the poorest blood pressure recovery, assessed as area under the curve (p = .044 [systolic blood pressure] and p = .046 [diastolic pressure]). Conclusions: People who have a tendency to ruminate about past anger-provoking events may be at greater risk for target organ damage as a result of sustained blood pressure elevations; the effect is exacerbated when distractions are not available to interrupt the ruminative process. ANOVA = analysis of variance; AUC = area under the curve; BP = blood pressure; HTN = hypertension; CHD = coronary heart disease; CVR = cardiovascular reactivity; CVD = cardiovascular disease; HR = heart rate; DAB-VR = Destructive Anger Behavior-Verbal Rumination; DBP = diastolic BP; HPA = hypothalamic-pituitary-adrenal; SBP = systolic BP.

Gender, social support, and cardiovascular responses to stress.

OBJECTIVE Laboratory research indicates that the presence of a supportive other can reduce physiological responses to a stressor. Whether there are gender differences, either on the part of the provider or the recipient, in this social support effect is explored. Such differences might shed some light on the frequent epidemiological reports of gender differences in social support and health. METHODS Male and female subjects gave an impromptu speech and received either standardized supportive or nonsupportive feedback from a male or female confederate. Blood pressure and heart rate were monitored continuously during baseline and speech periods. RESULTS Speakers with a supportive female audience showed a systolic increase of 25 mm Hg over baseline. Those with a nonsupportive female audience increased 36 mm Hg. A supportive male audience led to increases of 32 mm Hg, and a nonsupportive male audience 28 mm Hg. There was no significant effect of gender of subject. CONCLUSIONS Results indicate that social support provided by women reduced cardiovascular changes for both male and female speakers compared with presence of a nonsupportive female audience. Social support from men did not. These findings suggest a possible mechanism that might help explain the epidemiological literature on the relationship between gender, social support, and health. The findings are consistent with the notion that married men are healthier because they marry women. Women do not profit as much from marriage or suffer as much from separation, in terms of health outcomes, because the support they gain or lose is the less effective support of a man. These findings render more plausible the possibility that differences in social support might contribute to health differences, through the dampening of cardiovascular responses to stress.

Racism and ambulatory blood pressure in a community sample.

Objective: Racism has been identified as a psychosocial stressor that may contribute to disparities in the prevalence of cardiovascular disease. The goal of the present article was to investigate the relationship of perceived racism to ambulatory blood pressure (ABP) in a sample of American-born Blacks and Latinos. Methods: Participants included English-speaking Black or Latino(a) adults between the ages of 24 and 65. They completed daily mood diaries and measures of perceived racism, socioeconomic status, and hostility. Participants were outfitted with ABP monitors; 357 provided data on waking hours only, and 245 provided data on both waking and nocturnal ABP. Results: Perceived racism was positively associated with nocturnal ABP even when controlling for personality factors and socioeconomic status. Conclusions: The results suggest that racism may influence cardiovascular disease risk through its effects on nocturnal BP recovery. ABP = ambulatory blood pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure; CVD = cardiovascular disease; SES = socioeconomic status; HTN = hypertension; AHA = American Heart Association; GHI = gross household income; BMI = body mass index; PEDQ-CV = Perceived Ethnic Discrimination Questionnaire-Community Version.

Association between delayed recovery of blood pressure after acute mental stress and parental history of hypertension

Objective: To assess the influence of sex, race and parental history of hypertension on blood pressure and heart rate elevations during a stressor, and on the recovery of prestress baseline levels for these parameters. Design: Five hundred and thirty-seven university undergraduates underwent cardiovascular reactivity testing. A serial-subtraction task served as the stressor. Reactivity was assessed as the difference between baseline and during-task levels, and recovery as the difference between baseline and post-stress levels. Methods: The influence of sex, race and parental history of hypertension on reactivity and recovery was assessed, using analysis of variance models. Results: No differences were found in reactivity for any of the factors. For recovery, a significant effect was found for parental history of hypertension on systolic blood pressure and a marginal effect on diastolic blood pressure. Post hoc tests revealed that values in groups with two hypertensive parents remained elevated at a significantly higher level than in offspring with either no or one hypertensive parent. Conclusion: Parental history of hypertension may affect the duration of the blood pressure response to an acute stressor more than the magnitude of the response.